d) Heart Failure:
The patient has successful thrombolysis, but appears to have extensive myocardial damage and develops heart failure and hypotension. Lasix, Dopamine, Dobutamine, and Natrecor are needed sequentially to treat this heart failure following admission to the ICU.
The user selects Dopamine and two additional selectors appear, one detailing the common rates for the drug; the other listing the common concentrations.
In this example Select a moderate does of 10 mcg/kg/min, and the 3200 mcg/mL solution (as the patient should be fluid restricted). Then Press Result.
In addition to the usual weight based mixing and infusion recommendations on the results page, you may need to check Dopamine’s compatibility with other commonly infused drugs. That list includes Diltiazem, Dobutamine, Epinephrine, Esmolol, Lidocaine, Morphine Sulfate, Nitroglycerin, Norepi, Pancuronium, and Vecuronium.You would then hit the Drugs button to return to the drugs list, where you follow a similar process for both Dobutamine and Natrecor. (Noting that as per the compatible infusion drugs list, Natrecor cannot be infused through the same line as Dopamine).
In this example Adult drips was used six times to make calculations and to check on the relevant drug information.
3) Emergency Meds: includes
dosing recommendations and dosage calculations for drugs used in
emergencies such as conscious sedation medications, paralytics,
and anti-hypertensives and many other medications that are
administered via intravenous push. For example, if the previous
patient needed to be paralyzed for intubation and
Succinylcholine was needed:
Select Emerg Meds, the previously entered weight of 192 will be
present, press ‘Enter’.Select Succinylcholine and the
relevant information will display.
4) Fluid Wizard:
covers
calculations and information for IV Maintenance, Bolus, and Burn
related for both adult and Pediatric patients (based upon the
Parkland Formula).
Burn Victim Example: A 154lb woman arrives at ER 2 hours after
suffering 34% burns in a car accident. The patient received
250mL of NS during the 30 minute Ambulance trip to the hospital.
Select Fluid Wizard
Select Burn Fluids
Enter 154 and select Pounds and press ‘Enter’.Select 34% on
the BSA Burned.Select 2 hrs on Hours Since Burn Press the
‘C’ to the Right of the mL of Fluid Already Given and select
250.Press ‘Result’The results suggest a deficit of fluids
exists and that consideration of infusing 990mL/hr for the next
4Hours, then resume the recommended rate from the time of the
burn, which in this case is 700mL/hr from 1- 8 hrs, then
410mL/hr from 9-24hrs after the initial burn. The results also
display the details of the calculations and other relevant
recommendations.
5) Infusion Calc: is a
generic infusion calculator that basically solves the unknown
factor of either needed mL/hr or actual mcg/kg/min (whichever
one of the two you don’t know). This is most commonly used in
transferring patients (e.g. when ER receives a patient from
Paramedics, or the ICU dept receives a patient from ER).Patient
Transfer Example: The ICU receives a 79kg patient with a
solution hanging that is mixed at 250mcg/ml and infusing at
30ml/hr and the mcg/kg/min needs to be confirmed.
Select Infusion Calc
Select 79 then Kilograms then press ‘Enter’Press the C to
the Right of Solution Conc and enter 250Select from ‘Select
Desired Calculation’, the Calc. current mcg/kg/min.Press the
‘C’ to the Right of ‘Enter current mL/hr and enter 30 and
press the ‘Result’ button.The result is displayed as 1.6
mcg/kg/min
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