Naloxone Hydrochloride - Adult dose-

0.4mg slowly IVI/IMI (0.1mg/kg) Repeat every 5 minutes, up to 2mg Should 2mg fail to elicit the desired response, then overdose with agents other than opiods should be considered

Adult dosages Flashcards by Radomir Cermak

Corticosteroids

Pt with severe asthma attack

severe allergy/anapylaxis

Hydrocortisone:

200-500mg IVI slowly

(5mg/kg)

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Salbutamol

Premature/obstructed labour/prolapsed cord

Maintenance infusion?

Dilute

2 mg [4 x 500 mcg/ml] into 200 ml N/S (10mcg/ml solution)

Start with 10 mcg/min.

May increase by 10 mcg/min every 10 min to a max of 45 mcg/min

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Lorazepam

Pt with active convulsions

Initial dose?

If not terminated by intial dose?

Maximum dose?

2-4mg slowly IVI

If required an additional 4mg IVI may be administered after 10 minutes

Titrate to effect (use the lowest effective dosage)

Maximum 8mg/12hours

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Lignocaine Hydrochloride (Lidocaine) (Systemic)

Endotracheal Intubation Sequence

(for raised ICP)

Specifically indicated for patients who may already have an element of raised intracranial pressure, the addition to which would compromise the patient

administer 1.5mg/kg 3 minutes before intubation

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Thiamine Hydrochloride

Pt with suspected Wernicke’s encephalopathy

100 mg IVI bolus, slowly

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Magnesium Sulphate

Pt in cardiac arrest unresponsive to conventional therapy

1-2g (2 to 4ml of a 50% solution)

Dilute 1g/2ml vial to 10ml sterile water = 10% solution

Give slowly, not exceeding 1.5ml/min, with continuous careful monitoring

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Salbutamol

Pt in obstructed labour

IV Bolus dose and rate?

Slow IV

100-250 mcg IV

Administer

1ml/min until:

Total of 250mcg/10min has been given, i.e. 10ml
Mother’s heart rate >120bpm
Contraction cease

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Dextrose 50%

Pt in hypoglycemic coma

10g (20ml of a 50% solution) slowly IVI

Repeat

every 5 minutes should blood glucose remain

First give 100mg Thiamine if available and indicated

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Glyceryl Trinitrate

Pt with cardiac chest pain

One tablet sublingual

one spray (without inhaling) onto oral mucosa

(preferably sublingual)

Repeat

every 5 minutes until pain is relieved, or max dose taken

Maximum of 3 sprays/tablets

Terminate administration if systolic blood pressure:
- -Decreased by more than 10% in a normotensive patient -Decreases by more than 30% in a hypertensive patient -Measures lower than 90mmHg

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Lignocaine Hydrochloride (Lidocaine) (Systemic)

Pt with chest pains, BP 80/60mmHg, HR 92, with arrhythmia

loading dose?

When must the bolus dose be terminated?

Loading dose:

1mg/kg slowly IVI

Bolus doses must be terminated when either:

A maximum of 3mg/kg has been administered, or
The blood pressure drops by >10%, or
Ventricular arrhythmia ceases, or -

Signs of toxicity develop

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Thiamine Hydrochloride

Pt with suspected thiamine deficiency (eg alcoholims, malnourishment)

Dose prior IV 50% Dextrose administration

100 mg IVI bolus, slowly

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Atropine Sulphate

Pt with refractory symptomatic bradycardia

First dose?

0.5mg IVI push

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Midazolam

Adult dose -

Maintenance Infusion for a transfer of a 100kg intubated pt on mechanical ventilator

How many mls/hour if using 200mls NS?

(maximum recommended dose)

0.03mg/kg/hr-0.1mg/kg/hr

VR = SR/SS x VS

VR=(0.1mgx100)/15mg x 200ml

VR=133mls/hr

when used in combination with narcotic analgesics

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Adrenaline

Pt in cardiac arrest

Intravenous:

1 mg IVI push

Tracheal:

2 mg diluted with 10 ml of water for injection preferred

Repeat every 3-5 minutes

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Flumazenil

Pt overdosed on Valium (benzodiazepine) and is only responding to pain and breathing at a rate of 10/min.

Intitial dose?

Initial bolus:

0.2mg slowly IVI over 15 seconds

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Magnesium Sulphate

Pt with convulsions in toxaemia of pregnancy

Infusion dose and rate?

