Use of Dopamine in a Statewide Emergency Medical Services System

Background/Introduction: Dopamine is a potent, sympathomimetic medication used in emergency medicine and critical care to improve blood pressure (BP) in selected types of circulatory shock and to treat symptomatic bradycardia refractory to atropine and other interventions. While dopamine has been used by paramedics for many years, the prehospital experience in a statewide EMS system has not previously been reported. Objective/Purpose/Rationale: Describe the prehospital use of dopamine in a statewide EMS system. Materials and Methods: This is a retrospective, observational study of records obtained through the Michigan EMS Information System (MI-EMSIS). MI-EMSIS was filtered for the use of dopamine during 2015. The narrative report was manually reviewed and data were abstracted. In addition to basic demographics, clinical data such as pre/post-dopamine vital signs were obtained as well as post-dopamine adverse effects. Records were excluded for inter-facility transfers, dopamine not given, and when insufficient data existed. Standard descriptive statistical analysis was used. Results and Discussion: During the study period 1.6 million records were included in MI-EMSIS with 303,683 medications (excluding oxygen and intravenous fluids) administered. Dopamine was administered to 136 patients, with 22 patients excluded secondary to being inter-facility transports (18), having inadequate data (1), or no dopamine used (1), or other reason (2). There were 114 cases included for analysis representing \u3c0.01% of all medications administered. The median (IQ) age was 67 (55,82) years and 57% were male. Cardiac arrest was the primary impression in 101 (88.6%) cases with 31 (27.2%) experiencing a post-dopamine cardiac arrest. The median (IQ) pre- and post-dopamine systolic and diastolic BPs were 79/51 (69/42, 101/64) and 93/58 (75/44, 114/74), respectively with the maximum post-dopamine BP 222/142. The median pre- and post-dopamine heart rate was 72 (55,91) and 81 (62, 103), respectively. The maximum post-dopamine heart rate was 179. Significant post-dopamine arrhythmias were noted in 9 (7.9%) patients with ventricular fibrillation (2, 1.8%), ventricular tachycardia (3, 2.6%), and atrial fibrillation (4, 3.5%) reported. A pre-dopamine fluid bolus was documented in 55 (48.2%) cases, with the median (IQ) volume of 500 (400, 1200) mL administered. Dopamine use was highly variable by county and not related to urban or rural location. Conclusion: In a statewide EMS system, prehospital dopamine administration was rarely reported and moist commonly associated with cardiac arrest. Post-dopamine improvements in BP and heart rate were common, although subsequent cardiac arrest was not infrequent. Serious post-dopamine arrhythmias and severe hypertension and tachycardia were uncommon

The Role of Nutritional Education for the Homeless

Background and Purpose: Lack of nutritional knowledge in navigating limited dietary options is a major problem for homeless populations. Previous efforts have been focused on encouraging dietary changes by providing basic nutritional information. Still, the homeless have difficulty making these changes due to a lack of choices. This study implemented nutrition fairs at the Kalamazoo Gospel Mission, a homeless shelter and soup kitchen in downtown Kalamazoo, to inform homeless and transient population about nutrition and making healthier food choices. Methods: The nutrition fair comprised of 4 booths, each providing information about caloric intake, recommended portion size, healthy choices and nutrition labels. The main focus is to arm participants with the skills to make the most out of their food options. Each participant was administered a survey before (pretest) and after (posttest) attending the nutrition fair. The survey assessed how respondents’ dietary choices or satisfaction changed after attending the nutrition fair. There were similar six questions written in plain language with pictures, in both pre-and post-survey. Data was collected over six session and we conducted descriptive statistics. Results: Thirty-two adult participant completed the pre-and post-surveys. The study revealed a statistically significant improvement in nutrition knowledge after receiving information. About 65% of the study subjects did not report any significant change in knowledge. Within this group, several (30%) had perfect scores on the pretest, though this was insignificant. There were also some respondents (9.4%) who scored lower on the posttest than the pretest. We found that lack of education was not a major barrier to healthy eating. However, most of the participants identified insufficient quantities of food to maintain their energy level and weight as a major problem the homeless population encounter. In addition, lack of money was a critical problem and attempts to educate participants to purchase inexpensive produce rather than prepackaged or otherwise unhealthy options were somewhat inconsequential. Conclusions: Our study suggests that nutrition fair could be an efficient method for improving the nutritional knowledge of the homeless population. Rather than healthy choice food, majority of the study participant were concerned about lack of sufficient quantities of food to maintain their energy level and weight. Future nutritional education programs should focus on using items in locally prepared meals to encourage homeless population to make healthier food choices. Keywords: homeless, nutrition, fairs, education, healthy, options, improvemen