DRUGS
Epinephrine
Indication
VF, pulseless VT, PEA, or asystole
1 mg I.V push every 3-5 min
Intermediate dosing: 2-5 mg IV push over 3-5 min
Escalating dosing: 1mg, 3mg, 5 mg IV push 3 min
apart
High dosing: ,1 mg/kg IV push every 3 5 min
Symptomatic Bradycardia: continous infusion at 2-10
mcg/min
Nsg. consideration
Each dose is followed by 20 mL iv fluid flush.
Can be given via ET tube 2-2.5 x the IV dose,
followed with 10 mL Flush PNSS
IC when no other route is available
It increases systemic vascular resistance, BP,
Cardiac elec. Activity, strenth of contraction,
automaticity, and myocardial O2 requirement
Lidocaine
Indication
Nsg consideration
Toxicity( Slurred speech, altertered LOC, Muscle
twitching, and seizures), stop the drug/reduce
dose
Via ET: 2-2.5 times the iv dose, flush with 10 ml
PNSS
Dont give if PVC occurs with bradycardia or
escape rhythm.
No longer recommended for VT/VF prophylaxis
in acute MI
Atropine
Symptomatic Bradycardia
.5-1 mg iv push q 3-5 min, not to exceed .04 mg/kg
Asystole/PEA
1 mg iv push q 3-5 min, not to exceed a total dose
of .04mg/kg
Nsg consideration
Dont give less than .5 mg dose may further
slow heart rate
Via ET: dilute 1-2 mg in 10 mL sterile water of
PNSS, flush with 10 mL PNSS
Adenosine
PSVT or wide-complex tachycardia:
Initially 6 mg rapid iv push; if no response in 1-2
min, give 12 mg iv push; may be followed by a
third 12 mg dose given in 1-2 min.
Nsg consideration
Given rapidly over 1-3 sec ( half life is 5 sec)
Follow dose with a 20 ml PNSS flush
If methylxanthines, dipyridamole and
carbamazepine are present higher dose may be
needed
A brief period of Asystole is common after
administration
Bretylium
VF/ of pulseless VT unresponsive to
defibrilation, epi and lido
5mg/kg iv push; is arhythmia persists, increase to
10 mg/kg q 5-10 min, to a max dose of 35 mg/kg
Dobutamine
Heart Failure
2-20 mcg/kg/min
Nsg considerations
May cause tachycardia and other arhythmias, BP
fluctuations, nausea and hypokalemia
Monitor heart closely; increases in heart heart
rate more than 10% may induce or exacernate
Myocardial Ischemia
Dopamine
Hypotension c symptomatic bradycardia, heart
failure or after spontaneous return of circulation
Initially, 1-5 mcg/kg/min; max is 20 mcg/kg/min
Enhances renal blood flow 1-2 mcg/kg/min
Nsg consideration
May induce tachycardia, - dose
reduction/withdrawal
Extravasation may cause severe tissue sloughing and
necrosis
Norepinephrine should be added is more than max
dose is needed to maintain BP
Use slowest infusion first
Can exacerbate pulmonary congestion and
compromise cardiac output
Eliminate hypovolemia as a cause of hypotension
before treating
Magnesium
VF/VT with hypomagnesemia
1-2 grams diluted in 10 mL D5W given IV push
over 1-2 min
Nsg consideration
Flushing, sweating, mild bradycardia, and
hypotension may develop from rapid
administration in non arrest situations
Procainamide
PVCs or recurrent VT with pulse
Initially, 20 mg/min until
Hypotension occurs
QRS complex
PR interval
QT interval is widened by 50 %
Total of 17mg/kg of the drug was administered
Nsg consideration
Monitor BP closely during administration; may
cause precipitous hypotension, infuse cautiously
in patients with acute MI
Contraindicated in patients with preexisting long
QT intervals and torsades de pointes
Toxicology
Poisoning
Occurrence of Poisoning
Unintentional
Intentional
Toxin
Special Info
Botulinum Antitoxin
Botulism
Deferoxamine
Iron
Flumazenil
Benzodiazepines
Toxin
Special Info
Glucagon
Beta Blockers
NAC/Mucomyst/NAcetylcysteine
Acetaminophen
Naloxone
Nalmefene
Opiates, Clonidine
Short- acting.
Longer-acting.
Octreotide
Sulfonylureas
Inhibits growth
hormone and insulin
secretion
Toxin
Special Info
Physostigmine
Anti-cholinergics
Protamine Sulfate
Heparin
In severe overdose
and marked lab
indications
Pyridoxine
Isoniazid
Dose often
dependent on
amount INH ingested
Vitamin K 1
Anticoagulants/Rat
Poisons/Warfarin
Given
Emergency
DRUGS