I give up

  1. OK...I need an answer...some support please,my siblings....
    I have lost much sleep and have paced the floor for weeks over this "issue" and feel my mind (?) is convincing me that I am over the edge, hanging on by a thread...I have cussed, I have cried...
    I have searched all data bases and believe I am right but am told I am wrong so frequently that I wonder if I am wasting my time by verbalizing my concern to my "superiors"...
    In the past few months,I have seen during "codes" the docs are ordering Dopamine at "wide open" rate of flow...I have not touched the drip myself because I refuse to do so unless an acceptable dosage is ordered...I cannot believe this is happening...no,there has been NO POSITIVE response from the pts, they have died...all of them... It has been my understanding for years that the highest acceptable dosage of Dopamine is 50 mcg/kg/min...these drips were taken off the infusion pump and allowed to stream in by gravity...OK...I figured up rougly that if my last pt who was subjected to this recieved the infusion pump dosage max of 999 ml/hr,he was recieving 241.5mcg/kg/min...
    but he recieved a much higher dosage than that due to gravity...
    how the HELL do ya figure a weight based dosage by a gravity flow????
    I have verbalized my concerns to my managerial staff and they just excuse the docs by saying "well you know how things get hectic during a code,theyare just trying to help"...yeah they are...they are enhancing the funeral home business and are helping me lose sleep and causing me to wonder whether or not I can continue at this profession safely...
    WILL SOMEONE PLEASE EITHER TELL ME I AM LOSING MY MIND OR I NEED TO SEEK A JOB AT WAL-MART...
    Your crying and cussing cuzzin...
    Suz..... :uhoh21:
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  2. 24 Comments

  3. by   LasVegasRN
    I realize I have been out of bedside care for a very long time (10 years now) but it was not uncommon during a code to run all vasopressive drips wide open. Especially if the person was on Dopamine and Levophed.
  4. by   BadBird
    During codes we have run dopamine wide open, if we are lucky enough to get a pulse then the patient is wisked off to the unit and a proper dose is set.
  5. by   RNinICU
    I have been in code situations where these types of drips were run wide open. They are usually used in a situation where the patient is crashing so badly that the docs will try anything to get a response. The meds are run at this rate only a short time, and usually have no effect anyway. In my experience, most arrests don't survive, or if they do they have an anoxic brain injury, and never get off the vent. The few times I have seen patients survive, and be normal afterwards, it has been a witnessed arrest, and CPR was started immediately and properly. In house arrests on monitored patients don't even always survive. So running these drips at this rate for the short period of time is not really contraindicated.
  6. by   suzannasue
    Ok...can Understand fully "short periods of time"...I am talking wide open for the entire volume of 2, 500ml bags of dopamine infused...also with fluids wide open...these folks have ended up looking like they have melon-heads and are grossly edematous from the ankles up... we do not have an ICU there for continuance at an appropriate dosing... IF any one has lived through this situation and are transferred to a larger facility,the first thing the transport team has done is d/c the fluid boluses and begin appropriate titration of the dopamine....
    Thanks for your responses...I am just feeling very frustrated at this point and beating myself up on a second to second basis for allowing myself to get so far out if the loop...
    WELCOME TO WAL-MART !!!!
  7. by   LasVegasRN
    Originally posted by suzannasue
    ...also with fluids wide open...these folks have ended up looking like they have melon-heads and are grossly edematous from the ankles up...
    I can relate to your feelings totally. Sometimes, after we "saved" someone during one of these horrendous codes and they ended up looking like Michelin men or some grotesquely disfigured being, I used to feel almost guilty that I have contributed to their horrible death. I would ask myself, at what point are we really "saving" someone or removing all remnants of their human-ness by doing these measures. :stone
  8. by   ceecel.dee
    This has not happened in our facility...but we are rural...and let's say, not exactly behind the times, but definately not cutting edge.
  9. by   mattsmom81
    I have seen wide open vasopressors in codes too...with the hope that some perfusion will occur and assist in resuscitation efforts.

    I agree about the disfiguring that occurs in many codes...it's so awful for the family to see this...I feel so bad for them.

    A botched intubation perfing the neck tissues can cause subq air...I've seen patients who look like Jabba the Hut from the chest up.
  10. by   Nurse Ratched
    (Furiously taking notes here for my list of reasons I never want to work ICU - bless those that do!)
  11. by   PhantomRN
    I have seen this as well. When someone codes and they think there is little chance to bring them back the docs will try anything they can.
  12. by   fedupnurse
    I've worked ICU for 10 years and have NEVER seen this done and wouldn't do it even if they held a gun to my head! Dopamine above 20 mcg/kg/min is really of no value and could be harmful. Sure they will say how can you harm a dead patient. Levophed isn't of much use when you get to about 40 mcg/min. It is called IT IS TIME TO PRONOUNCE THIS PATIENT if you get to this point in a code where there is a consideration to run pressors wide open. So, no, you aren't crazy. I am just shocked at all of the yes responses so far!!!!
    Another thing the residents and supervisors do here is demand a doppler to make sure there is no pulse. This is against ACLS protocol (as per the director of ACLS at my facility) because a doppler pulse really isn't perfusing all that well and you don't have dopplers out in the field. So I also refuse to get one of those when they start barking for it. Only exception is if they have such horrible PVD that they were doppler before the code!
  13. by   live4today
    Originally posted by Nurse Ratched
    (Furiously taking notes here for my list of reasons I never want to work ICU - bless those that do!)
    My sentiments were exactly like yours, Nurse Ratched. I worked SICU for a brief period of time, and it didn't take long for me to realize that I was in the wrong part of the hospital. Now....I have often floated to ICU units...taking the patients that didn't require intensive ICU care. ICU nurses amaze me, and hats off to them all. :kiss
  14. by   Zee_RN
    Yes, have seen it. Not 2 bags though. If we are running dopamine wide open, there's very very little hope. We're just getting them every shot at it that we can. I've never seen even one whole bag infuse; we call the code before that.

    I think it's based on the theory that "You can't get deader than dead" so why not try it?

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