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...
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?
I still believe the rationale is with even perfectly performed CPR, the cardiac output and circulation is very low....so give the patient a chance to get some pressor action by putting a bolus into his circulation and you may see some response.
Actually I have seen this method work occasionally...short periods of bolus Dopamine (wide open). You may see a rebound effect of tachycardiac and hypertension but at least you have a chance at regaining some perfusion...and you can go from there. JMHO.
Interesting...very interesting. I'm also taking mental notes to help remind me why I don't want to work ICU.
I wonder if there have been studies done on this. Docs like to have statistics to back them up...don't know how/why a doc could justify the charges without some kind of research to back it up. I know, I know, just another opportunity for the insurance companies to rule medical care. I'll hush now.
I loved ICU. IF, I say IF there was the remote chance I had to be dragged back to working in a hospital kicking and screaming I would go back to ICU. No where else.
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.
this is exactly what we used to do, in fl, and ga, when i worked er. i have had more than one icu nurse livid with me because i couldn't give her a mics/min rate. they always tried to treat me (and other er nurses) like i was crazy, or imncompetent, or something! imho, we did pretty damned good, getting the patient back, and up to icu, in the first place! :stone
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?
I've seen it, too, though I've not been at the bedside in a loonnng while. I agree with Zee on both counts above.
I also DO NOT think that wide open vasopressors are part of ACLS, so likely you have some rationale for refusing to do it but tread carefully knowing that there is precedent, if not rationale, for the procedure
I think I read somewhere on the net--You know the code has gone on too long when the doctor is writing hyper-al orders during the code. Well, I think that you could also say that the code has gone on too long when you are on your second bag of Dopamine at wide open.
I think this quirky practice shows how far we will all go in this litiginous world to be able to say, "we did everything to prevent death," even when THAT is no longer in our domain.
Once you start resorting to wide open pressors I expect the patient is pretty much a turnip anyway. Along with a high risk to code again within an hour and NOT make it.
Where does it say to open the doapmine in the ACLS protocol? I would imagine that this should be considered the legal standard and I wouldn't touch the dopamine either.
Worked ICU 7 years, initially freaked with dopamine wide open. The rattionale is not for perfusion. Refer to CCRN... when dead all cell receptors are down regulated. Dopamine is an adrenergic drug, the purpose to give wide open is to stimutate the cell receptors and illicit a response. In severe down regulated states..death and severe sepsis... unusually high doses are required to obtain response... After pulse return occurs, dopaminie is returned to the pump set at hospital max dose. Ours is 20/mcg/kg/min. Micromedex suggests up to 50. Hope this helps
:uhoh21: 
:stone 
Zee_RN, BSN, RN
951 Posts
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?