Flow Sheet

KAISER PERMANENTE MEDICAL CENTER-NAPA SOLANO

Dobutamine Stress Echo Flow Sheet
IMPRINT OR PRINT

Date:____________ MD: __________
Pt’s wt = ____________Lbs÷2.2 lbs/kg = _________ Kg
Pt’s age __________ 85% PMHR __________________

Name
MRN

IV Start_________________________
Baseline EKG_______________HR_______BP______
Maximum EKG Change________________HR________BP________
Symptoms:__________________________________________________________

Time

DOBUTAMINE
___Baseline Vitals__
Rate of Infusion
5ug/kg/min
10 ug/kg/min
20 ug/kg/min
30ug/kg/min
40 ug/kg/min
Total Mg infused
Recovery Vitals

B/P

HR

Additional
Medications

O2 Sat
%

Notes

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