How fast does dopamine work?

[ornurse25]

I took a patient on a transfer to another facility today and ended up starting a Dopamine drip at 10 mcg/min. He was a dialysis patient who was septic with new onset atrial fib. BPs in the ER and in the squad were running about the same. The last BP we got in the squad before taking the patient to ICU was 88/48. When we got to the unit his BP was 159/84, it only took a couple minutes to go from the squad to the unit. I'm wondering if dopamine can cause that big of a jump that fast? The whole situation was weird, especially since our BPs were matching the ERs.

[Nccity2002, MSN, RN]

I took a patient on a transfer to another facility today and ended up starting a Dopamine drip at 10 mcg/min. He was a dialysis patient who was septic with new onset atrial fib. BPs in the ER and in the squad were running about the same. The last BP we got in the squad before taking the patient to ICU was 88/48. When we got to the unit his BP was 159/84, it only took a couple minutes to go from the squad to the unit. I'm wondering if dopamine can cause that big of a jump that fast? The whole situation was weird, especially since our BPs were matching the ERs.

Dopamine (dopamine hydrochloride) 's onset of action occurs within five minutes of intravenous administration, and the half-life of about two minutes, the duration of action is less than ten minutes. Because dopamine is one of those drugs metabolized by the kidney (also by liver), you need to be cautious with renal patients. I assume you are ACLS certified, since you are transporting ICU patients...but I strongly encourage you to review of your emergency drugs, to be safe.

[nicu4me]

We use it on our preemies, mcg/kg/min, gtt for days/weeks. We look at our means (BP) to adjust. One was on 14mcg, however your patient was much heavier I know.

[emtb2rn, BSN, RN, EMT-B]

Works fast, we usually titrate to mean bp as well.

[umcRN, BSN, RN]

we go up to 20 mcg/kg/min in the NICU...PICU too I think, usually starting lower and working up as needed, it works pretty fast which is good when you need it asap, you can pull it from the pyxis, string it up and hit go pretty quickly, on my unit at least

[Babycatcher2Be]

A dialysis patient with a blood pressure of 88/48 isn't that alarming. You still have a pulse pressure of 40 and sometimes renal patients run lower. And starting the dopamine at 10 mcg for a pressure in the 80's seems a little overkill doesn't it? It is generally started at 5mcg/kg/min. I believe it is completely plausible that you then had a pressure in the upper 150's.

[steelydanfan]

A dialysis patient with a blood pressure of 88/48 isn't that alarming. You still have a pulse pressure of 40 and sometimes renal patients run lower. And starting the dopamine at 10 mcg for a pressure in the 80's seems a little overkill doesn't it? It is generally started at 5mcg/kg/min. I believe it is completely plausible that you then had a pressure in the upper 150's.

Agree, would not have started it at 10mcgs for a pt. with a BP in the 80's, probably would not have started it at all.

[ObtundedRN, BSN, RN]

I agree too. May not of started it for a patient with that BP unless symptomatic, and then would probably start at 5. I'm just curious why you were transporting and starting that drug if you're unfamiliar with it, as opposed to someone more experienced with it. I'm not knocking you for using it, everyone has to use it for the first time and learn about it, but using it for the first time outside of the hospital on a transport truck, would be safer with someone more experienced.

[ckh23, BSN, RN]

Very possible. Like others have said I would necessarily have jumped to a dopamine for that BP. If he is septic maybe a few fluid challenges first, but not to go over board because of his renal failure. He could be a little volume depleted if he had HD that day. We don't use dopamine all that much anymore, but when we do it is mcg/kg/min.

[ckh23, BSN, RN]

Also, I know the ER loves dopamine but if you really wanted to start something on someone in a rapid or new onset AF neo may have been a better choice.

[Nccity2002, MSN, RN]

Also, I know the ER loves dopamine but if you really wanted to start something on someone in a rapid or new onset AF neo may have been a better choice.

What??!

Why??

[Altra, BSN, RN]

Although a SBP of 88 is not necessarily a big deal in a stable renal patient, I can see the decision to start the pressor, given that the patient was known to be septic. There is a risk of rapid decompensation.

I am surprised, given the sepsis, that the pressor of choice was not Neo or Levo.

During the transport, what what was the trend of the BP? Was the Dopamine titrated at all?

Also, if the patient was awake & alert, consider the effect of some additional stimulation/anxiety upon arrival to the second facility.