Stimulates HR, BP, CO, and vasoconstriction. Stimulates renal, venous, mesenteric arterial. basic chart below) (alpha receptors) vasoconstriction

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1 Bolus Alternate Range Drip ACLS Drugs and Drips Amiodarone / Cordarone Lidocaine Procainamide / Pronestyl Dopamine / Intropin CARDIAC ARREST PULSELESS VT/VF Arrest Kit: (300mg bolus) Amiodarone 6 Vial = 300mg 50 Mini Bag D5W 30 syringe with needle X 1 Draw up 24 D5W in 30 syringe (discard bag) In same syringe, draw up 6 (300mg) Amiodarone to make up 30 solution Inject Amiodarone rapidly STABLE VT Tachycardia Kit: (0mg / 10min) Amiodarone 3 Vial = 0mg 100 Mini Bag D5W & tubing 5 syringe with needle X 1 Draw up 3 (0mg) of Amiodarone with 5 syringe and add to mini bag To infuse mini bag over 10 minutes Set VTBI = 100 and Primary Rate = 600 / hr Pre-loaded syringe 1 syringe = 100mg mg/kg IV push Example: A patient weighing 100 kg is given pre-loaded syringes IV push Repeat : Lidocaine 0.5 to 0.75 mg/kg IV push over 3-5min, q5-10 minutes to a maximum total dose of 3mg/kg Kit: Procainamide 1G (10 of 100mg/) 50 Mini Bag D5W X1 10 syringe with needle X1 ContinuFlow Tubing X1 LeverLoc Cannula X1 Med Added Label X1 Alcohol swabs X 2 : Mix 1G (10 of 100mg/) of procainamide in 50 D5W (Concentration = 20mg/) Set VTBI = 50 Primary Rate = 60/hr Infuse 60/hr (or 20mg/min) until: a) dysrhythmia is suppressed b) hypotension occurs c) QRS widens by 50% d) the maximum dose of 17mg/kg is given Inotrope / Pressor Pre-mixed: 400mg / 250 D5W 200mg / 250 D5W Renal : 1-5 /kg/min Stimulates renal perfusion (dopaminergic alpha receptors) Inotropic : 5-10 /kg/min Stimulates HR, BP, CO, and vasoconstriction (alpha & beta receptors) Pressor : > 10 /kg/min Stimulates renal, venous, mesenteric arterial vasoconstriction (alpha receptors) Titrate according to patient s weight (see basic chart below) mg / minute MAX daily dose = 2g 1 4mg / minute MAX dose = 3mg/kg 1 4mg / minute 2 20 /kg/min Kits: Amiodarone 6 & 3 Vials (Volume = 9 = 450mg) 250 Glass Bottle D5W 10 syringe with needle X 1 Kit 1: mix Amiodarone 9 or 450mg in 250 glass bottle D5W Rate 1 (1mg/min) X 6 hours: Set VTBI = 200 and Primary Rate = 33 / hour Rate 2 (0.5mg/min) X 18 hours: Set VTBI = 50 and Primary Rate = 17 / hour Kit 2 mix Amiodarone 9 or 450mg in 250 glass bottle D5W Continue Rate 2 (0.5mg/min) Set VTBI = 250 and Primary Rate = 17 / hour Premixed bag of 1 gram Lidocaine in 250 D5W = 4mg/ 1mg/min = / hour 2mg/min = 30 / hour 3mg/min = 45 / hour 4mg/min = 60 / hour (0.5mg/kg boluses for breakthrough arrhythmia) Reduce dose after 24hrs (drug accumulation) For pts > 70, decreased CO, or hepatic dysfunction: same bolus but ½ initial infusion rate Mix 1 gram (10 of 100mg/) of Procainamide in 250 D5W = 4mg/ 1mg/min = / hour 2mg/min = 30 / hour 3mg/min = 45 / hour 4mg/min = 60 / hour Decrease dose in presence of renal failure. / kg/ min FOR USE WITH 400mg/250 ONLY Prepared by: W. Kirenko RN(EC), EDNP Chatham-Kent Health Alliance, Chatham, Ontario June 2002 Rate / hour

