Adenosine |
- Narrow PSVT/SVT
- Wide QRS tachycardia, avoid adenosine in irregular wide QRS
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- 6 mg IV bolus, may repeat with 12 mg in 1 to 2 min.
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- Rapid IV push close to the hub, followed by a saline bolus
- Continuous cardiac monitoring during administration
- Causes flushing and chest heaviness
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Amiodarone |
- VF/pulseless VT
- VT with pulse
- Tachycardia rate control
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- VF/pulseless VT: 300mg dilute in 20 to 30ml., may repeat 150mg every 3 to 5 minutes
- Stable VT with a pulse: 150mg bolus followed by amiodarone drip (300 mg should only be used in a code situation)
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- Anticipate hypotension, bradycardia, and gastrointestinal toxicity
- Continuous cardiac monitoring
- Very long half-life (up to 40 days)
- Do not use in 2nd or 3rd-degree heart block
- Do not administer via the ET tube route
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Atropine |
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- 0.5 mg IV/IO every 3 to 5 minutes
- Max Dose: 3 mg
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- Cardiac and BP monitoring
- Do not use in glaucoma or tachyarrhythmias
- Minimum dose 0.5 mg
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- Specific Toxins/overdose (e.g. organophosphates)
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- 2 to 4 mg IV/IO may be needed
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Dopamine |
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- 2 to 20 mcg/kg/min
- Titrate to desired blood pressure
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- Fluid resuscitation first
- Cardiac and BP monitoring
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Epinephrine |
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- Initial: 1.0 mg (1:10000) IV or 2 to 2.5 mg (1:1000)
- Maintain: 0.1 to 0.5 mcg/kg/min Titrate to desire blood pressure
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- Continuous cardiac monitoring
- NOTE: Distinguish between 1:1000 and 1:10000 concentrations
- Give via central line when possible
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- 0.3-0.5 mg IM
- Repeat every 5 mins as needed
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- Symptomatic bradycardia/Shock
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- 2 to 10 mcg/min infusion
- Titrate to response
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Lidocaine
(Lidocaine is recommended when Amiodarone is not available) |
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- Initial: 1 to 1.5 mg/kg IV loading
- Second: Half of first dose in 5 to 10 min
- Maintain: 1 to 4 mg/min
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- Cardiac and BP monitoring
- Rapid bolus can cause hypotension and bradycardia
- Use with caution in renal failure
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- Wide Complex Tachycardia with Pulse
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- Initial: 0.5 to 1.5 mg/kg IV
- Second: Half of first dose in 5 to 10 min
- Maintain: 1 to 4 mg/min
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Magnesium Sulfate |
- Cardiac Arrest/pulseless Torsades
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- Cardiac Arrest: 1 to 2 gm diluted in 10 mL D5W IVP
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- Cardiac and BP monitoring
- Rapid bolus can cause hypotension and bradycardia
- Use with caution in renal failure
- Calcium chloride can reverse
hypermagnesemia
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- Torsades de Pointes with pulse
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- If not Cardiac Arrest: 1 to 2 gm IV over 5 to 60 min
- Maintain: 0.5 to 1 gm/hr IV
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Procainamide |
- Wide QRS Tachycardia
- Preferred for VT with pulse (stable)
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- 20 to 50 mg/min IV until rhythm improves, hypotension occurs, QRS widens by 50% or MAX dose is given
- MAX dose: 17 mg/kg
- Drip = 1 to 2 gm in 250 to 500 mL at 1 to 4 mg/min
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- Cardiac and BP monitoring
- Caution with acute MI
- May reduce dose with renal failure
- Do not give with amiodarone
- Do not use in prolonged QT or CHF
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Sotalol |
- Tachyarrhythmia
- Monomorphic VT
- 3rd line anti-arrhythmic
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- 100 mg (1.5 mg/kg) IV over 5 min
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- Do not use in prolonged QT
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