Question about reading really low BP's

[vampireslayer]

I had a pt. the other day who'd coded, they'd gotten her back but she was unresponsive, very little brain activity (but some...). During the code they'd given dopamine wide open...then when I got there, she was on a dopamine drip @ 50mcg/kg/min (yes, 50). Still, her pressures were unreadable by our auto. BP monitors, and I couldn't hear anything when I tried to do manual pressures. The code was over, no one was in the room but me, it was quiet...is it common not to be able to hear it if the BP's really low? Or is it me?

So for her vitals, the only thing I could think of was to use the manual BP cuff & the doppler, find her pulse with the doppler, then inflate the cuff until I couldn't hear the pulse anymore, and slowly deflate it until I could hear it. I assume the point at which I could hear the pulse via the doppler would be considered her systolic BP, is that right? But then there's no diastolic since you continue to hear the pulse via the doppler as the cuff is uninflated....right? Could this method be skewed simply based on how firmly I was holding the doppler against her artery?

Also, I've just been watching the very first season of ER (never watched it before now, but since I've gotten this job in the ER, it's become fascinating to me!) and they're constantly calling out really low pressures like "60/40"...can you REALLY hear a pressure that low? Is that real? Why couldn't I hear it? I tried several times, couldn't hear a thing. & I tried both arms, many times, with the auto. BP monitor, it couldn't detect it.

Oh, one more question...what does "palp" mean, when they say "pressure's 50 palp"...

And finally, before anyone wonders why I was the only one there with her pressure that low...she was DNR. They didn't know that before the ran the code, of course...

Thanks!

VS

[hrtprncss]

The OP specified that the code was called and the patient was revived, though 50mcg/kg/min of dopa was used. Then during the code or after the first code they found out the patient is a DNR.

[austin heart, BSN, RN]

The OP specified that the code was called and the patient was revived, though 50mcg/kg/min of dopa was used. Then during the code or after the first code they found out the patient is a DNR.

I think that you misunderstood me. Where I work when we are coding (or here we call it Dr. Leo) a patient and it is obvious that the person is not going to make it or there will not be much left despite our best efforts we "call the code" or in other words quit trying to revive the patient. I understand that they coded the patient I just don't understand why the ER doc felt the need to continue to flog this patient when it was taking 50mcg of Dopa to keep any pressure at all. Who even goes that high with their Dopa drips? Max rate is 20mcg/kg/min for ICU maintenance rate. Was no one concerned with toxicity?

[hrtprncss]

Hello yes I believe I misunderstood what you said, but if you look at the original OP she said that they were giving dopamine wide open. And my original response to this on the first page shows my opinion on why this practice should not be done. I think that they were able to get a pulse and pressure back, but was not able to do anything further because the DNR status was confirmed. Was it a succesful code? in part yes because the pt regained her pulse and pressure even if it is that low after that specified code(we're just talking about this particular code). Now was it an efficient code? NO we all know it wasn't. But changing drips at that time is not possible anymore because of the DNR status. The dopamine at 50mcg/kg/min was most likely started when they got the pulse and pressure back but before they found out what the DNR status is. :)

[austin heart, BSN, RN]

Hello yes I believe I misunderstood what you said, but if you look at the original OP she said that they were giving dopamine wide open. And my original response to this on the first page shows my opinion on why this practice should not be done. I think that they were able to get a pulse and pressure back, but was not able to do anything further because the DNR status was confirmed. Was it a succesful code? in part yes because the pt regained her pulse and pressure even if it is that low after that specified code(we're just talking about this particular code). Now was it an efficient code? NO we all know it wasn't. But changing drips at that time is not possible anymore because of the DNR status. The dopamine at 50mcg/kg/min was most likely started when they got the pulse and pressure back but before they found out what the DNR status is. :)

I am not trying to start an argument here but my post has nothing to do with them running the Dopa wide open or changing drips or anything other than why did this ER doc feel the need to continue to flog this poor person whether they where a DNR or not. When you have to run the Dopa wide open and then run it at doses well above the maximum dose to maintain the pulse/pressure it is time to call it quits. We sometime push it to the max during codes but I think that this was way beyond excessive.