I give up

Zee_RN, BSN, RN · Jul 16, 2002

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?

suzannasue · Jul 16, 2002

Thank you all ...I do appreciate your responses and was somewhat reassured (?) that "Hooterville Hospital" is not the only place where this is done.

Happened again last night......

dawngloves, BSN, RN · Jul 16, 2002

Originally posted by Zee_RN
[
I think it's based on the theory that "You can't get deader than dead" so why not try it? [/b]

Yeah, I don't think large bolus of Dopa did them in. They most likely would have expired anyway.

mattsmom81 · Jul 16, 2002

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.

eltrip · Jul 16, 2002

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.

caroladybelle, BSN, RN · Jul 16, 2002

I will never work ICU - I will never work ICU - I will never work ICU

I WILL NEVER WORK ICU!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

LasVegasRN · Jul 16, 2002

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.

CATHYW · Jul 16, 2002

originally posted by badbird
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! :rolleyes: :stone :nono:

MollyJ · Jul 17, 2002

Originally posted by Zee_RN
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.

**canoehead, BSN, RN** · Jul 17, 2002

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.

I would vote for calling the code at that point.

Jeanine · Jul 17, 2002

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.

nimbex, RN · Jul 17, 2002

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