EMTprep Free Training Materials


What size drips set do you use for and Epinephrine drip? Dopamine drip? Nitroglycerine drip?

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You use a micro drip set for Dopamine and Nitroglycerine and a macro drip set for Epinephrine. Micro drip sets are usually 60 gtt/ml and macro drips sets are usually 15 gtt/ml.

Which would you use as a first line drip on a sepsis patient and why?

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Epinephrine is typically used as a first line drip instead of Dopamine due to the wide range of adverse effects that are possible with Dopamine. Dopamine has a risk of causing a fib, ventricular arrhythmias, and widened QRS. It has has a longer half life than Epinephrine so if the patient does begin to experience these effects it takes longer for the Dopamine to get out the system than it does for the Epinephrine. Also if the patient is needing a drip for blood pressure they likely have multiple medical problems that can be exacerbated by a drip.

What are contra-indications of a Dopamine drip? Nitroglycerine drip? Epinephrine drip?

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Contra-indications for a Dopamine drip include v fib and tachydysrrhythmias because Dopamine will increase the heart rate and can cause dysrrhythmias, so if the patient already has this then it can become worse. Contra-indications for a Nitroglycerine drip include use of erectile dysfunction medications in the last 24 hours, cerebral bleeds, hypotension, bradycardia, or right ventricular infarction. This is because it is a vasodilator so if the patient is already bradycardic or hypotensive they may become more hypotensive, they may bleed more because of the vasodilation allowing more blood flow, and they may lose their preload if they have a right ventricular infarction. Epinephrine may be contra-indicated in patients with hypovolemic shock, coronary insufficiency, or hypersensitivity, however in an emergency setting it is not typically contra-indicated. This is because it is a vasoconstrictor so it can contribute to infarction in the heart if they have coronary insufficiency and in hypovolemic shock the patient needs fluid replacement and may be vasoconstricting adequately and you will cause tissue ischemia.

What are side effects or adverse reactions of Dopamine drips? Nitroglycerine drips? Epinephrine drips?

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Adverse effects of Dopamine drips include tachycardia, dysrrhythmia, increased myocardial oxygen demand, headache, anxiety, nausea and vomiting, and widened QRS. Adverse effects of Epinephrine include headache, nausea and vomiting, dysrrhythmias, angina, and tachycardia. Adverse effects of Nitroglycerine include headache, reflex tachycardia, hypotension, nausea and vomiting, and flushing.

What receptors do Dopamine and Epinephrine work on and what does this cause?

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Dopamine and Epinephrine both bind to alpha 1 and beta 1 receptors to cause vasoconstriction and increase the positive inotropic and chronotropic effects on the heart. So it they cause increased heart rate and contractility to increase blood pressure and heart rate.

What receptors does Nitroglycerine work on and what does it do?

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Nitroglycerine is broken down into nitric oxide which binds to receptors in smooth muscle in the vasculature to cause vasodilation and particularly venodilation meaning that it works more on veins than arteries thereby lowering blood pressure.

What is the dose for a Dopamine drip? Epinephrine drip? Nitroglycerine drip?

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The dose of Dopamine for a drip is 2-20 mcg/kg/min. The dose for Epinephrine is 2-10 mcg/min. The dose for Nitroglycerine is 10-200 mcg/min.

What is your drip rate for a 100kg pt at the lowest dose and either a 15 gtt/ml or 60 gtt/ml drip set for Dopamine with a concentration of 1600 mcg/ml? Epinephrine with a concentration of 1 mcg/ml? Nitroglycerine with a concentration of 100 mcg/ml?

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  • Your drip rate for Dopamine is 2 mcg/kg/min times 100 kg to get 200 mcg/min, we are going to use a 1600 mcg/ml concentration so we need 200 mcg/min divided by 1600 mcg/ml to get 0.125 ml/min, we multiply that by 60 gtt/ml to get 7.5 gtt/min.
  • Your drip rate for Epinephrine is 2 mcg/min with a solution of 1 mcg/ml is 2 mcg/min times 1 mcg/ml equals 2 ml/min, if you use a 15 gtt/ml set then you multiply 2 ml/min times 15 gtt/ml to get 30 gtt/min.
  • Your drip rate for Nitroglycerine is 10 mcg/min with 100 mcg/ml solution is divide 10 mcg/min by 100 mcg/ml to get 0.1 ml/min and if you use a 60 gtt/ml set then multiply 0.1 ml/min by 60 gtt/ml to get 6 gtt/min.

What are indications for starting a Dopamine drip? Epinephrine drip? Nitroglycerine drip?

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Indications for starting a Dopamine drip is if a patient is still hypotensive or bradycardic after fluid resuscitation such as after a cardiac arrest, or in symptomatic bradycardia not responding to Atropine and pacing. Epinephrine is also indicated in these patients, but may also be used in patients that are septic and fluid resuscitated, and in anaphylaxis patients that are either not responding to boluses of IV Epinephrine or are requiring frequent doses of IV Epinephrine. Nitroglycerine is indicated in patients that are hypertensive, or having angina or myocardial infarction, or patients with pulmonary edema.

What happens to the area if the IV extravasates in a Dopamine drip? Epinephrine drip? Nitroglycerine drip?

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If Dopamine extravasates it causes localized tissue ischemia as it is a potent vasoconstrictor and can also cause tissue infarction and loss of tissue in the area due to ischemia. Epinephrine that extravasates may cause some pallor and coolness in the area due to vasoconstriction but is not likely to cause infarction as it is the same concentration that is used with local anesthesia to reduce blood flow to the area. Nitroglycerine that extravasates may cause flushing and heat in the area as it is a venodilator and will cause increased blood flow to the area.

Are there medication incompatibilities or needs for a new line with Dopamine? Epinephrine? Nitroglycerine?

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Dopamine is incompatible and may be deactivated by sodium bicarb and furosemide so it should be given in a separate line. Epinephrine may also be incompatible with and deactivated by sodium bicarb and furosemide so it cannot be given at the same time but can go in the same line if it is flushed well in between. Nitroglycerine does not need a separate line and can be given with other medications.

What category of medication is Dopamine? Epinephrine? Nitroglycerine?

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Dopamine and Epinephrine are both strong sympathomimetics and Nitroglycerine is a Vasodilator.

What is your drip rate for Dopamine for a 75 kg patient at 5 mcg/kg/min and a 60 gtt/ml set?

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75 kg times 5 mcg/kg/min is 375 mcg/min, Dopamine is usually 1600 mcg/ml so 375 mcg/min divided by 1600 mcg/ml is 0.23 ml/min and your drip set is 60 gtt/ml so 0.23 ml/min times 60 gtt/ml is 13.8 gtt/min.

What is your drip rate for Epinephrine for a 75 kg patient at 10 mcg/min and a 15 gtt/ml set?

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For this one you don’t need the weight and Epinephrine is often 1 mcg/ml so 10 mcg/min times 1 mcg/ml is 10 ml/min and if your drip set is 15 gtt/ml then 10 mcg/min times 15 gtt/ml equals 150 gtt/min.

What is your drip rate for Nitroglycerine for a 75 kg patient at 15 mcg/min and a 60 gtt/ml set?

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For this one again you don’t need the weight and Nitroglycerine is often 100 mcg/ml so 15 mcg/min divided by 100 mcg/ml is 0.15 ml/min and if your set is 60 gtt/ml then 0.15 ml/min times 60 gtt/ml is 9 gtt/min.