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Journal of Medical Toxicology

, Volume 15, Issue 4, pp 276–286 | Cite as

Human Errors and Adverse Hemodynamic Events Related to “Push Dose Pressors” in the Emergency Department

  • Jon B. ColeEmail author
  • Sarah K. Knack
  • Erin R. Karl
  • Gabriella B. Horton
  • Rajesh Satpathy
  • Brian E. Driver
Original Article

Abstract

Background

Though the use of small bolus doses of vasopressors, termed “push dose pressors,” has become common in emergency medicine, data examining this practice are scant. Push dose pressors frequently involve bedside dilution, which may result in errors and adverse events. The objective of this study was to assess for instances of human error and adverse hemodynamic events during push dose pressor use in the emergency department.

Methods

This was a structured chart and video review of all patients age ≥ 16 years undergoing resuscitation and receiving push dose pressors from a single center from January 2010 to November 2017. Push dose pressors were defined as intended intravenous boluses of phenylephrine (any dose) or epinephrine (≤ 100 mcg).

Results

A total of 249 patients were analyzed. Median age was 60 years (range, 16–97), 58% were male, 49% survived to discharge. Median initial epinephrine dose was 20 mcg (n = 139, IQR 10–100, range 1–100); median phenylephrine dose was 100 mcg (n = 110, IQR 100–100, range 25–10,000). Adverse hemodynamic events occurred in 98 patients (39%); 30 in the phenylephrine group (27%; 95% CI, 19–36%), and 68 in the epinephrine group (50%; 95% CI, 41–58%). Human errors were observed in 47 patients (19%), including 7 patients (3%) experiencing dosing errors (all overdoses; range, 2.5- to 100-fold) and 43 patients (17%) with a documentation error. Only one dosing error occurred when a pharmacist was present.

Conclusions

Human errors and adverse hemodynamic events were common with the use of push dose pressors in the emergency department. Adverse hemodynamic events were more common than in previous studies. Future research should determine if push dose pressors improve outcomes and if so, how to safely implement them into practice.

Keywords

Epinephrine Phenylephrine Push-dose pressors Free online open access medical education Medication safety 

Notes

Compliance with Ethical Standards

Conflicts of Interest

None.

Supplementary material

13181_2019_716_MOESM1_ESM.docx (15 kb)
ESM 1 (DOCX 14 kb)

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Copyright information

© American College of Medical Toxicology 2019

Authors and Affiliations

  1. 1.Department of Emergency MedicineHennepin HealthcareMinneapolisUSA
  2. 2.Duke University School of MedicineDurhamUSA
  3. 3.University of Minnesota Medical SchoolMinneapolisUSA

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