# Medical. : Titrating to effect ??



## 8'Duece (Jun 18, 2009)

I've often heard docs and medics refer to "Titrating to effect" especially with narcotic pain meds.  

How is this done in a clinical setting and a combat trauma setting (on the ground) ?  Can one you medical types explain this to me without getting into the ph factors and end point factors without confusing me ??? 

What is it, how's it accomplished and what are it's benefits ???


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## HeloMedic1171 (Jun 18, 2009)

ok - don't get offended to how I break this down, cuz' it's gonna be barney-style...  but that's about as deep as I know it myself....

it's like when you hear TKO - to keep open.... you're giving or doing what's needed to get the job done to minimum standards, nothing more nothing less - i.e in the case of Volume resuscitation with Hextend, you infuse enough fluid to the desired benchmark, such as semi-normal mentation or returned radial pulses.  but then, you stop it.  just enough to get what you're looking for, nothing more.  with pain meds - take the edge off, or make them comfortable, but not necessarily enough to remove all the pain.  you're just trying to make the screaming lessen or lower the heartrate/BP/Breathing rate.


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## HeloMedic1171 (Jun 18, 2009)

in terms of combat trauma, this goes hand in hand with things like "permissive hypotension", which is essentially what i described in my hextend example - get the pulses back enough to push blood and ease the strain on the heart, but not enough so that it could blow out the clots you just formed with TQ's and pressure dressings.  titrating allows you more precise and more varied interventions, and give you the ability to ave valuable supplies for other casualties or patients who may need them.  hope this helps.  fellow practitioners, did I miss anything?


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## Muppet (Jun 19, 2009)

Well said Helo. In the civ. setting, it's the same. For example: Dopamine is used for raising the b/p. We don't carry I.V. pumps so we "triate" to a systolic b/p to 90/p. Runn it in until the b/p is stable. Thats it.

F.M.


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## HoosierAnnie (Jun 19, 2009)

Spot on guys.  In 82nds case, for IV pain meds, its a matter of giving incremental doses of say dilaudid, each long enough apart so that you can accurately say that the last dose has had a chance to "kick in".  I'd give 1 mg at a time in this case, each at least 5 min apart.  You use pt's report as to pain relief to gauge the necessity of giving another dosage.

HM  Love the "screaming" level to measure by  ;)


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## HeloMedic1171 (Jun 19, 2009)

PITPP.     hearing loss, however, is mine..... now what did you say?  I couldn't hear you....


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