2 ACLS Drugs and Drips - Continued Bolus Alternate Nitroglycerin / Tridil Vasodilator Nitroglycerin spray 1 2 sprays ( mg) under the tongue Epinephrine / Adrenalin Sympathomimetic 1 mg (1 pre-loaded 1:10,000 syringe) IV Peripheral injection should be followed by 20 flush Pre-loaded syringe = 1:10,000 / 10 (1mg) Repeat q3-5 minutes during arrest 2 2.5mg (2 2.5 of 1:1000 concentration) diluted in 10 NS via ET tube Isoproterenol / Isuprel Inotrope Recommended only for temporary control of symptomatic bradycardia when atropine and dobutamine have failed and pacing is not available Diltiazem / Cardizem Nitroprusside / Nipride First : 0.25mg/kg IV slowly over 2 minutes (Conc. 5mg/) First dose in Second : 0.35mg/kg IV slowly over 2 minutes (Concentration 5mg/) Second dose in Vasodilator Potent vasodilator used in hypertensive crisis and CHF Note: Wrap solution and tubing in foil or other opaque cover Mix Nitroprusside 50 mg in D5W 250 (200 /) and run as per chart below Range / minute 2 10 / minute 2 10 / minute 5 mg / hour / kg / min Drip Pre-mixed 50mg in 250 glass bottle D5W Increase by 5 10 /min q 5 minutes to desired effect 10/min = 3 / hr 20/min = 6 / hr 30/min = 9 / hr 40/min = 12 / hr 50/min = / hr 60/min = 18 / hr 70/min = 21 / hr 80/min = 24 / hr 90/min = 27 / hr Mix Epinephrine 1mg (1 of 1:1000 amp) in D5W or NS 250 (conc. = 4 /) 2/min = 30 / hr 3/min = 45 / hr 4/min = 60 / hr 5/min = 75 / hr 6/min = 90 / hr 7/min = 105 / hr 8/min = 120 / hr 9/min = 135 / hr 10/min=0 / hr Mix Isoproterenol 1 mg (5 ) in D5W 500 (conc. = 2 /) Titrate to HR (60 beats / min) 2/min = 60 / hr 3/min = 90 / hr 4/min = 120 / hr 5/min = 0 / hr 6/min = 180 / hr 7/min = 210 / hr 8/min = 240 / hr 9/min = 270 / hr 10/min=300 / hr Mix Diltiazem 125mg (25) in D5W 100 (concentration = 1 mg/) * The recommended initial infusion rate of Diltiazem is 10 mg / hour. An infusion rate of 5 mg / hour may be appropriate / kg / min for some patients. 1 Infusion Rate mg / hour * 5 / hour mg / hour 10 / hour mg / hour / hour Rate / hour

