Relevant Flashcards
Epinephrine Indications
Cardiac arrest (PEA, VF & Pulseless VT)
Anaphylaxis & Bronchial asthma
Symptomatic Bradycardia
Hypotension
Epi Pulseless Arrest Dosage
1mg IV/IO push (follow w/ flush);
Repeat q 3-5 minutes
0.2mg/kg in beta or calcium channel blockers OD; poison/drug induced shock
PED: 0.01mg/kg q 3-5 minutes;
1mg Max dose
Epi Infusion for Bradycardia or hypotension
2-10mcg/min; titrate to response
PED: 0.01mg/kg
Continuous: 0.1-1mcg/kg/minute
Epi ET dose
0.1mg/kg
Epi Anaphylaxis or bronchoconstriction dosage
0.3-0.5mL IM (1:1); repeat q 5-15 min
0.5mcg/kg/minute Rapid Fluid Bolus (if shock persists)
PED: 0.01mg/kg (0.1ml/kg of 1:1) IM;
0.3mg max single dose; repeat q15 minutes prn
0.1-1 mcg/kg/minute IV infusion (if shock persists)
Nebulized Epi dosage
3mg/3mL NS
Amiodarone Indications
VF
VT (monomorphic & Torsades)
Cardiac arrest
Amiodarone contraindications & considerations
Pulmonary congestion
Cardiogenic shock
2nd or 3rd degree AV blocks (if no pacemaker present)
Severe sinus node dysfunction
Hyperkalemia
(Give slowly)
Amiodarone Dosages
Cardiac Arrest:
300mg IV/IO push
150 mg 2nd dose
Deadly arrhythmias:
Rapid infusion: 150mg IV over 1st 10 minutes; repeat q 10 minutes prn up to 3 doses
2.2g IV/ 24 hours (Adolescents included)
PEDS:
5mg/kg IV/IO bolus, repeat to daily max 15mg/kg (300mg max); over 20-60 minutes in SVT, VT w/ pulses
Adenosine Indications
SVT
Junctional Tach
Adenosine Contraindications
Drug induced tachycardia
2nd or 3rd degree AV block
Sick sinus syndrome
Dipyridamole & Carbamazepine (potentiated effects)
Adenosine dosage
6mg rapid IV push followed by 20mL saline bolus; may double dose in 1-2 minutes
PEDS: 0.1mg/kg IV/IO followed by 5-10mL saline flush, may double dose in 2nd attempt
Atropine Indications
Bradycardia
Organophosphate or nerve gas poisoning
Atropine contraindications
Glaucoma
Obstructive GI tract disease
Obstructive uropathy
Thyrotoxicosis
Unstable cardiovascular status in acute hemorrhage w/ Myocardial ischemia
Atropine dosage
1mg bolus, repeat q 3-5 minutes
3mg max
PEDS: 0.02mg/kg; repeat q 3-5 min
Max single dose: 0.5mg
Max total dose: 1mg; 3mg adolescents
Atropine SLUGDE dosing
1-4mg q 15 min until effects are observed, then q 1-4 hrs for 24hrs
PEDS:
<12 years: 0.05mg/kg IV/IO initially;
Then repeated and doubled dose q 5 minutes until effects reversed
> 12 years: 1mg IV/IO (Same as above)
Diltiazem Indications
A fib & w/ RVR
A flutter
Junctional tach
SVT
Diltiazem Contraindications
Wide QRS tachs of unknown origin
Poison/drug induced tach
WPW > A fib or flutter
VT
Sick sinus syndrome
2nd or 3rd degree AV block (except w/ a functioning pacemaker)
Hypotension
cardiogenic shock & acute MI
Diltiazem Dosage
0.25mg/kg IV over 2 minutes;
- may repeat in 15 minutes-
0.35mg/kg over 2 minutes
Maintenance infusion:
5-15 mg/hour, titrate to response
