Dopplers on your crash cart?

suzanne4, RN · Apr 7, 2005

I have never used a doppler on a crash cart................if you need to doppler the pulses, then your perfusion is that poor and needs to be treated as such.

over&over · Apr 8, 2005

If you don't use dopplers in codes how do you differentiate between someone in PEA & someone with a hypotensive bradycardia or other hypotensive rhythm? We have found that severely hypotensive patients may have a doppled pulse that we simply can't palpate. There may be a rhythm on the monitor but because you can't feel a pulse, you treat as PEA. Both patients need emergent treatment, but the treatment protocol differs. Does anyone else use a doppler during a code? :)

gwenith, BSN, RN · Apr 8, 2005

I too, have never heard of carrying a doppler on a crash cart but then the diagnosis of PEA rests on the assumption that severe hypotension might be a cause and it is treated as such so that there is no real "difference" in treatment protocols.

I would think that the time it took to GET an accurate dopplered pulse would be better spent on differential diagnosis based on clinical apprearance.

suzanne4, RN · Apr 8, 2005

I definitely agree with Gwenith on this one..............I have worked Critical Care areas in all specialties, plus ER and have never used a doppler during a code.

If you ar not perfusing enough to get a pressure, then that is going to need treating as well. I personally would not waste a minute to worry about a doppler.............and I do not know of anyone else that would...........

What type of area are you working in?

Heartman · Apr 10, 2005

I have used a doppler in codes when one is available.

I have not seen them generally included on the crash cart as standard equipment but think it would be a good idea.

In the PEA algorithm if no pulse is detectable, CPR is initiated. If a pulse is detected it is not PEA and CPR is not initiated.

Walter :redbeathe

suzanne4, RN · Apr 10, 2005

If perfusion is so bad that a pulse can't be detected, you need to treat...Simple as that.............

A doppler is only useful when the technician is skilled, and if you do not use one that often, you will only be wasting time, that you usually don't have to begin with.

I have been working in critical care for too many years to count, and just don't think that it would be useful. The amount of cases that you see that are PEA are quite slim to the number of codes called. Perhaps in an ER, but the other units, not worth the expense to the unit in terms of what it is going to show.

To those of you out there that use the doppler, how many times have you actually had PEA, when it wasn't after a trauma etc. in a unitother than ER?

I am sure, very rarely.

LindaMarie76 · Apr 19, 2005

IMHO....

I believe that dopplers should have a permanent place on the crash cart. We frequently use them during our codes because there has been more than one time where we thought a pulse could not be palpated, yet the patient was perfusing weakly via doppler. If we know we have a doppler pulse, we can spent time on inserting lines and running meds rather than pounding on the patient's chest.

suzanne4, RN · Apr 19, 2005

Out of all of the codes that you have used a doppler in, how many have actually turned out to have a pulse? Very few, I am sure.........

You also need proficency in using a doppler, and one more thing to be on the crash cart.............crash carts if anyhting need ot have fewer things to be able to get to what you need.

Sure, there are specific units that may see more PEA, but on a routine ICU, it just doesn't happen...........

LindaMarie76 · Apr 19, 2005

About half and half

Proficiency is using a doppler? How so? I am honestly curious.

I just ran this by nursing colleague of mine and she agrees with you that med-surg nurses may not know how to use a doppler. However, we both agree that all of our critical care nurses are proficient in doppler use.

She also states that Dopplers are not necessarily needed on crash carts because dopplers are readily available in the units. I agree with this, but still believe that dopplers would be advantageous in the carts on the floors.

Thanks for the feedback.

Linda

Out of all of the codes that you have used a doppler in, how many have actually turned out to have a pulse? Very few, I am sure.........
You also need proficency in using a doppler, and one more thing to be on the crash cart.............crash carts if anyhting need ot have fewer things to be able to get to what you need.
Sure, there are specific units that may see more PEA, but on a routine ICU, it just doesn't happen...........

mommatrauma, RN · May 4, 2005

If you don't use dopplers in codes how do you differentiate between someone in PEA & someone with a hypotensive bradycardia or other hypotensive rhythm? We have found that severely hypotensive patients may have a doppled pulse that we simply can't palpate. There may be a rhythm on the monitor but because you can't feel a pulse, you treat as PEA. Both patients need emergent treatment, but the treatment protocol differs. Does anyone else use a doppler during a code? :)

We keep a doppler in all of our crash carts...and frequently use them in codes...Also keep 2 in our trauma bay...

nursenatalie, ADN, RN · May 4, 2005

I just ran this by nursing colleague of mine and she agrees with you that med-surg nurses may not know how to use a doppler. However, we both agree that all of our critical care nurses are proficient in doppler use.

Why would a nurse who worked on a surgical floor not be proficient with a doppler? Do you think we wait for the doctor to come in to check doppler only pulses? We have a doppler on each med cart and have used them often in codes, I would say 50% of the time.