3g in 200ml 0.9% sodium chloride solution

at a rate not exceeding 3ml/min

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Lignocaine Hydrochloride (Lidocaine) (Systemic)

80kg male pt with stable BP, no chest pain, HR of 180 and the following ECG rhythm. Amiodarone is not available

loading dose?

When must bolus dose be terminated?

Loading dose:

1mg/kg slowly IVI

Bolus doses must be terminated when either:

A maximum of 3mg/kg has been administered, or
The blood pressure drops by >10%, or
Ventricular arrhythmia ceases, or
Signs of toxicity develop

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Sodium Bicarbonate 8.5%

Pt in cardiac arrest due to suspected cocaine overdose

1ml/kg (8.5%) slowly IVI with free flowing line

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Lignocaine Hydrochloride (Lidocaine) (Systemic)

Pt in cardiac arrest with the following arrhythmia.

(Amiodarone is not available)

Bolus dose?

Repeat dose?

Maxium total dose?

Administer a bolus dose of

1mg/kg IVI/IO push

0.5mg/kg IVI/IO (or 1 mg/kg ET) every 5 minutes

Maximumm total bolus dose

3 mg/kg IVI

Following successful defibrillation, follow with maintenance infusion

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Naloxone Hydrochloride

Adult dose-

0.4mg slowly IVI/IMI (0.1mg/kg)
Repeat every 5 minutes, up to 2mg
Should 2mg fail to elicit the desired response, then overdose with agents other than opiods should be considered

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Flumazenil

Pt overdosed on Valium (benzodiazepine), responds only to pain and has a RR 10/min. You have already administered a bolus of 0.2mg IVI

Repeat dose?

(Include max dose that can be administered)

Repeat:

0.1mg at 1 minute intervals

Max dose:

1mg

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Metoclopramide Monohydrochloride

Pt that is feeling nauseous and is vomitting

>60 kg:

10 mg slowly IVI/IMI

< 60 kg:

5 mg slowly IVI/IMI

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Calcium Chloride 10%

Pt with Verapamil (calcium channel blocker) overdose

10ml of calcium chloride 10% solution, slowly IVI

If being administered pre-arrest, administer at 1ml/min

Magnesium Sulphate

Pregnant female convulsing (toxemia of pregnancy)

Bolus dose?

2-4g of a 10% solution given very slowly,

with careful monitoring not exceeding 1.5ml/min

(10% solution is obtained by diluting the 1g/2ml vial to 10ml with sterile water)

**Adenosine** Pt with otherwise stable signs and symptoms with the following ECG (HR 170)

Rapid **6mg IV** push (followed immediately by rapid 20mls IV push) **12mg IV** push if no response after **2minutes** **12mg IV** push may be considered if no response after **2minutes**

**Magnesium Sulphate** Pt in acute severe asthma unresponsive to conventional therapy

**1-2g** (2 to 4ml of a 50% solution) Dilute 1g/2ml vial to 10ml sterile water = 10% solution Give slowly, not exceeding **1.5ml/min**, with continuous careful monitoring

**Midazolam** Induction

## Footnote **1mg/15 to 30 seconds IVI**

**Sodium Bicarbonate 8.5%** Pt with suspected Amitriptyline overdose, decreased LOC, systolic BP of 75mmHg

**1ml/kg (8.5%) slowly IVI** with free flowing line

**Adrenaline** - Adult Dose - Symptomatic Bradycardia (SBP

* IV infusion 2-10 mcg/min * Titrate to effect

**Diazepam** - Adult dose- Convulsions when IV access is unsuccessfull

Rectally: 10mg (maximum 20mg)

**Glucagon** - Adult dose- Severe anaphylactic reaction

* 1-2mg every 5 min IM or * slow IV if unresponsive to adrenaline, & especially if on beta blockers

**Sodium Bicarbonate 8.5%** - Adult dose- 105 kg trapped pt who is about to be relased from under a truck How many mls?

1ml/kg (8.5%) slowly IVI with free flowing line 105 ml

**Glucagon** Calcium Channel blocker/beta blocker OD Intial dose? and Follow up infusion rate?

**3mg IV** initially as adjuvant treatment followed by **3mg/hour** infusion

**Amiodarone Hydrochloride** Pt in cardiac arrest with VF refractory to defibrillation or pulses VT

**300 mg IVI** as a rapid bolus Consider additional dose of **150 mg** in **3** to **5 minutes** if VF persists

**Lignocaine Hydrochloride (Lidocaine) (Systemic)** 65 yrs old male in cardiac arrest with the following arrhythmia. (Amiodarone is not available. and you are not able to establish IV access) Bolus dose through ETT?

