ANTIHYPERTENSIVES IV PUSH

clonidine Catapres

Bolus: 1‐5 mcg /kg IV slowly; avg 3 mg/kg

esmolol Brevibloc

See also cardiac infusions

Bolus: 500 mcg/kg IV over 2 min

hydralazine Apresoline

Bolus: 0.1‐0.2 mg/kg/dose IV slowly

Max: 2 mg/kg q 6 hr

labetalol Normodyne, Trandate

Bolus: 0.2‐1.0 mg/kg IV slowly q 10 min

Start 0.2 mg/kg max 20 mg/dose; 3 mg/kg/hr

nicardipine Cardene (off-label)

Bolus: 0.5‐3 mcg/kg/min IV slowly

EMERGENCY MEDICATIONS: BOLUS

adenosine Adenocard

First dose:

100 mcg/kg rapid IV push (0.1 mg/kg) and rapid flush; max: 6 mg

Repeat dose:

200 mcg/kg rapid IV push (0.2 mg/kg) and rapid flush; max: 12 mg

amiodarone Cordarone SVT, VT, VF

See also cardiac infusions

5 mg/kg IV/IO over 20‐60 min; max: 300 mg/dose

Repeat to daily max of 15 mg/kg

atropine

There is some debate regarding minimum dosing of atropine; it is listed here for your information.

0.02 mg/kg slow IV/IO/IM (10‐20 mcg/kg)

Minimum dose: 0.1 mg; max single dose: 0.5 mg

May repeat q 5 min; max: 1.0 child, 2.0 mg adolescent

20‐30 mcg/kg IM/PO

0.04‐0.06 mg/kg ETT; 2‐3 × IV/IO dose

Optimal max ETT dose not established

calcium chloride 10%

3 times as potent as calcium gluconate

20 mg/kg IV/IO slowly of 10% solution; may repeat × 1

Slowly: 100 mg/min

calcium gluconate 10% (100 mg/mL)

60‐100 mg/kg/dose IV/IO slowly

Can give q 10 min; max: 800 mg/dose; 3 Gm/episode

dantrolene Dantrium

2.5 mg/kg IV q 5 min; max: 30 mg/kg

ephedrine (hypotension and bradycardia: range 0.1‐0.2 mg/kg)

0.15 mg/kg IV slowly

epinephrine Adrenalin

1:1,000 = 1 mg/mL

1:10,000 = 0.1 mg/mL

See also cardiac infusions

Pulseless arrest or bradycardia:

0.01 mg/kg IV/IO (0.1 mL/kg of 1:10,000); same as 10 mcg/kg

Can repeat q 3‐5 min; max: 1 mg

0.1 mg/kg (0.1 mL/kg) 1:1,000 ETT q 3‐5 min

ETT dose of epinephrine is 10 × IV/IO dose

Max dose ETT epinephrine: 2.5 mg/dose

lidocaine Xylocaine See also cardiac infusions

1 mg/kg IV/IO slowly; may repeat × 1 in 15 min

2‐3 mg/kg ETT

magnesium sulfate

25‐50 mg/kg IV/IO infuse over 15 min; max: 2 Gm

phenylephrine Neosynephrine

See also cardiac infusions

5‐20 mcg/kg/dose IV bolus q 10‐15 min as needed; max: 5 mg

sodium bicarbonate NaHCO₃

(BW × BD × 0.3/2)

1 mEq/kg IV/IO very slowly; max: 50 mEq

Not routinely given; guide by bicarbonate concentration

vasopressin ADH

Vasopressin is given after at least two doses of epinephrine have been given.

Cardiac arrest:

0.4 units/kg IV/IO; max: 40 units

Vasopressin can be given via ETT but human studies regarding dosing are limited.

verapamil Isoptin SVT

<1 y: 0.1‐0.2 mg/kg/dose IV over 2 min

1‐15 y: 0.1‐0.3 mg/kg/dose max 5 mg

EMERGENCY MEDICATIONS: INFUSIONS

amiodarone Cordarone

Load: 5 mg/kg IV over 50‐60 min

Infusion: 5‐15 mcg/kg/min IV

dobutamine Dobutrex

2‐20 mcg/kg/min IV infusion; start at 0.5‐1 mcg/kg/min

dopamine Intropin

2‐20 mcg/kg/min IV infusion

epinephrine Adrenalin

Hypotensive shock: 0.1‐1 mcg/kg/min IV/IO infusion

esmolol Brevibloc

Infusion: 50‐150 mcg/kg/min IV infusion; max: 300 mcg/kg/min

isoproterenol Isuprel (off-label)

0.05 mcg/kg/min IV, increase by 0.1 mcg/kg/min q 5‐10 min; max: 2 mcg/kg/min

lidocaine Xylocaine

20‐50 mcg/kg/min IV/IO infusion

milrinone Primacor

Load: 50‐75 mcg/kg slow IV/IO over ≥ 15 min

Infusion: 0.5‐0.75 mcg/kg/min IV/IO infusion

nitroglycerin

0.5‐2.0 mcg/kg/min IV/IO infusion; max: 6 mcg/kg/min

nitroprusside

0.5‐10 mcg/kg/min IV infusion

norepinephrine Levophed

0.1‐2.0 mcg/kg/min IV/IO infusion; max: 2 mcg/kg/min

phenylephrine Neosynephrine

0.1‐0.5 mcg/kg/min IV infusion

procainamide Pronestyl

Load: 15 mg/kg IV/IO over 30‐60 min; max: 500 mg in 30 min

Infusion: 20‐80 mcg/kg min infusion; max: 2 Gm/day

prostaglandin E₁ PGE-1

0.05‐0.1 mcg/kg/min infusion

vasopressin ADH

Hypotensive shock: 0.0003‐0.002 units/kg/min infusion

Same as 0.3‐2 milliunits/kg/min infusion

IM: intramuscular; IN: intranasal; IO: interosseous; IV: intravenous; PR: per rectum; RSI: rapid sequence induction; SQ: subcutaneous.

CARDIOVERSION/DEFIBRILLATION

cardioversion

0.5 J/kg; repeat 1‐2 J/kg

defibrillation

2 J/kg; repeat 4 J/kg