Help!

[PSYCtest040]

Here is another good one we ran in tonight. 68 YO male with extensive cardiac history, type II diabetes, Hyperlipidemia and HTN complaining of feeling flushed while at rest. On our arrival patient is semi fowlers on BLS gurney, A&Ox3 with no complaints.

Palpable pulse of 22, B/P of 130/P, SpO2 of 97 room air and RR of 14 non-labored.

[wvditchdoc]

Here is another good one we ran in tonight. 68 YO male with extensive cardiac history, type II diabetes, Hyperlipidemia and HTN complaining of feeling flushed while at rest. On our arrival patient is semi fowlers on BLS gurney, A&Ox3 with no complaints.

Palpable pulse of 22, B/P of 130/P, SpO2 of 97 room air and RR of 14 non-labored.

There are no P waves in either strip attached and wide QRS's so it's not Atrial in origin. The rate is too slow even for a Junctional Rythym.

I am going with an Idioventricular Rythym. This guy needs a implanted pacer, do not pass go, do not collect 200 dollars.

[PSYCtest040]

There are no P waves in either strip attached and wide QRS's so it's not Atrial in origin. The rate is too slow even for a Junctional Rythym.

I am going with an Idioventricular Rythym. This guy needs a implanted pacer, do not pass go, do not collect 200 dollars.

I agree with you on that but the patient is refusing a pace maker.

[SpotsyMedic]

There are no P waves in either strip attached and wide QRS's so it's not Atrial in origin. The rate is too slow even for a Junctional Rythym.

I am going with an Idioventricular Rythym. This guy needs a implanted pacer, do not pass go, do not collect 200 dollars.

I think I'm going to go with DitchDoc on this one, with one small exception... I think it is an Idioventricular Escape Rhythm... rate's too slow for Junctional... no discernable P waves... wide QRS... and if you look closely, could be Q waves in V1 and V2 from an old Septal Wall infact... the peaked (and inverted in Leads II, III) T waves are most likely indicative of hyperkalemia or other electrolyte imbalance.

If it WALKS like a duck, and QUACKS like a duck, it must be an idioventricular escape rhythm. :)

[Ditch Doc]

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.

Okay, so I suck at the clock method. Here's what works for me:

Weight in pounds / 10, then subtract 2 will give you ml/hr
For example, 220 lb / 10 = 22. Subtracting 2 will give you 20ml/hr

This gives you the ml/hr for Dopamine at 5mcg/kg/min in a bag of 1600 mcg/ml.

#ml/hr is the same as #gtt/min on a 60gtt set.

Hope this helps!

[PSYCtest040]

Okay, so I suck at the clock method. Here's what works for me:

Weight in pounds / 10, then subtract 2 will give you ml/hr
For example, 220 lb / 10 = 22. Subtracting 2 will give you 20ml/hr

This gives you the ml/hr for Dopamine at 5mcg/kg/min in a bag of 1600 mcg/ml.

#ml/hr is the same as #gtt/min on a 60gtt set.

Hope this helps!

Cool, thanks.

[Mogollon]

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.

[Ditch Doc]

Crap! Sorry dude! Didn't realize you had already posted it. LOL