**2 mg/kg ET** as last resort

**Diazepam** - IV Adult dose- Convulsions

* 5mg/min slowly IVI (0.15mg/kg) * Repeat every 2-5 minutes * Titrate to effect (use the lowest effective dosage Maximum 20 mg

**Glucagon** Pt in hypoglycemic coma and you are unable to obtain IV access to administer 50% Dextrose.

**1mg IMI**/IVI/SC **IMI** is preferred route

**Midazolam** Maintenance Infusion for sedation?

**0.03mg/kg/hr**-**0.1mg/kg/hr** when used in combination with narcotic analgesics

**Midazolam** Pt presenting with active convulsions

**0.15mg/kg** slowly **IVI** (maximum 0.3mg/kg) IMI not recommended as first line route - absorption too slow ONLY give IMI if no IV access available **0.15mg/kg IMI** (maximum 0.3mg/kg)

**Clopidogrel** Pt with true aspirin allergy with suspected AMI

Administer **300mg** orally, i.e. four of the 75mg tablets

**Lignocaine Hydrochloride (Lidocaine) (Systemic)** Stable VT/Complex Ventricular Ectopy with Myocardial Ischaemia or causing haemodynamic compromise - Maintenance infusion after restoration of stable rhythm?

**1-4mg/min** (20-50mcg/kg/min) upon restoration of a stable rhythm Reappearance of arrhythmia during a constant infusion of lignocaine should be treated with **0.5mg/kg** slow **IVI** bolus dose, and an increase in the infusion rate in incremental doses (**maximal** rate = **4mg/min**)

**Adrenaline** Pt with Anaphylaxis

**0.3mg (1:1000)** undiluted (anterolateral thigh) Repeat : **every 15-20 minutes**

**Amiodarone** Stable pt with VT/SVT and HR180 Inital dose? Follow up infusion? Maximum cummulative dose?

**150 mg IVI** over 10 minutes (15mg/min), followed by infusion: slow IVI of **1 mg/minute** (360 mg over 6 hours) Maximum cumulative dose **2.2 g IV/24 hours**

**Salbutamol** Pt with acute bronchospasm IV infusion dose and rate? Total dose?

**250 mcg**/**10min** Administer **1ml/min** over **10 min** Total of **250mcg/10 min**

**Adrenaline** - Adult Dose - 75 kg pt in severe life-threatening asthma attack Initial dose?

0.01mg/kg divided into 3 doses of 0.3mg **0.3mg** undiluted (1:1000)

**Thiamine Hydrochloride** Pt with suspected Wernicke's encephalopathy

**100 mg IVI** bolus, slowly

**Midazolam** Sedation

**1mg/min** slowly IVI titrate to effect

**Diazepam** Sedation

**1mg** every **30 second**s IV titrated to effect when necessary

**Lignocaine Hydrochloride (Lidocaine) (Systemic)** Pt with Stable VT/Complex Ventricular Ectopy with Myocardial Ischaemia or causing haemodynamic compromise loading dose?

Loading dose: **1mg/kg slowly IVI**

**Atropine Sulphate** Refractory Symptomatic Bradycardia after first dose What is the next and maximum dose?

Repeat: **0.5-1mg** every **3 to 5 minutes** Maximum: **3mg** (0.04mg/kg) = total vagolytic dose

**Furosemide** Pt with pulmonary oedema

**0.5mg - 1mg/kg** IVI slowly over **1-2minutes**

**Promethazine** Pt with severe anaphylaxis

**25mg deep IMI** or **slowly IVI** after **10-fold** dilution with water for injection

**Atropine Sulphate** Organophosphate poisoning

**0.5-2.5mg IVI** Repeat: every **4 minutes** until **atropinization** occurs (decreased bronchial secretions is single most reliable factor) Titrate to effect No absolute maximum dose

**Morphine Sulphate** Pt requiring pain management

Dilute to concentration of 1mg/ml and titrate to effect at **1mg/30** **seconds** slowly IVI Titrate to effect

**Adrenaline** Pt with obstructing laryngeal oedema

Nebulization: Initiate with **1 ml of 1 : 1000** + 4 ml of N/S If necessary increase **2 - 4 mg** adrenaline diluted with **5 ml** N/S