Most drips at once

[delphine22]

Most drips I've had running at one time so far is nine. (Vaso, levo, neo, heparin, diprivan, fentanyl, saline, zosyn, cardizem.) I know people have had to have more. What's your record? And why? (My pt went into afib RVR after rewarming from hypothermia.)

[LoriNelsonLeydon]

Probably around 7. My hospital doesn't allow Propofol so here goes.....versed, morphine, levophed, vasopressin, IVPB, insulin, swan,

cardizem, tracrium. Phew! :-)

of course this pt would be intubated.

:-)

[calivianya, BSN, RN]

I had one once that was running fent, versed, nimbex, insulin, levo, vaso, neo, milrinone, TPN, and IVF once. That was a busy patient.

[AnnieOaklyRN, BSN, RN, EMT-P]

First of all, to the OP, "saline" doesn't count as a drip, lol.

As far as my experience, it was an exercise in futility, trying to save a patient who over-dosed on Calcium channel blockers. Having witnessed it first hand, its an awful way to go, since in his few lucid moments between vomiting his guts out, he was beggign me to save him.

For Ca-channel blockers, we don't have a true reversal agent, like we do with narcs...

I believe it was Levo, Neo, Vaso, Dopa, Dobuta, Insulin, Glucagon, Calcium Chloride, Mag/K/Phos replacement, two misc antibiotics, and low-dose Versed.

Hi,

I had the same type of OD in the ER... He took 2 months worth of extended release CCB (I do not remember which one) and we didn't know why he passed out at work and was hypotensive until he began vomiting pill fragments. He would not tell us what he took, so his wife had to go home (40 minutes away) and see which medications he was on and which ones were empty) so his treatment was delayed.

It was just so cool calling poison control and learning about the medications he needed to receive (high dose insulin, that dopamine is usually not effective in CCB overdose because it requires calcium to be converted into nor-epi once in the body, go lightley (sp) etc... ) It was a great learning experience. We had him in the ER for a couple of hours trying to at least get him so he was safe for transfer upstairs. We ended up pacing him transcutaneously and then transvenous, giving Epi because he arrested (we got him back believe it or not), tons of glucaon and calcium, go lightly, high dose insulin bolus and drip, and of course neo and levo.. he lived for three days in the ICU, but ended up with a horrible bowel obstruction and cardiovascular collapse. He had made multiple suicide attempts in the past and did not want us fixing him.. terrible way to die though you are right!

HPRN

[Dranger]

Propofol

Vaso

Levo

Neosynephrine

NS

Fentanyl

Versed

Flolan

Various ABX

Another cardiac drip, amio/card but I can't remember

[OhioCCRN, MSN, NP]

Levo

vaso

amiodarone

octreotide

ivf

heparin

insulin

Amicar

propofol

fentanyl

tpn

all the above running continuously

abx

FFP

platelets

PRBC

calcium (post transfusion)

K

albumin

- Liver tx w/ anastamotic leak and arterial bleed (multiple trips to OR) He actually made it to the shock and surprise of all involved!

[WrekDiver88]

The most I have had was nine drips, plus the intermittent bags like antibiotics, albumin, boluses, K+, etc. Neo, Levo, Vaso, Hpp, Insulin, Fentanyl, Versed, Fluids, and a cardiac med (don't remember which one). Plus he had a temp pacer, IABP, and eventually CRRT. He coded twice the morning of the second day, and because of the IABP/CRRT and how unstable he was a 2:1 for awhile. Unfortunately he didn't make it. The most drips I have heard about was 15, it was a coworker who had the patient.

[SubSippi]

My record so far includes:

Levophed

Amiodarone

Dopamine

Heparin

Integrelin

NS

Insulin

PRBCs/FFP/Platelets

D5W with K and bicarb

Propofol

...I would also like to give an honorable mention to the IV Pepcid and millions of antibiotics I hung that night.

[dandelion9]

The pt was on pretty much every pressor - levo, vaso, dopamine, epi, dobutamine, and neo; bicarb for sure because I remember the pt was very acidotic. I don't remember the rest of the meds, but I had three Alaris "brains" at capacity (12 gtts total). One of my colleagues grabbed a fourth set for me because we thought we were going to need it. The pt was also getting IVF boluses because the gtts were nearly at max rates and there was very little wiggle room.

This was on a post-cardiac arrest pt who had been struck by lightning. Needless to say, it was a busy night.

[Christy1019, ASN, RN]

The pt was on pretty much every pressor - levo, vaso, dopamine, epi, dobutamine, and neo; bicarb for sure because I remember the pt was very acidotic. I don't remember the rest of the meds, but I had three Alaris "brains" at capacity (12 gtts total). One of my colleagues grabbed a fourth set for me because we thought we were going to need it. The pt was also getting IVF boluses because the gtts were nearly at max rates and there was very little wiggle room.

This was on a post-cardiac arrest pt who had been struck by lightning. Needless to say, it was a busy night.

Any chance that person made it? Is there any special considerations when taking care of a person who has been struck by lightning?

[sugarmagnolia3]

vaso, levo, epi, neo, dopa, dobutamine, insulin, bicarb, nimbex, fentanyl, versed, TPN, blood products, Xigris & multiple ABX. 2009 pt had H1N1, was younger and was on HFOV and rotoprone. All gtts were either maxed or above max, levo was running at 100mcg/min. She lived and came to visit months later.

[RNDude2012]

I had a 1:1 liver patient gone septic who was on 60mcg/min of levo (double the max, the patient was maxed on the rest), vaso, dobutamine, dopamine, neosynephrine, epinephrine, multiple antibiotics, multiple boluses via a pressure bag, octreotide, prbcs, ffp, and albumin. The patient coded and did not make it right before shift change. Busy night!

[EuropaRN]

I think 8. Heparin (then argatroban), insulin, bicarb gtt, arivan, fent, neo, levo, vaso, and then fluids with abx and lyte replacement riders. He was on crrt and obviously vented. Came to us because he was in dka. Actually damaged his pancreas from etoh use and made himself a type 1. He was breaking down adipose tissue so severely the fat would separate out of his blood when drawn. At least 5cc of lipids were in a 10 cc syringe. His cholesterol levels were like 10x the normal values. He eventually made a full recovery and walked out. After threatening to kill himself...