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traumajunkyems/fire · 08-10-2009, 02:32 AM

Calling all paramedics/ paragods/ nursing folks...

Looking for a math wizard for some tips on dosing solutions...
and some 12 lead interpretations... need refreshment!!!

PM me please!

PSYCtest040 · 08-10-2009, 03:34 AM

Try this one of for size. 59 YO male with what the ex-wife reports as seizure like activity lasting about 30 to 40 seconds. PMH of psyc issues and taking no meds. Patient himself has no verbal complaints, is alert x3 however answering questions slowly.

Below is the initial rhythm strip and 2 12 lead ECG.

Sorry for the piss poor quality, their scans of the copies.

**medic pathetic** · 08-10-2009, 07:33 AM

Ditchdoc gave me a great formula for dopamine. And now I can't remember it to save my life...

PSYCtest040 · 08-10-2009, 07:48 AM

Quote:

Originally Posted by medic pathetic

Ditchdoc gave me a great formula for dopamine. And now I can't remember it to save my life...

Ohhh please remember....(Ditch Doc maybe you can chime in here) Because if I were let loose on the world now, I'd kill someone administering Dopamine. I don't know why but it's the one calculation I botch 100% of the time.

CombatMedic · 08-10-2009, 07:58 AM

Quote:

Originally Posted by PSYCtest040

Ohhh please remember....(Ditch Doc maybe you can chime in here) Because if I were let loose on the world now, I'd kill someone administering Dopamine. I don't know why but it's the one calculation I botch 100% of the time.

I just got done with my 12 lead class this weekend. I will send you some stuff when I get to a computer that has some power. I forgot half of my power cord at home so my laptop is about to go into asystole.

There are two ways that you can figure Dopamine. I like the clock method. There is also a method that uses pounds. Don't ask me I like the clock.

I will get the 12 lead information and send it to you.

I could always use a refresher and constant studying.

PSYCtest040 · 08-10-2009, 08:02 AM

Quote:

Originally Posted by CombatMedic

I just got done with my 12 lead class this weekend. I will send you some stuff when I get to a computer that has some power. I forgot half of my power cord at home so my laptop is about to go into asystole.

There are two ways that you can figure Dopamine. I like the clock method. There is also a method that uses pounds. Don't ask me I like the clock.

I will get the 12 lead information and send it to you.

I could always use a refresher and constant studying.

We are going to start our (in depth) 12 lead classes in September, I can hardly wait. Right now I'm reading the Dubins 12 lead for dummies book and it's helping but I'm all about getting all the information I can get my hands on. Thanks.

Never heard of the clock method for calculating dopamine, be interested in seeing it. My old partner taught me the pounds version a couple of years ago but I promptly forgot it. My instructor wants us to calculate it EXACTLY during class, after that........

Sorry for the thread hijack TJ.

SpotsyMedic · 08-10-2009, 08:55 AM

Quote:

Originally Posted by PSYCtest040

Try this one of for size. 59 YO male with what the ex-wife reports as seizure like activity lasting about 30 to 40 seconds. PMH of psyc issues and taking no meds. Patient himself has no verbal complaints, is alert x3 however answering questions slowly.

Hmmmmmmmmmmmmmm... looks a bit like a stable ventricular tachycardia w/possibly a bundle branch block(s). But your mileage may vary.

Medic101Charlie · 08-10-2009, 09:38 AM

Kind of irregular with no p-waves so I'm calling it afib RVR with completed LBBB.

Mogollon · 08-10-2009, 02:37 PM

I would also call it atrial fibrillation with RVR and LBBB. The irregular rhythm is not typical for ventricular tachycardia. Additionally, the axis appears fairly normal. This is another finding that suggests something other than ventricular tachycardia.

I know of the down and dirty Colorado dopamine formula: You take the patients weight in pounds and divide by 10, then subtract 2. This will give you the rate in ml/hr for a dose of 5 mcg/kg/min. For example: 180 pounds/10 = 18. 18 subtract 2 = 16. 16 ml/hr.

CAVEAT LECTOR: This formula only works in a 1,600 mcg/ml concentration. Therefore, it will NOT work with any other concentration. In fact, I strongly advise people not to use formulas and do the math for every infusion they set up or have to manage. This is especially true with facility transports where different facilities mix their medications with different concentrations. Using formulas like this as a crutch is a med error waiting to occur.

SpotsyMedic · 08-10-2009, 02:47 PM

I was thinking A-Fib, since it is irregularly irregular, but the QRS complexes seemed a bit too wide. I stand corrected though. :)

08-10-2009, 02:32 AM	#1
traumajunkyems/fire MostEducatedDollInCharge! Join Date: Jul 2006 Location: A small white padded room in Western NY Posts: 922 My Mood: Rep Power: 62	Help! Calling all paramedics/ paragods/ nursing folks... Looking for a math wizard for some tips on dosing solutions... and some 12 lead interpretations... need refreshment!!! PM me please! __________________ PARAMEDICS: We Don't Save Lives We Just Help Prolong Your Miserable Existence Shocking Now... What The Hell Does That Mean?

08-10-2009, 07:33 AM	#3
medic pathetic It's just me. Join Date: Apr 2006 Location: In the cabinet behind the normal saline. Posts: 2,973 Blog Entries: 3 My Mood: Rep Power: 113	Re: Help! Ditchdoc gave me a great formula for dopamine. And now I can't remember it to save my life... __________________ "I'm shattered, but it really doesn't matter. My rescue is gonna be here soon."- Coldplay "I love the body. Flesh is so honest, and organs do not lie." ~Candea Core- Starke “It is sometimes an appropriate response to reality to go insane.” -Philip K. Dick FNG: Required dress code Click Here (safe for work.)

08-10-2009, 09:38 AM	#8
Medic101Charlie Paranoid Bi-Polar Medic Join Date: Dec 2007 Location: Central Ohio Posts: 1,462 My Mood: Rep Power: 66	Re: Help! Kind of irregular with no p-waves so I'm calling it afib RVR with completed LBBB.

08-10-2009, 02:37 PM	#9
Mogollon Senior Member Join Date: Dec 2008 Location: Back in the United States Posts: 246 Rep Power: 22	Re: Help! I would also call it atrial fibrillation with RVR and LBBB. The irregular rhythm is not typical for ventricular tachycardia. Additionally, the axis appears fairly normal. This is another finding that suggests something other than ventricular tachycardia. I know of the down and dirty Colorado dopamine formula: You take the patients weight in pounds and divide by 10, then subtract 2. This will give you the rate in ml/hr for a dose of 5 mcg/kg/min. For example: 180 pounds/10 = 18. 18 subtract 2 = 16. 16 ml/hr. CAVEAT LECTOR: This formula only works in a 1,600 mcg/ml concentration. Therefore, it will NOT work with any other concentration. In fact, I strongly advise people not to use formulas and do the math for every infusion they set up or have to manage. This is especially true with facility transports where different facilities mix their medications with different concentrations. Using formulas like this as a crutch is a med error waiting to occur. __________________ He lives vicariously through himself.

08-10-2009, 02:47 PM	#10
SpotsyMedic Senior Member Join Date: Dec 2008 Location: On the couch in the Day Room. Posts: 414 My Mood: Rep Power: 27	Re: Help! I was thinking A-Fib, since it is irregularly irregular, but the QRS complexes seemed a bit too wide. I stand corrected though. :) __________________ "ALS means 'Ain't Lifting Shit'" - NBC train-wreck Trauma Approach stressful situations like a dog... if you can't eat it, lick it, or hump it, just piss on it and walk away.

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