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

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

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

• 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)