3 ACLS Drugs and Drips - Continued Verapamil / Isoptin Vasopressin / Pitressin Norepinephrine / Levophed Labetolol / Trandate Dobutamine / Dobutrex Bolus Alternate PSVT, Rapid Afib/Flutter give 2.5 5mg IV slowly Give 5 10mg IV slowly every minutes to a maximum of 30mg Vasopressor Cardiac Arrest (VF/VT) give 40 U IV Push Vasopressor Antihypertensive Give 10 20mg IV over 1 2 minutes May repeat or double dose every 10 minutes until a total dose of 0 300mg OR Start infusion of 2 8mg / min according to the following basic chart Inotrope Mix 250mg in 250 D5W for a concentration of 1mg/ and run according to the following basic chart Range 1 10mg / hr U / min Max 1 2 U / min / min 2 8mg / min 2 20 / kg / min Drip Mix 100mg verapamil in 250 D5W For a conc. of Mix 125 U in 250 D5W Conc. = 0.5U/ Mix 4mg in 250 D5W Conc. = 16/ U / min = / hr / min = / hr 0.4mg/ / kg / mg / hr = / hr 1mg/hr 2mg/hr 3mg/hr 4mg/hr 5mg/hr 6mg/hr 7mg/hr 8mg/hr 9mg/hr 10mg/hr 3/hr 5/hr 8/hr 10/hr 13/hr /hr 18/hr 20/hr 23/hr 25/hr 0.1 U 0.2 U 0.3 U 0.4 U 0.5 U 0.6 U 0.7 U 0.8 U 0.9 U 1.0 U 1.1 U 1.2 U 1.3 U 1.4 U 1.5 U 1.6 U 1.7 U 1.8 U 1.9 U 2.0 U 12/hr 24/hr 36/hr 48/hr 60/hr 72/hr 84/hr 96/hr 108/hr 120/hr 132/hr 144/hr 6/hr 168/hr 180/hr 192/hr 204/hr 216/hr 228/hr 240/hr 0.5/min 1/min 2/min 3/min 4/min 5/min 6/min 7/min 8/min 9/min 10/min 11/min 12/min 13/min 14/min /min 16/min 17/min 18/min 19/min 20/min 25/min 30/min 2/hr 4/hr 8/hr 11/hr /hr 19/hr 23/hr 26/hr 30/hr 34/hr 38/hr 41/hr 45/hr 49/hr 53/hr 56/hr 60/hr 64/hr 68/hr 71/hr 75/hr 94hr 113/hr Mix 250mg (50) labetalol in 200 D5W for a concentration of 1mg/ and run at: 2mg / min 120 / hr 4mg / min 240 / hr 6mg / min 360 / hr 8mg / min 480 / hr min Drugs that can be given via Endotracheal Tube: L = Lidocaine E = Epinephrine A = Atropine N = Narcan Administer at times the recommended IV dose, diluted in 10 of NS or distilled water. Pass a catheter beyond the tip of the tracheal tube, stop compressions, spray the drug solution quickly down the tracheal tube, follow immediately with several quick insufflations to create a rapidly absorbed aerosol, then resume chest compressions Rate / hour

4 Medication Drug Type Adenosine Adenocard ASA Antiplatelet Atropine Vagolytic Calcium Chloride 10% Calcium Gluconate 10% Electrolyte Electrolyte Digoxin Lanoxin Furosemide Lasix Magnesium Sulfate 10% Diuretic Electrolyte Metoprolol Betaloc Beta Blocker Verapamil Isoptin Calcium Channel Blocker Cardiac Care Drugs Primary Indications Contraindications Usual Dosage Side Effects PSVT AMI, Acute coronary syndrome Asystole and symptomatic bradycardia Calcium blocker toxicity; hypocalcemia with tetany; hyperkalemia; hypermagnesemia CCB OD; hypocalcemia; hyperkalemia; hypermagnesemia Atrial fibrillation; Atrial flutter; PSVT CHF / pulmonary edema, hypertensive crisis Cardiac arrest (Torsades, hypomagnesemia) Tachycardia, hypertension, myocardial salvage after Mi and refractory chest pain or tachycardia - excess sympathetic tone PSVT, rapid atrial fibrillation, atrial flutter 2 nd or 3 rd degree AV block, V-Tach, sick sinus syndrome Allergy. Caution with asthma, ulcers, GI bleeding or disorders Tachycardia Glaucoma VF, digitalis toxicity, hypercalcemia VF, digitalis toxicity, hypercalcemia VF, V-tach; use caution in renal failure. If HR < 60 withhold drug and consult Dehydration, hepatic coma, hypokalemia Renal disease, heart block, hypermagnesemia CHF, bronchospasm, bradycardia, hypotension, cardiomegaly, thyrotoxicosis, history of asthma WPW or short PR syndrome with A-Fib or A- Flutter, heart blocks, V- Tach, hypotension, shock, IV beta blocker use, sick sinus syndrome, CHF 6mg (2) IV rapidly over 1 3 sec. Then flush with 20 NS bolus; and elevate IV arm. Initiate IV at antecubital site if possible. If no response in 1-2min, 12mg repeat dose with flush mg P.O. (2 4 children s aspirins) Chew and swallow Asystole, PEA: 1mg IV Push q3-5min; up to 0.04mg/kg total dose Symptomatic Bradycardia: mg IV Push q3-5min; up to 0.04 mg/kg total dose mg IV slowly, (over 5 10 minutes) mg IV slowly mg IV slowly, (over 2-3 minutes) mg/kg IV slowly. If no response, 2 mg/kg over 1-2min 1 2 grams IV Push (5 10 grams may be required) 5 mg IV slowly over 2 5 minutes, repeated q 5 minutes to a total of mg. Then 50 mg orally bid for at least 24 hours, thereafter increased to 100 mg bid mg IV slowly over 2min (3min in elderly patients) (5 10 mg q minutes) to a maximum total dose of 30 mg Transient dysrhythmias, facial flushing, dyspnea, chest pressure, hypotension, headache, nausea, bronchospasm. GI bleeding Dilated pupils, increased heart rate, V-Tach and VF, headache, dry mouth Bradycardia, asystole, hypotension, VF, coronary & cerebral artery spasm, nausea and vomiting, extravasation causes necrosis Bradycardia, hypotension, VF, arterial spasm, infiltration causes necrosis Toxicity: VT, hyperkalemia, anorexia, nausea and vomiting, fatigue, headache, hypotension, visual disturbances, weakness, diarrhea. Hypokalemia, hypotension, dehydration Hypotension, asystole, cardiac arrest, respiratory and CNS depression, flushing, sweating Hypotension, CHF, bronchospasm bradycardia, dizziness, chest pain, headache, nausea and vomiting. Note: Use of calcium blockers may potentiate side effects Hypotension, AV block, bradycardia, asystole

