I rank Dopamine 13 out of the 33 drugs I carry.
We use Dopamine for cardiogenic shock or septic shock refractory to fluids.
I have never used a lot of Dopamine over the years. When I started we carried Dopamine in vials and had to mix up our own drips. Working as a single medic, if I had a patient who needed Dopamine, they usually needed too much attention from me for me to break away and mix up a drip (and we had fairly short transports to the hospital). Over the years I have grown more comfortable with mixing drips, while at the same time we now carry a premixed Dopamine. Lately I have started to use Dopamine more with return of spontaneous circulation (ROSC) from cardiac arrest. I have had success to the extent that where before I often lost pulses after regaining them as the epinephrine wore off, I have had many more patients gain and hold a decent pressure once I have the Dopamine hung. Still, most of these patients end up dying in the ICU.
If I am giving someone Dopamine, as I said before, they are pretty bad off. I have only ever given it twice for septic shock after having dumped a liter of fluid into a patient with no change in hypotension, but I don’t know the patients’ final outcomes.
I rate Dopamine where I do because it at least has the potential to be a lifesaver.
We don’t carry med pumps so the drip is pretty much of an eyeball, and then titrate to blood pressure. When you have no pressure, you bump it up. You get a pressure above 90, you ease it down.
Several times at the hospital I have had to warn nurses about shutting the Dopamine off completely. Recently I brought in a cardiac arrest ROSC with a BP of 120-something systolic, the nurse shut off (unhooked) the Dopamine because the pressure was good. I said, you might not want to do that, but she never hooked it back up, and when I came back from writing my run form,they were doing CPR. They eventually got pulses back and ended up putting the patient back on Dopamine. Like so many others, she made it to the ICU only to die within a few days.
I only used Dopamine once last year, but have used it twice so far this year. All three cases were post-rescucitation care.
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Dopamine (Intropin)
Class: Naturally occurring catecholamine, adrenergic agents
Action: Stimulates ?, ?1 and dopaminergic receptors
Effects: 0.5 to 2 ?g/kg/min – Renal and mesenteric vasodilation.
2 to 10 ?g/kg/min – Renal and mesenteric vasodilation persists and
increased force of contraction (FOC).
10 to 20 ?g/kg/min – Peripheral vasoconstriction and increased FOC (HR may
increase).
20 ?g/kg/min or greater – marked peripheral vasoconstriction (HR may
increase).
Indication: Shock – Cardiogenic
– Septic
– Anaphylactic
Contraindication: Pre-existing tachydysrhythmias or ventricular dysrhythmias.
Precaution: Infuse in large vein only
Use lowest possible dose to achieve desired hemodynamic effects,
because of potential for side effects.
Do not D/C abruptly; effects of dopamine may last up to 10 minutes after drip
is stopped.
Do not mix with NaHCO3 as alkaline solutions will inactivate dopamine.
Side effect: Tachydysrhythmias
Ventricular ectopic complexes
Undesirable degree of vasoconstriction
Hypertension relate to high doses
Nausea and vomiting
Anginal pain
Dose: 2.0 – 20. ?g/kg/min titrated to desired effect
Route: IV drip
Pedi dose: same as adult dose – titrate to effect
