Epi drip

[akroeze]

Hey folks, there is something I have been trying to wrap my head around.

We have two options, we can do a Dopamine drip by protocol or we could possibly patch in to an MD to get permission for an Epi drip. I'm wondering what situations you would (or even have) chosen Epi over Dopamine?

Thanks

[AZCEP]

I've used an epinephrine infusion on a few cardiac arrests, but I don't think that is the information you are looking for.

With the availability of TCP, I've never used an epinephrine infusion for bradycardia. Can't say I wouldn't consider it, just have never needed to yet.

[Ridryder 911]

I am re-writing our protocol for cardiogenic shock. Our medical director wants me to include Dobutamine (preload), Dopamine (afterload) and Epi drip for use of an increased vasopressor, and for bradycardia.

R/r 911

[ccmedoc]

Other than the previous two, we (generally) initiate Epinepherine with cardiogenic shock and a blood pressure of 70 systolic or less. between 70 and 100 systolic we use Dopamine, and above or around 110, use Dobutamine..less work on the heart.

You can get as in depth with this as you want, and each doc likes different numbers, but this is a good starting point. A lot of these meds are titrated with each other or a few others for the desired effect..depending on the patients condition of course.

[p3medic]

Anaphylaxis.

[akroeze]

Anaphylaxis.

You've done an Epi drip for anaphylaxis? Must have been a pretty crappy call

[p3medic]

Yeah, it was great fun. 50 year old male in a doctors office being tx for prostate cancer with reaction to his new chemotherapy, eyes bugging out of his head, red as a tomato, silent chest. After he was intubated bagging him was like trying to squeeze a football, no blood pressure. Doc had given him epi prior to our arrival, we gave more, wide open fluids, epi drip....was extubated next day, doing fine. I remember the call well because we both have the same last name, although no relation.

[MSDeltaFlt]

I've used Epi drip when Dopamine was maxed out.

[akroeze]

Is there a situation other than Anaphylaxis and profound (<70) hypotension in sepsis where anyone would use an Epi infusion as a first choice?

[AZCEP]

Status asthmaticus, perhaps.

I'd tend to use dopamine first for sepsis, just out of familiarity then move to epinephrine.