Critical care drips

[kc87t]

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! :)

[Medic2RN, BSN, RN, EMT-P]

Another point not mentioned so far, if you have an ICU bed hold, you will be taking care of that ICU patient in the ED. Now you are an ICU nurse.

It's good to be familiar with the critical care drips and know the common ED drips.

[Delete_Me_Please]

Such as, if a pt is hypotensive and tachycardic dopamine is out of the question

Not sure where you got that information, but you should check again. Hypotension and tachycardia (shock!!!) are two of the symptoms that accompany most acutely ill patients who receive dopamine. Neither is a contraindication.

[Jennifer, RN]

This is my favorite IV drug book by far.

It is located on every PICIS in our ED and I have a copy of my own in my locker, just in case the others disappear.

It is not pocket sized, but such a good reference for compatibilities, rates of administration, side affects, and dosages, not only for IV critical care gtts, but for IV pushes and piggy backs too.

[kc87t, BSN, RN, EMT-P]

kcrncen- really? I'm not arguing, just saying I don't understand. I'm talking tachycardia in like the 150s-170s. Neo-Synephrine seems to be the more popular choice in our ER since it only works on BP, not HR.

[murphyle, BSN, RN]

Sometimes dopamine is the only option you have, if your patient is circling the drain, you don't have central access and/or you can't give "peripheral mix" Neo-Synephrine for some reason. Yes, it's going to make the tach worse to some degree, but it'll also give you some much-needed arterial squeeze in a septic patient, which in turn will buy you time to get a central line in, so it'll all balance out. (You hope, right? )

Levophed is usually our go-to pressor for sepsis, followed by neo (this may be reversing in the future, as I've seen notices from Pharmacy about a levo shortage). Dobutamine is straight beta-1, helpful to buy you enough time to get a massive MI patient up on an IABP. I've also seen it used to "touch up" cardiac output in sepsis with underlying cardiac insufficiency. (You can give them back all the squeeze in the world and get nowhere if they came in with an EF of 25%...) Vasopressin and epinephrine pretty much live exclusively in the ACLS cart for us; I saw them used as drips in nursing school on CVSICU, but never in Emergency.

Other critical-care drips we deal with: nitroglycerin (funny, we don't consider it "critical," we hang it fifteen times a night...), propofol, Dilantin; rarely Nipride or Integrilin; and sometimes really wacky stuff like Flolan or Remodulin for PAH if the patient's portable pumps have failed.

[RN1980]

i prefer levophed over dopamine as vassopressor for many personal reasons and past exp. but mainly due to norepinephrine wont tickle the hr as much as dopamine.

[Delete_Me_Please]

kcrncen- really? I'm not arguing, just saying I don't understand. I'm talking tachycardia in like the 150s-170s. Neo-Synephrine seems to be the more popular choice in our ER since it only works on BP, not HR.

When i read 'out of the question,' to me, that implies an absolute contraindication, so it may have just been mis.confus.ication on our parts. Hypotensive ans tachycardia shocj patients have received dopamine and dobutamine from me and me crews, and ive worked placed where the did levophed... didnt really seem to be any sit better than the other - halfass drugs in the hands of an excellent nursing team beats the hell out of selfish whiny hacks with all the best drugs abd equipment...

just my $0.74 worth... (adj for inflation)

[kc87t, BSN, RN, EMT-P]

kcrncen- haha! made me laugh. I get what you're saying. Thanks for the input guys!!!

[emtb2rn, BSN, RN, EMT-B]

Levophed a.k.a. "leave 'em dead"

[mmutk, BSN, RN, EMT-I]

If you have an iPhone there are several apps you can use. Our heart monitors do critical care drips and titration tables that print off for us and they are VERY helpful.