Positive Test dose

[dabears505]

How long should heart rate remain elevated with a positive test dose?

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[GassYous]

If you're asking then it's too long

 

[ethilo]

about as long as it takes for a single dose of about 20-50 mcg of IV epinephrine to last

 

[IMGASMD]

Minutes. I’d say more than 1, less than 15….

 

[narcotics999]

Epi half life 2-3 minutes. I think by 4-5 half life, it should be all gone, if you just injected 5ml (25mcg)

Tachycardia is a good thing. If Bradycardia, oh well.....

 

[deleted1111114]

The usual >20 bpm from baseline lasts about 30 seconds. Of course the slope up and down within the 2 mins or so is unmistakable unless the sound is off.

 

[DrOwnage]

The trick is to give the test dose after you've seen a contraction.

 

[Mman]

The tachycardia from the epi usually starts within seconds and the patients will simultaneously tell you they feel like their heart is beating out of their chest. Not a pleasant sensation. Resolves fairly quickly, within 30 seconds to maybe 2 minutes (unless you sent them into some sort of tachyarrhythmia that persists).

On a somewhat related note, I once had to give adenosine on the L&D floor for a patient in SVT. That was quite the production.

 

[IMGASMD]

The tachycardia from the epi usually starts within seconds and the patients will simultaneously tell you they feel like their heart is beating out of their chest. Not a pleasant sensation. Resolves fairly quickly, within 30 seconds to maybe 2 minutes (unless you sent them into some sort of tachyarrhythmia that persists).

On a somewhat related note, I once had to give adenosine on the L&D floor for a patient in SVT. That was quite the production.

Anything on l&d is a production. I had a cardioversion on a tele floor. The nurse was so overwhelmed, because they just don’t do it at bedside anymore. Can’t imagine that l&d is “okay” with anything more than to give 5mg of ephedrine.

 

[abolt18]

The tachycardia from the epi usually starts within seconds and the patients will simultaneously tell you they feel like their heart is beating out of their chest. Not a pleasant sensation. Resolves fairly quickly, within 30 seconds to maybe 2 minutes (unless you sent them into some sort of tachyarrhythmia that persists).

On a somewhat related note, I once had to give adenosine on the L&D floor for a patient in SVT. That was quite the production.

Had one positive test dose on OB on a little Hispanic lady. Within maybe 10-15 seconds she grabbed her chest and exclaimed "Mi corazon!!!!"

As noted, resolved in maybe 1-2 minutes.

 

[DrOwnage]

Had one positive test dose on OB on a little Hispanic lady. Within maybe 10-15 seconds she grabbed her chest and exclaimed "Mi corazon!!!!"

As noted, resolved in maybe 1-2 minutes.

I hope you were like "Mierda!!"

 

[AnesRunner]

Never leave in a questionable catheter. It will most definitely come back to bite you or bite a colleague in the arse. Just take it out and replace.

 

[narcotics999]

Had one positive test dose on OB on a little Hispanic lady. Within maybe 10-15 seconds she grabbed her chest and exclaimed "Mi corazon!!!!"

As noted, resolved in maybe 1-2 minutes.

For the positive, no blood from aspiration?

 

[abolt18]

For the positive, no blood from aspiration?

No blood before OR after the test dose.

 

[woopedazz]

Never given an adrenaline test dose before 😅

 

[nimbus]

No blood before OR after the test dose.

Then what did you do with that information? Did you use the catheter or pull it?

 

[abolt18]

Then what did you do with that information? Did you use the catheter or pull it?

Pulled it. Went down a level.

 

[Arch Guillotti]

No blood before OR after the test dose.

Could have just leaked over into a blood vessel that was breached during placement but not cannulated.

 

[pgg]

I put in my first Braun epidural catheter in probably 10 years a couple weeks ago. (Covering OB in a new hospital, just grabbed the first kit I could find.) Blood flowed back into the catheter. Didn't test dose it, just pulled it and found an Arrow kit. I have never ever had one of the spring wound Arrows go intravascular.

 

[dabears505]

The Braun ones are so trash. Cheap hospital only supplies those for us.

 

[deleted875186]

We used Braun in residency, but perhaps the catheters were better than what people are describing above, they were fairly soft similar to the arrow kits, never had an intravascular placement in the couple hundred I did.

I second above, for an easy lumbar epidural, if in doubt replace on the spot, it’s so easy to place that I would not mess around with it.

 

[Southpaw]

I put in my first Braun epidural catheter in probably 10 years a couple weeks ago. (Covering OB in a new hospital, just grabbed the first kit I could find.) Blood flowed back into the catheter. Didn't test dose it, just pulled it and found an Arrow kit. I have never ever had one of the spring wound Arrows go intravascular.

The Brauns are awful. Arrow catheters are the only way to go.

 

[IMGASMD]

We had Braun kits without any drugs….. try that for fun. Basically just 30ml of bupivicaine for everything….. multiorifice catheter probably makes the most difference than any kits.

 

[DrZzZz]

I put in my first Braun epidural catheter in probably 10 years a couple weeks ago. (Covering OB in a new hospital, just grabbed the first kit I could find.) Blood flowed back into the catheter. Didn't test dose it, just pulled it and found an Arrow kit. I have never ever had one of the spring wound Arrows go intravascular.

In residency, we used Braun and intravascular placement probably ranged 5-10% (always had blood on aspiration, never experienced a +test dose because I never bothered giving it if aspiration was +). At my job, we've got Arrows and same here, not a single intravascular catheter through maybe 250 or so epidurals I've placed.