Push Dose Pressors

Epinephrine

  • Mix: Add 1mL (1:10,000 cardiac epi) to 9mL saline syringe

    • Take 10mL saline flush and discard 1mL

    • Draw up 1mL of cardiac epinephrine into saline flush with remaining 9mL saline

    • LABLE SYRINGE

    • Final concentration: 10mcg/1mL

  • Administer: 0.5-2 mL (5-20mcg) q2-5 min PRN

Phenylephrine/NeoSynephrine

  • Mix: Add 1mL (10mg phenyl) to 100 mL NS bag

    • Draw up 1mL (10mg) of phenylephrine into empty syringe

    • Inject 10mg phenylephrine 100mL normal saline bag

    • Draw up 10mL from 100mL bag into empty syringe

    • LABLE SYRINGE

    • Final Concentration: 100mcg/1mL

  • Administer: 0.5-2mL (50-200mcg) q2-5min PRN


Drips

Levophed/Norepinephrine

  • Mix: Add 4mg to 250mL bag NS (bag=16 mcg/mL)

  • Administer: 5-30mcg/min

Epinephrine

  • Mix: Add 1mg epinephrine (1 amp cardiac epi) to 100mL NS bag (bag=10mcg/mL)

  • Administer: 5-30mcg/min or 0.01-0.5 mcg/kg/min

Dobutamine

  • Mix: Add 500mg to 250mL bag NS (bag=2000mcg/mL)

  • Administer: 2-20mcg/kg/min

Dopamine

  • Mix: Add 400mg to 250mL bag NS (bag=1600mcg/mL)

  • Administer: 2-20mcg/kg/min

Nicardipine

  • Mix: Add 50mg to 250mL bag NS (bag=0.2mg/mL)

  • Administer: 5-15mg/hr (25-75 ml/hr)

Esmolol

  • Administer:

    • Bolus: 500 mcg/kg over 1min

    • Drip: 50-300 mcg/kg/min

Ketamine

  • Mix: Add 200mg ketamine to 100mL bag NS (bag=2mg/mL)

  • Administer: start at 0.6 mg/kg/hr

TXA

  • Mix: Add 1g (1 vial) to 100mL bag NS

  • Administer: entire 100mL bag/1g TXA via dedicated IV/IO line over 10 minutes

Cyanokit

  • Indications:

    • Evidence of smoke inhalation from fire in enclosed space OR Industrial exposure (KCN, HCN, etc)

      AND

    • Altered Mental Status OR Hemodynamic instability

  • Mix: Add Cyanokit vial to 200mL NS

  • Administer: via dedicated IV/IO line over 15min

    • Adults: Hydroxycobalamin 5g

    • Children: Hydroxycobalamin 70mg/kg

See blog post and podcast for key pearls regarding Cyanokit administration and Cyanide Poisoning!

RSI

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spiking blood

Procedure:

  1. Set-up Buddy Lite with Buddy Lite tubing

  2. Attach blood tubing to Buddy Lite tubing (red to blood)

    NOTE: You must put Buddy Lite tubing into Buddy Lite before priming, otherwise tubing will expand and leak

  3. Prime tubing with saline:

    • Remove red cap from one line and remove cap from NS bag

    • Hold NS bag with port facing up and insert blood tubing connector

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  • Hold blood tubing so ball reservoir is upside-down at or slightly above level of drip chamber/filter

  • Allow saline to fill ball reservoir completely, then ball can be lowered and remaining tubing can fill by gravity

  • Ensure there is no air in tubing (air in drip chamber is normal and needs to be there to allow you to assess infusion rate)

  • Use roller ball clamp to stop fluid flow (preferentially use roller clamp closest to NS bag)

  • Blood product can then be spiked on second line and administered to patient (ensure roller clamp left open to blood product) 

  • Ensure there is no air in tubing (air in drip chamber is normal and needs to be there to allow you to assess infusion rate)

  • Use roller ball clamp to stop fluid flow (preferentially use roller clamp closest to NS bag)

  • Blood product can then be spiked on second line and administered to patient (ensure roller clamp left open to blood product)

Other

PCC (Kcentra)

  • Dosing: based on units of Factor IX

    • INR 2.0-3.99: 25 units/kg (max 2500 units)

    • INR 4.0-6.0: 35 units/kg (max 3500 units)

    • INR >6.0: 50 units/kg (max 5000 units)

  • Administer: via dedicated line @ 0.12 mL/kg/min (max 8.4 mL/min)