I give up

J_W, DNP, APRN, CNS · Jul 18, 2002

Been in many codes. When the MD orders wide open I would tell them it is at whatever mcg/kg/min...Would try to get it calculated based on weight, even a rough estimate, that way they have to say go up or go down, then you can say how far up or how far down do you want it. I had many fresh open hearts come out of wide open Neo drips, it would be connected to the end of the manifold flushing in all the other drips, and when we would ask the anesthesiologist what the rate was he usually would not tell us we would have to guess. So I would put it on a pump, and ask him what kind of dose he would like, he would usually say 'just titrate it', and I'm like titrate it to what, SBP, MAP, or the amount of snot coming out of the patient's nose. As for the Dopamine wide open thing, I would say in a crunch start it at a good rate (ml/hr), and if patient survives, calculate a dose, and titrate it to MAP. Last hemodynamics course I went to, really pushed looking at SvO2, CI, CVP, and PAWP, and not depending on only the SVR for perfursion, because SVR does not tell you anything about perfusion.

Current research shows that end tidal CO2 is a very good indicator of survival to discharge, so in those codes especially where chest coompressions are the main source of cardiac output, that go on longer than 15-20 minutes, ask yourself and the MD 'wonder what this patient's end-tidal CO2 value might be' because if it is less than 10 mmHg, then the chance of survival is ZERO. I know many pulmonologists that really are into the latest research, and are very good at advocating for DNR orders for those patient's that have no chance of surviving.

Hope this helps suzannasue.....