NORTH COAST EMERGENCY MEDICAL SERVICES Policy # 5408

POLICIES AND PROCEDURES

Subject: Medical Direction

Dopamine Hydrochloride Protocol

Associated Policies: 02/08/98

  1. Class:
  1. Sympathomimetic. Stimulates dopaminergic, á adrenergic, and à-adrenergic receptors. Effects are dose related.
  1. Therapeutic Effects:
  1. Increases cardiac output by increasing contractility and stroke volume, thereby increasing blood pressure.
  2. Selectively dilates blood vessels supplying the brain, kidneys, heart, and gastrointestinal tract at certain infusion rates.
  3. Increases heart rate.
  1. Indications:
  1. Hemodynamically significant hypotension in the absence of hypovolemia.
  2. Cardiogenic shock.
  3. Low cardiac output following resuscitation.
  4. Symptomatic bradycardia.
  5. Continuing hypovolemic shock after sufficient volume replacement.
  1. Contraindications:
  1. Absolute: None for field use.
  2. Relative: Pulmonary congestion.
  1. Adverse Effects:
  1. Ventricular irritability.
  2. Nausea, vomiting and angina (rarely).
  3. Dose related hypertension, tachycardia and severe vasoconstriction.
  4. Increased myocardial oxygen demand.
  5. Hypotension can occur at low infusion rates.
  6. Increased pulmonary congestion.
  1. Administration and Dosage:
  1. Adult dose range: beginning at 2-5 æg/kg/minute. Total dose range of 2-20 æg/kg/minute.
  1. 1-2 æg/kg/minute: renal, and mesenteric vasodilation.
  2. 2-10 æg/kg/minute: increases cardiac output.
  3. Greater than 10 æg/kg/minute: peripheral, renal, and mesenteric vasoconstriction.

To prepare solution:

Add 800 mg to 500 ml IV solution for a concentration of 1600 æg/ml. Or use premixed solution with a concentration of 1600 æg/ml.

Recommended infusion rates:

æg/kg

ADULT PATIENT WEIGHT IN KGS

min

50

55

60

65

70

75

80

85

90

95

100

110

2æg

4

5

5

5

5

5

6

6

7

7

8

10

5æg

9

10

11

12

13

14

15

16

17

18

19

21

10æg

19

21

22

25

26

28

30

32

34

35

38

41

15æg

28

31

33

37

39

42

45

48

51

52

57

62

20æg

38

41

45

49

53

55

60

63

68

70

75

83

Microdrops(60 gtts) per minute ( ml/ hr)

  1. Pediatric dose range: beginning at 1-2 æg/kg/minute. Total dose range 2-20 æg/kg/minute.
  1. Refer to Pediatric Resuscitation tape for specific ml of medication to add and ml of solution to remove from a 100 ml bag to achieve desired weight specific concentration and delivery dose.

OR

  1. Dilute 6 mg/ kg in enough NS to create a 100 ml infusion solution. 1 ml/ hr (1 drop per minute) delivers 1 æg/kg/minute. Begin the initial infusion rate at 2-5 æg/kg/minute IV or IO, then titrate to the desired effect.
  1. Special Information:
  1. Infuse through large, stable IV to avoid the possibility of extravasation injury.
  2. Effects cease 10 minutes after infusion is stopped.
  3. May be deactivated by alkaline solutions including sodium bicarbonate and furosemide.