Cardiac and Respiratory Dosages

Question 1

Nitroglycerin (Nitrostat, Nitro-Bid, Tridill)

Answer 1

Dosage: A: Tablet 0.3-0.4 mg SL (5min Intervals) Max 3 doses. NGT Spray 1-2 spray 0.5-1 second (5min intervals) Max 3 doses in 15min. NGT IV: begin 10ug/min; increase by 10ug/min every 3-5min until desired effect. Max dose 200ug/min. PEDI: not recommended. NGT IV:0.25-0.5ug/kg/min. IO: titriated by 1ug/kg/min. Max Dose 5ug/kg/min

Question 2

Lidocaine Hydrochloride (Xylocaine)

Answer 2

Dosage:A: 0.5-0.75mg/kg. IV/IO: 5-10 min intervals. Max TOTAL dose: 3mg/kg. ET Dose: 2-4mg/kg. Maintain infusion:1-4mg/min (30-50ug/kg/min); can dilute in D5W or NS. PEDI: IV/IO dose: 1mg/kg rapid IV/IO push. Max Dose 100 mg Continuous IV/IO:20-50ug/kg/min. Repeat Bolus dose (1mg/kg)

Question 3

Labetalol (Normodyne, Trandate)

Answer 3

Dosage:A: 10mg IV push over 1-2min. May repeat or double every 10 min. Max Dose 150mg. Infusion: 2-8mg/min. Titriated to supine BP. PEDI: Not recommended

Question 4

Furosemide (Lasix)

Answer 4

Dosage: A:0.5-1mg/kg IV over 1-2min. If no response; double the dose to 2mg/kg slowly over 1-2min. PEDI: 1mg/kg IV/IO

Question 5

Epinephrine (Adrenalin)

Adult

Answer 5

Mild Allergic Reaction & Asthma: Dosage: 0.3-0.5mg (0.3-0.5 ml 1:1,000)SC. Anaphylaxis: 0.1mg(1mL) of 1:10,000 Solution IV. Cardiac Arrest: IV/IO:1mg (10mL, 1:10,000) 3-5min during resuscitation. Follow each dose w/20mL flush and elevate arm for 10-20seconds after dose. Continuous Infusion: add 1mg(1mL, 1:1,000) to 250mL NS or D5W (4ug/mL). Initiate infusion rate of 1ug/min titriated to effect (typical dose:2-10ug/min). Profound Bradycardia or Hypotension:2-10ug/min: titriated to pt response. Higher doses (up to 0.2/kg) may be used for beta blockers or calcium channel blockers OD

Question 6

Epinephrine (Adrenalin)

PEDI

Answer 6

Mild Allergic Reaction &Asthma: Dosage: 0.01mg/kg (0.01mg/mL) od a 1:1,000 solution SC (Max of 0.3mL). Anaphylaxis/severe status asthmaticus: 0.01mg/kg (0.01mL/kg) IM: 1:1,00 solution (Max single dose 0.3mg). Cardiac arrest: IV/IO: 0.01mg/kg (0.01mL/kg) of a 1:10,000 solution (3-5min intervals during arrest). All ET doses:0.1mg/kg (0.1mL/kg) of a 1:1,000 mixed in 3-5mL of NS until IV/IO access is est. Max single dose 1mg. Symptomatic bradycardia: IV/IO: 0.01mg/kg (0.01mL/kg) of 1:10,000 solution. Continuous IV/IO infusion: begin with rapid infusion, and then titriate to response. typical initial infusion:0.01-1ug/min. Higher dose may be effective.

Question 7

Diltiazem (Cardizem)

Answer 7

Dosage: A: Initial dose: 0.25 mg/kg (15-20mg for the average pt) IV over 2min. If inadequate response, may re-bolus in 15min. Secondary dose: 0.35mg/kg (20-25mg for the average pt) IV over 2min. Maintenance infusion of 5-15mg/h titriate tp physiologically appropriate heart rate. PEDI: Not recommended

Question 8

Calcium Chloride

Answer 8

Dosage:A: Calcium channel blocker OD and Hyperkalemia 500mg to 1,000mg (5-10mL) of 10% solution) IV push. May repeat as needed. PEDI: Calcium channel blocker OD and hyperkalemia: 20mg/kg (0.2mL/kg) slow IV/IO push. Max 1-g dose: may repeat 10min intervals.

Question 9

Atropine Sulfate

Answer 9

Dosage:A: unstable bradycardia: 0.5mg IV/IO (3-5min intervals) as needed. Max TOTAL dose 0.04mg/kg (max 3mg total). Use shorter intervals (3min) and higher doses in severe clinical conditions. Organophosphate poisoning: Extremely large doses (2-4mg or higher) may be needed. PEDI: Unstable bradycardia: 0.02mg/kg IV/IO (mini: 0.1mg). May repeat once. Max single dose: Child: 0.5mg Adolescent: 3mg. RSI:0.01-0.02mg/kg IV/IO (min:0.1mg) (max: 0.5mg)

Question 10

ASA (Aspirin, Bayer, Ecotrin)

Answer 10

Dosage:A: 160mg-325mg PO. Chewing is preferable to swallowing. PEDI: not recommended

Question 11

Amiodarone (Cordarone, Pacerone)

Adult Dose

Answer 11

Dosage: V-Fib/ Pulse-less V-Tach unresponsive to CPR, Defibrillation and vasopressors 300mg IV/IO push. Initial Dose can be followed one time in 3-5min at 150mg IV/IO push. Recurrent life-threatening Ventricular Dysrhthmias: Max cumulative dose: g IV/24hr. admin as follows: rapid infusion (150mg IV/IO) every 10min (15mg/min). May repeat rapid fusion: 150mg IV/IO every 10min as needed.