5 References American Heart Association (2000). Guidelines 2000 for cardiopulmonary resuscitation and emergency cardiovascular care international consensus on science. Hagerstown, MD: Lippincott Williams & Wilkins. American Heart Association (2000). Overview of international guidelines. Currents, American Heart Association (2000). Handbook of emergency cardiovascular care for healthcare providers. Dallas, TX: Author. American Heart Association (2001). ACLS provider manual. Dallas, TX: Author. Canadian Pharmacists Association (2002). Compendium of pharmaceuticals and specialties. Ottawa, ON: Author. Derr, P. (2001). Emergency & critical care pocket guide (2nd ed.). Lake Oswego, OR: InforMed.

6 AMIODARONE KIT CONTENTS AND PROCEDURE CARDS AMIODARONE CARDIAC ARREST PULSELESS VT/VF Arrest Kit: (300mg bolus) Amiodarone 6 Vial = 300mg 50 Mini Bag D5W X1 30 syringe with needle X 1 Alcohol Swabs X 2 Draw up 24 D5W in 30 syringe (discard bag) In same syringe, draw up 6 (300mg) Amiodarone to make up 30 solution Inject Amiodarone rapidly AMIODARONE STABLE VT Tachycardia Kit: (0mg / 10min) Amiodarone 3 Vial = 0mg 100 Mini Bag D5W X 1 5 syringe with needle X 1 Continu-Flo Tubing X 1 LeverLock Cannula X 1 Medication Added Label X 1 Alcohol Swabs X 2 Draw up 3 (0mg) of Amiodarone with 5 syringe and add to mini bag To infuse mini bag over 10 minutes Set VTBI = 100 and Primary Rate = 600 / hr AMIODARONE DRIP Kits: Amiodarone 3 & 6 Vials (Volume = 9 = 450mg) 250 Glass Bottle D5W X 1 10 syringe with needle X 1 Vented IV Tubing X 1 LeverLock Cannula X 1 Medication Added Label X 1 Alcohol Swabs X 2 Kit 1: mix Amiodarone 9 (450mg) in 250 glass bottle D5W Rate 1 (1mg/min) X 6 hours: Set VTBI = 200 and Primary Rate = 33 / hour Rate 2 (0.5mg/min) X 18 hours: Set VTBI = 50 and Primary Rate = 17 / hour Kit 2 mix Amiodarone 9 (450mg) in 250 glass bottle D5W Continue Rate 2 (0.5mg/min) Set VTBI = 250 and Primary Rate = 17 / hour

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