Critical care drips

[kc87t, BSN, RN, EMT-P]

Hey all,

I spent the past 7 months on a med-surg/telemetry floor. The most complicated drip I hung was dopamine and since we can only run that at a max of 5 mcg/kg/min it wasn't something that was a huge deal. But, now I'm in the ER which I'm super excited about but also kind of intimidated by the acuity of the patients. I've done some pretty hardcore research about critical care drips but everything I've found is very extensive and in-depth. I'm really just looking for something basic I can use as a quick reference so I don't feel so in over my head. Something that has indications, contraindications, side effects, special considerations in renal and hepatic patients and half-life would be a fantastic reference. On the bright side, there's only so many drips that are indicated for certain problems. Such as, if a pt is hypotensive and tachycardic dopamine is out of the question and you're only left with a few options. The adrenergic receptors also confuse me sometimes such as what works on what receptor. Also, I struggle some with calculating mcg/kg/min to ml/min. Anyone have any good references to share? Thanks so much! :)

[don2]

your question is bit complicated can u make it simpler?

[kc87t, BSN, RN, EMT-P]

I'm looking for a quick reference for critical drips that I can use in the ER.

[brownbook]

Many issues for you. First of all outside of ACLS protocol most patients get quickly sent to ICU/CCU to be placed on drips. They are not usually started in the ER.

If you start a drip you need to have a good idea of the mcg/kg/min in your head to make sure the pumps "computer" is correct, but IV pumps have commonly used drips and their calculations programmed into them. Many years ago (before fancy phones/I-pads, etc) we had pre-printed graphic sheets that had the medication, weight, doctor order, etc., graphed out, you just had to read the correct column to find your drip rate. I've forgotten the mcg/kg/min formula, and it is good to know, but in a emergency you don't want to be trying to multiply and divide numbers. You will make a mistake!

I can never get a good handle on adrenergic receptors but it has been really well covered on other Allnurses sites.

[kc87t, BSN, RN, EMT-P]

Thanks. I know they will quickly get sent to ICU but from what I can tell they seem to start a lot of drips in the ER. Guess I'll just have to figure it out as I go!

[psu_213, BSN, RN]

Thanks. I know they will quickly get sent to ICU but from what I can tell they seem to start a lot of drips in the ED. Guess I'll just have to figure it out as I go!

If a person needs a gtt, then it gets started in the ED. I don't want to say we start "a lot" or "not very many" because I am in my first ED job, so I really have nothing to compare it to.

Know, I heard an ICU nurse once say, re: ICU pts and ggts in the ICU, that the nurse needs to understand what each gtt does, what its mechanism of action is, its side effect, etc. Now this is for the ICU where the nurse might be responsible for titrating the gtts. In the ED with a physican right there and experienced nurses there, I would think this is a little extreme for gtts in the ED, espeically given that the pt will be there for a relatively short time (hopefully!) while they are on the gtt. Either way, I would think it is a good idea to have the basics down for the most common gtts. If you find something helpful to use a quick reference, let me know!

[Esme12, ASN, BSN, RN]

now days there are many apps that can be down loaded to your phone. micromedex is a great one i have used extensively and it is excellent. there are any number of pocket references that you can purchase....google them.....emsguide.com is one i have used........

below are some excellent references and pocket guides as well as a power point presentation....

http://www.workplacenurses.com/id69.html

http://prodruginfo.com/formulary/adult_standard_drip_rate_charts.htm

http://docmd.com/files/pocket4.pdf

http://www.gwicu.com/assets/info/welcome%20to%20the%20icu.pdf

shopping results for critical care pocket drip charts

emergency and critical care: pocket guide (acls version)

$20.85 - [color=#0e774a]webmedbooks.com

emergency & critical care pocket guide - item # 1-890495-24-4

$21.95 - [color=#0e774a]code-2

emergency & critical care pocket guide

http://www.nnccusa.com/

welcome to critical care and emergency medicne....good luck!:redpinkhe

[Isabelle49]

Thanks. I know they will quickly get sent to ICU but from what I can tell they seem to start a lot of drips in the ER. Guess I'll just have to figure it out as I go!

Your facility/ER should have some type of quick reference note or cards for you to use. Just be sure you have your numbers double checked by another nurse. Hope you enjoy ER.

[futbol84]

Maybe try this website and click on the presentation or contact the person that put the presentation together:

http://classic.aacn.org/AACN/NTIPoster.nsf/vwdoc/2008CSGCorliss1

As for Adrenergic receptors I try to keep it simple and just remember if the drip will affect Alpha or Beta receptors and than you kind of know what effect the drug will have. Alpha 1 gives you smooth muscle contraction like phenylephrine so BP up but not HR. Dopamine gets both hence the BP and HR. Or Dobutamine which is for Beta 1 so get cardiac output going and HR which should help BP but main goal is cardiac output. Hope this helps and I am no expert so double check my info =)

[Daisy Doodle]

In actuality, we start MANY drips in the ED.

Dopamine, Dobutamine, Norepinephrine, Nitroglycerine, Amiodarone, Labetalol, Diltiazem, Epinephrine, Lidocaine, Integrilin, Heparin, Magnesium, Diprivan, Mannitol, and Nitroprusside just to name a few off the top of my head.

I kept a running list of the drips as I hung them. Looked them up understood what their actions were and any special notes such as if they needed to have a filter for example, and an idea of what the starting doses are. Definately look them up, use your pumps, and a second person just to verify with you.

Daisy

[PMFB-RN, RN]

Get yourself a Cathy White book. It is THE quick ICU (including drips) reference book. It is small in size and made durable enough to survive being hauled around in your bag or pocket. It has a great quick reference section with tabs that allow to to flip directly to whatever drug you need to know about. Has starting rates, how to titrate and the basics of mechanism of action and interactions with other drugs.

The Cathy White book is given to all of our ICU and ER nurse residents at my hospital.

[PMFB-RN, RN]

In the ED with a physican right there

*** I absolutly would not count on your physicians to know about starting and titrating drips. A few may but mostly they don't.