Question 12

Amiodarone (Cordarone, Pacerone)

PEDI Dose

Answer 12

Dosage: Re-factory V-Fib/ pulse-less V-tach: 5mg/kg IV/IO bolus. Can Repeat the 5mg/kg IV/IO bolus up to TOTAL dose 15mg/kg/24hr. Max Single dose: 300mg. perfusing super-ventricular and ventricular tachycardia. Loading dose 5mg/kg IV/IO 20-60min (Max Single dose 300mg). Can repeat to max dose of 15mg/kg/24hr (2.2g in adolescents). Max single dose 300mg.

Question 13

Adenosine (Adenocard)

Answer 13

Dosage:A: 6mg rapid IV Bolus over 1-3 second, followed by a 20mL saline flush and elevate extremity. If no response after 1-2min admin second dose of 12mg rapid IV bolus over 1-3 seconds. PEDI: Initial dose 0.1mg/kg rapid IV/IO push (max first dose 6mg) followed by 5-10mL saline flush. Second dose 0.2mg/kg rapid IV/IO push (Max second dose 12mg) followed by a 5-10 saline flush

Question 14

Albuterol (Proventil, Ventolin)

Answer 14

Dosage:A: 2.5mg dilute in .5mL of 0.5% solution for inhalation with 2.5mL NS in nebulizer and administer over 10-15min. Meteredose inhaler: 1-2 inhalations (90-180mg): wait 5min between inhalations. PEDI: <20kg: 1.25 mg/dose via handheld nebulizer or mask over 20min. Repeat once in 20min.

Question 15

Dexamethasone Sodium Phosphate (Decadron)

Answer 15

Dosage:A: 10-100mg IV (1mg/kg slow IV Bolus) considerable variance through medical control. PEDI: 0.25-1mg/kg IV/IO/IM. Given one time with Max dose of 16mg,

Question 16

Etomidate (Amidate)

Answer 16

Dosage:A: 0.2-0.6mg/kg IV over 30-60 seconds (typical adult dose is 20mg). PEDI: 0.2-0.4 mg/kg IV/IO over 30-60 seconds RSI (older than 10yr), one time only. Max dose: 20mg.

Question 17

Ipratropium (Atrovent)

Answer 17

Dosage:A: 250-500ug via inhalation w/hand-held nebulizer every 20min up to 3 times. PEDI: Same as adults

Question 18

Oxygen

Answer 18

Dosage:A: cardiac arrest and carbon monoxide poisoning:100%. Hypoxemia: 10-15 L/min via NRB. COPD: 0-2 L/min via nasal cannula or 28%-35% ventri mask. PEDI same as Adults.

Question 19

Rocuronium Bromide (Zemuron)

Answer 19

Dosage:A: 0.6-1.2mg/kg IV/IO. PEDI:(Older than 3m) 0.6-1.2mg/kg IV/IO

Question 20

Methylprednisolone Sodium Succinate (Solu-Medrol)

Answer 20

Dosage:A: Acute spinal cord trauma: 30mg/kg IV over 30min followed by: infusion: 5.4mg/kg/hr. Asthma, COPD, Anaphylaxis: 1-2mg/kg IV. PEDI: Acute spinal trauma: Same as Adults. Asthma/ Anaphylaxis: 2mg/kg IV/IO/IM Max dose 60mg.

Question 21

Succinycholine Chloride (Anectine)

Answer 21

Dosage:A: 1-1.5mg/kg rapid IV/IO. Repeat once if needed. PEDI: 1-1.5mg/kg rapid IV/IO. Repeat once if needed 2mg/kg in infants

Question 22

Terbutaline Sulfate (Brethine)

Answer 22

Dosage:A: 0.25 mg/kg SC may repeat in 15-30min to Max dose of 0.5mg in a 4hr period. PEDI: not recommended for children under 12yr. 0.25mg/SC may repeat in 15-30 min to Max dose of 0.5mg in 4hr.

Question 23

Vercuronium Bromide (Norcuron)

Answer 23

Dosage:A: 0.1-0.2mg/kg IV push. Maintenance dose within 45-60min: 0.8-1.2mg/kg IV push. PEDI: 0.1-0.3mg/kg IV/IO maintenance dose within 20-40min: 0.01-0.015mg/kg IV push.

Question 24

Levalbuterol (Xopenex)

Answer 24

Dosage:A: 1.25mg-2.5mg in 3mL admin by nebulizer every 20min to a Max of 3 doses. PEDI: 0.075mg/kg (min of 1.25mg) admin by nebulizer every 20min to a Max of 3 doses.