(D5W or NS)
Mag Sulfate indications
Eclampsia seizures
Torsades
Respiratory distress
Hypomagnesemia
Mag sulfate contraindications
Heart block or myocardial damage
Diabetic coma
Mag dosage
Seizure (eclampsia):
4g dilutes in D5W or NS for IV piggy back over 15 minutes; followed by continuous load over 15-20 minutes of 1-2g/hr (30-40g/day Max)
Pulseless Torsades: 1-2g (2-4ml of a 50% solution) diluted in 10mL of D5W IO/IV push
Torsades w/ pulse & Respiratory distress:
Loading dose: 1-2g in 50-100mL of D5W over 5-60 minutes IV; followed w/ 0.5-1g/hr IV
Mag PEDS dosage
PEDS: 25-50mg/kg IV/IO over 10-20 min; 2g max dose
Calcium Chloride Indications
Hyperkalemia (except if its from Digitalis)
Hypocalcemia (multiple blood transfusions)
Calcium channel blocker OD
Hypermagnesemia
Prevent hypotension from calcium channel blockers (diltiazem or verapamil)
Calcium Chloride contraindications
VF during cardiac resuscitation
Digitalis OD
Calcium chloride dosage
500-1000mg (5-10mL of a 10% solution); may be repeated prn
PEDS: 20mg/kg (0.2ml/kg) IV of 10% solution slow IV/IO; may be repeated if indications persist (shouldnt exceed adult dose)
Aspirin Contraindications
GI bleeding
Active ulcer disease
Hemorrhagic stroke
Peds with flulike symptoms
Nitroglycerin Indications
Ischemic CP
Heart failure
Acute MI
Hypertensive emergencies w/ ACS
Pulmonary edema
Nitro contraindications
Volume depletion
Hypotension (<90 or 30 below baseline)
Head injury
Extreme bradycardia
Extreme tachycardia in the absence of heart failure
Right ventricular infarction
Cerebral hemorrhage
PDE5 inhibitors
Aortic stenosis
Morphine Indications
Pain
Chest pain associated with ACS
Acute cardiogenic pulmonary edema
Morphine contraindications
Hypersensitivity
Hypovolemia
Hypotension
Head injury/ increased ICP
Severe respiratory depression
MAO inhibitors w/in 14 days
Caution in right ventricular infarction
May worsen heartblock in inferior MI
Morphine dosage
STEMI: 2-4mg IV; may repeat in doses of 2-8mg IV @ 5-15 minute intervals
Unstable angina/NSTEMI: 1-5mg IV
Pain: 0.1mg/kg IM (15mg Max dose); 10mg max dose IV/IO
PEDS: 0.1-0.2 mg/kg dose IV (15mg max total)
Naloxone Dosage
IV: 0.4mg until adequate ventilations;
2mg for complete OD reversal; up to 6-10mg in under 10 minutes
PEDS: up to 5yrs or 44lbs (20kg) = 0.1mg/kg
> 5yrs or >44lbs (20kg) = 2mg
Methylprednisolone (Solumedrol)
Indications
Anaphylaxis
Respiratory distress
Solumedrol Contraindication
TBI
Solumedrol dosage
2mg/kg up to 125mg IV; 40-125mg IV
PEDS: 2mg/kg IV loading dose
(60mg max)
Albuterol Indications
Respiratory distress
Hyperkalemia
Albuterol Dosage
Solution: 2.5-5 mg (0.5-1 mL of 0.5% solution) diluted to 3ml w/ 0.9% NS (0.083% solution); administer over 5-15 minutes; 3-4x /d by nebulizer
Albuterol Peds dosage
Solution: 0.1-0.2 mg/kg per dose diluted in 2 mL of 0.9% NS; may be repeated q 20 minutes.
