Dopamine - Nice Packaging

Dopamine is one of those drugs that seems to have been designed by a plaintiff's lawyer, at least as far as the dosing is concerned. The dose range is 2 to 20 mcg/kg/min (micrograms per kilogram per minute). Some complicated math to be performing, especially since the main indication for treating a patient with dopamine is that the patient is trying to die before arriving at the hospital. If you do not have this concern about the survival of the patient, perhaps the dopamine is not indicated. It isn't enough that our patient is seeking out the stability of the grave, we seem to find ways to make it as difficult as possible to safely treat these unstable patients.

But on critical care transports dopamine is often used at a renal dose.

That is a whole different post. This is about the packaging of dopamine.

200 mg (milligrams) in 250 ml (milliliters) of D5W (A solution of 5% Dextrose in Water) -

Or -

400 mg (milligrams) in 250 ml (milliliters) of D5W (A solution of 5% Dextrose in Water) -

Or -

800 mg (milligrams) in 250 ml (milliliters) of D5W (A solution of 5% Dextrose in Water) -

Or -

Maybe even some other concentration. Those are the only concentrations I have seen, but that does not mean that others do not exist. Some places carry the dopamine that needs to be mixed by the medic prior to use. That means that there are practically endless possibilities for concentrations, based on the actions of the medic.

Here are some charts for calculating the drip rates for different concentrations. The different concentrations are in different colors near the top. You can open these in their own tab, or window, and print them out. I used to do this and tape them to the dopamine bags, so that every bag had a copy of the correct chart taped to it. When you need, or think you need, dopamine is not the time to be messing around with math. Your attention should be on patient assessment. It isn't as if we do not already have enough distractions from patient assessment.

200 mg in 250 ml (which also works for 400 mg in 500 ml and 800 mg in 1 liter):

400 mg in 250 ml (which also works for 800 mg in 500 ml and 1,600 mg in 1 liter):

And then there is the highly concentrated 3.2 mg/ml dopamine. At one place, where I used to work, this was the concentration they carried, but the punchline was that they only used 10 drop/ml tubing (trauma tubing). Look at this chart of drip rates and divide everything by 6 to get the right drip rate. Most patients were in the 1 or 2 drops per minute range. The pot holes had more of an effect on the drip rate than I did. A 100 kg patient (220 pounds - no lightweight) at 10mcg/kg/min would be getting all of 3 drops per minute. Of course, when you have a basic EMT as the ALS coordinator and he is more concerned about keeping the costs down by ordering only one type of tubing, or whatever brainstorm might have been going on in his head, well then patient care is definitely not the priority.

Of course, it does not help that we are still in the dark ages, using ounces and pounds, and miles, and all sorts of other bizarre measurements. The metric system is much easier to work with, but when we are using entirely different measurements outside of patient care, we need to be able to convert from that Imperial System to the metric system.

We in the US almost switched, back in the 1970s. If we had, most of you reading this would have grown up with the metric system. You would not have to do all of these conversions. You can thank your parents for that piece of stupidity. They were not thinking of you.

Of all of the iatrogenic deaths in the US, how many are due to conversion errors? Thousands each year? Tens of thousands each year? Nobody knows. If we admit that this is a problem, then we might feel obligated to do something about it. Better to ignore the problem. Just be glad that we switched to a decimal monetary system long ago.

We package dopamine in 200/400/800/1,600/3,200 concentrations. Why? Do we need to make it complicated for people to calculate? We could use nice simple numbers, as we do with dobutamine, which comes in 250 mcg/ml, 500 mcg/ml, 1 mg/ml, 2 mg/ml, and 4 mg/ml concentrations. Nice simple math. Not dopamine with 800 mcg/ml, 1.6 mg/ml, and 3.2 mg/ml concentrations. It is as if ATLA (the American Trial Lawyers Association) designed the packaging to assure a steady supply of cases.

We can change the labels to DOPamine and DOBUTamine, so that the drugs are not confused, because reading is not one of our strong points, but how many people are better at math than they are at reading?

Risk management is not among our strong points.

Maybe it is all a part of a fiendishly clever plan to free up beds, so that hospitals are not on divert all of the time? Yeah! That's the ticket. It's a conspiracy.


1 comment:

Anonymous said...

That's interesting. I thought all Dopamine was packaged 1600mcg/mL. Good to know, though I'm certain that all we carry prehospitally is that concentration. Are the others to be found in the ED, or are some services using different concentrations ?