Sodium Bicarbonate

(Cardiac Arrest)

Phys: Bicarb detaches from Na to buffer H⁺ ions

Purpose:Electrolyte replenisher/Systemic Alkilizer

Amount: 50 mL syringe

Rate: (2) 50 mL syringes: each syringe q5-10 min

Atropine

(Bradycardia and Arrythmias)

Phys: blocks the action of the vagus nerve: Increases HR

Amount: 0.1 mg/mL (10 mL syringe)

Rate: give quickly with 20 mL flush

How often: Brady: 0.5 mg q 3-5 min: max 3 mg

Asytole: 1 mg q 3-5 min: max 3 mg

Epinephrine

(Cardiac Arrest, Asystole, PEA, VF, VT)

Phys: Increases blood flow; increases BP and myocardial and cerebral blood flow: alpha- and beta-adrenergic agonist

Amount: 10 mL syringe = 1 mg

Rate: 1 mg over 1 min: flush with 20 mL

How often: q 3 -5 min

Lidocaine 2%

(Cardiac Arrest)

Phys: effects fast sodium chnnels, shortens refratory periods, and suppresses spontaneous depolarization

Amount: 5mL syringe with 100 mg (20mg/mL) 1-1.5 mg/kg intial dose

Rate: 1-4 mg/min

How often: 0.5-0.75 mg/kg q 5-10 min, Max 3mg/kg

10% Calcium Chloride

(arrhythmia)

Phys: activates nerve impules and contraction of cardiac, skeletal, and smooth muscle

Amount: 10 mL syringe: 100mg/mL

Rate: 0.5-2 mL/min

How often: Repeat as needed

Phenylephrine

(Hypotension/arryhthmias)

Phys: constricts blood vessels

Amount: 10 mg/mL

Rate: 0.2 mg over a min

How often: q 10-15 min: increase dose by 0.1-0.2 mg (don't exceed 0.5 mg)

Vassopressin

(CPR, VF, PEA)

Phys: ADH, increases BP (Replaces epinephrine)

Amount: 20u/mL

Rate: 40 u given intally

How often: only given once

Mg Sulfate

(Arrythmias, polymorphic VT (VT))

Phys: Mg facilitates repolarization by enhancing the intracelllar K influx and dilating coronary arteries

Amounts: 1–2 g in 10 mL 5% dextrose injection

Rate: over 5–20 minutes

How often: 0.5 - 1 g/hr IV up to 24 hr

Amiodarone

(VT, VF)

Phys:Prolongs action potential, duration, and refractory period in myocardial cells (slows down excitablility); acts as noncompetitive inhibitor of alpha- and beta-adrenergic receptors.

Amount: 150mg/3 mL

Rate: rapid administration of 150 mg over first 10 min (15 mg/min)

How often: followed by 360 mg over next 6 h (1 mg/min), then 540 mg over remaining 18 h (0.5 mg/min).

Verapamil

(angina, hypertension, and supraventricular tachyarrhythmias)

Phys: Blocks the calcium channels in the heart causing vasodialation

Amount: 2.5 mg/mL

Rate: 5–10 mg (0.075–0.15 mg/kg) given by IV injection over ≥2 minutes

How often: If the patient tolerates but does not respond adequately to the initial IV dose, a second IV dose of 10 mg (0.15 mg/kg) may be given 30 minutes after the initial dose

Norepinephrine

(Hypotension, Cardiac arrest)

Phys: peripheral vasoconstrictor (alpha-adrenergic action) and as an inotropic stimulator of the heart and dilator of coronary arteries

Amount: 1mg/mL in 4 mL ampule

Rate: Add a 4 mL vial (4 mg) of Norepinephrine to 1,000 mL of a 5% dextrose containing solution. Each mL of this dilution contains 4 mcg of the base of Norepinephrine. 2-3 mL per min

How often:  average maintenance dose ranges from 0.5 mL to 1 mL per minute (from 2 mcg to 4 mcg of base).

Procainamide

(life-threatening arrhythmias)

Phys: blocks cardiac sodium channels: this decreases conduction velcoity in the atria, ventricles, and His-Purkinje system

Amount: 100 mg/mL in 100 mL vial

Rate: done slowly at a rate not to exceed 50 mg per minute. It is advisable to dilute either the 100 mg/mL or the 500 mg/mL concentrations

How often: Doses of 100 mg may be administered every 5 minutes at this rate until the arrhythmia is suppressed or until 500 mg has been administered

Adenosine

(paroxysmal supraventricular tachycardia (PSVT))

Phys: slows conduction time through the A-V node, can interrupt the reentry pathways through the A-V node, and can restore normal sinus rhythm

Amount: 6 mg/2 mL

Rate: 6mg rapid bolus dose (1-2 seconds)

How often: if no effect within 1-2 minutes, 12 mg should be given as a rapid intravenous bolus