Nebulized: <44 lbs (20 kg): 2.5 mg/dose (inhalation)
>44 lbs (20 kg): 5 mg/dose (inhalation)
Ipatropium Dosage
0.5 mg nebulized; repeated twice. Nebulized ipratropium can be simultaneously administered w/ the first 3 doses of Albuterol or after the first dose of Albuterol. Can be administered as 1-2 inhalations via MDI
Ipatropium Peds dosage
250-500 mcg (by nebulizer or MDI) q 20 minutes times 3 doses
Glucagon indications
Hypoglycemia
Symptomatic bradycardia from beta blocker or calcium channel blocker OD
Glucagon hypoglycemia dosage
1mg IM/IN, may be repeated in 7-10 minutes
PEDS: >44lb or >5yr = same as adult
<44lb or <5yr = 0.5mg IM/IN
Glucagon Calcium or Beta blocker OD dosage
3-10mg SLOW IV over 3-5 minutes, followed by a 3-5mg/hr infusion
PEDS: 25-40kg = 1mg IV push q 5 minutes prn
<25kg = 0.5mg IV push q 5 minutes prn
Dextrose Indications
Hypoglycemia
ALOC
Seizure or coma of unknown origin
Dextrose contraindications
Intracranial or intraspinal hemorrhage
Stroke in the absence of hypoglycemia
Dehydrated w/ delirium
Can cause tissue necrosis if extravasated
Dextrose dosage
12.5 - 25g SLOW IV
*25-50mL of 50%
*50-100mL of 25%
*125-500mL of 10%
may repeat up to max dose
PEDS:
0.5-1g/kg IV/IO (*25% max recommended concentration)
2-4mL/kg 25%
5-10mL/kg 10%
*use 10% for infants >1month & neonates
Diphenhydramine Indications
Allergic reactions
dystonic reactions from antipsychotics
Diphenhydramine contraindications
Newborns
Nonselective MAO inhibitors
Caution in pts w/ CNS depression or asthma
Diphenhydramine dosage
1mg/kg IV SLOW/IM/oral
*50mg max dose
PEDS: 1mg/kg IV/IM/oral
*25mg max dose
Ondansetron contraindications
Prolonged QT
<1 month
Liver disease
GI obstruction
Apomorphine
Ondansetron dosage
IV: up to 4mg may be given undiluted (inject over 30-150 seconds)
up to 16mg max (chemotherapy)
Infusion: dose diluted in 50mL of D5W over 15 minutes
IM: 4mg in well developed muscle
PEDS: 0.15mg/kg per dose IV /oral
*4mg max
Midazolam Indications
Seizures
Sedation
Agitation/excited delirium
Uncontrolled shivering (hypothermia)
Painful procedures
Midazolam contraindications
Respiratory/CNS depression
Shock
Depressed vitals
Downers (drugs/etoh or meds)
Severe glaucoma
Midazolam dosage
*10mg Max total/ 5mg PEDS
IV: 0.1mg/kg
IM: 0.2mg/kg
PEDS: 0.05mg/kg per dose
Exited delirium:
5mg IV/IM
PEDS: IV= 0.05-0.1mg/kg
IM= 0.1-0.15mg/kg
Ketamine Indications
Pain/painful procedures
Severe agitation/exited delirium
Ketamine contraindication
Angina
CHF
Cardiac decompensation
Severe hypertension
Stroke
Increased ICP
Pregnancy
Schizo hx
Ketamine dosage
Pain: *100mg max cumulative dose
IM/IV/IO: 0.25mg/kg; 25mg max dose
Exited delirium:
IV: 2mg/kg over 1 minute
IM/IN: 4mg/kg
PEDS (>2yr):
IV: 1mg/kg over 1 minute
IM: 3mg/kg
TXA contraindications
HX of:
Coagulopathy
PE
DVT
Ischemic cerebrovascular accident
Acute myocardial infarction
Ischemic retinopathy
TXA dosage
10mg/kg IV; 15mg/kg in certain situations
PEDS: 10mg/kg IV
Sodium Bicarb Indications
Hyperkalemia
Rhabdomyolysis
Acidosis:
-DKA
-TCA OD
-Aspirin OD
-Cocaine OD
-Diphenhydramine OD
Sodium Bicarb contraindications
Cardiac Arrest & CPR w/out intubation
Alkalosis
Abdominal pain of unknown origin
Severe vomiting
Severe pulmonary edema
Hypernatremia
Hypocalcemia
Hypokalcemia
Sodium Bicarb Dosages
1 mEq/kg IV bolus
PEDS: Same as adult, just infuse slowly & only if ventilations are adequate
Oxytocin Indications
Postpartum hemorrhage (after baby & placenta delivery)
Oxytocin Contraindications
Hypertonic or hyperactive uterus
Presence of 2nd baby
Fetal distress
Oxytocin Dosage
3-10 units IM after delivery of placenta
Bleeding following Incomplete or Elective Abortion:
Mix 10-40 units (1-4ml) in 1000ml of NS/LR solution;
Infuse @ 10-40 milliunits/min via microdrip tubing, titrate to bleeding or uterine response
Thiamine Indications
Coma of unknown origin (w/ D50
or naloxone)
Delirium tremens
Wernicke encephalopathy
Thiamine Dosage
100mg slow IV/IM
PEDS: 10-25mg IV/IM
