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- DESCRIPTION: Amiodarone is an antidysrhythmic that prolongs the duration of the action Potential and Refractory Period and Relaxes smooth muscles, reducing Peripherial Vascular Resistance and Increasing Coronary Blood Flow.
- INDICATIONS: Life threatening recurrent Ventricular and SupraVentricular Dysrythmias that have not responded to other antidysrhythmic agents.
- CONTRAINDIACTIONS: Hypersensitivity, Cardiogenic Shock, Severe Sinus Bradycardia, or Advanced Heart Block.
- PRECAUTIONS: Hepatic Impairment, pregnancy, nursing mothers, children.
- DOSAGE/ROUTE: 150-300mg IV over 10 min, then 1mg/min over next 6hrs.
- PED: 5mg/kg IV/IO, then repeat up to 15mg/kg.
- DESCRIPTION: Adenosine is a naturally occuring agent that can "chemically Cardiovert" PSVT to a normal sinus rhythm. It has a half-life to 10 sec and does not cause Hypotension.
- INDICATIONS: Narrow Complex Supraventricular Tachycardia Refractory to Vagan Maneuvers.
- CONTRAINDICATIONS: Hyperssensitivity 2nd and 3rd degree heart block, sinus node disease, or asthma.
- PRECAUTIONS: It may cause Transient Dysrhythmia, COPD.
- DOSAGE/ROUTE: 6mg rapidly (over1-3 sec) IV, then flush the line rapidly with saline. If ineffective, 12mg in 1-2min, may be repeated.
- PED: 0.1mg/kg to a maximum of 6mg(rapidly) IV followed by rapid saline flush, then 0.2mg/kg in 1-2 min max 2nd dose of 12mg.
- DESCRIPTION: Lidocaine is an antidysrhythmic that supresses automaticity and raises stimulation threshold of the ventricles. It also causes Sedation, Anticonvulsant, and Analgesic effects.
- INDICATIONS: Pulseless ventricular tachycardia, ventricular fib, ventricular tachycardia (wwith pulse).
- CONTRAINDICATIONS: Hypersensitivity to Amide-type local anesthetic. Supraventricular dysrhythmias, Stokes-Adams Syndrome, 2nd and 3rd degree heart block, Bradycardias.
- PRECAUTIONS: Hepatic or renal impairment, CHF, Hypoxia, Respiration Depression, Hypovolemia, My Asthenia Gavis, Shock Debilitated Pts, Elderly, family history of malignant hypothermia.
- DOSAGE/ROUTE: Cardiac arrest: 1-1.5mg/kg IV/IO repeated at 0.5-0.75 Q5-10 min up to 3mg/kg, follow conversion with a drip of 1-4mg/min.
- PED: 1mg/kg rapid IV/IO to 100mg, follow conversion with a drip of 20-50mg/kg min.
- VENTRICULAR TACHY (with pulse): 0.5-105mg slow IV.May repeat at on half dose Q 5-10min until conversion up tp 3mg/kg.
GOOD WAY TO REMEMBER DOSE:
- DESPRIPTION: Atropine blocks the Parasympathetic Nervous System Specifically the Vagal effects on Heart Rate. It does not increase Contractility but may increase Myocardial 02 Demand.Decreasaes airway secretions.
- INDICATIONS: Hemodynamically significant Bradycardia, Bradyasystolic arrest, and organophosphate posioning.
- CONTRAINDICATIONS: NONE in the emergency setting.
- PRECAUTIONS: Acute MI, Glaucoma
- DOSAGE/ROUTE: Symptomatic Bradycardia: 0.5mg IV, repeat 3-5 min to 3mg.
- PEDS: 0.02mg/kg IV, 0.03 mg/kg ET may double and repeat IV dose in 5 min up to 1mg.
- ADOLESCENT: 1mg x 2
- ORGANOPHOSPHATE POSIONING: 2-5m IV/IM/IO 10-15 min.
- PED: 0.05 MG/KG IV/IM/IO 10-15 min.
CALCIUM CHANNEL BLOCKER
- DESCRIPTION: Diltiazem is slow Calcium Channel Blocker similar to Verapamil. It dilates coronary and peripheral arteries and arterioles, thus increasing circulation to the heart and reducing Peripheral Vascular Resistance.
- INDICATIONS: Supraventricular Tachydysrhythmias (Atrial Fib, Atrial Flutter, and PSVT Refractory to Adenosine) and to increase Coronary Artery Perfusion in Angina.
- CONTRAINDICATION: Hypersensitivity, Sick Sinus Symdrome, 2nd and 3rd degree Heart Block, Systolic BP ^ 90, Diastolic 60, wide complex tachycardia and WPW.
- PRECAUTIONS: CHF (esp with Beta Blocker), Conduction abnormalities, renal or hepatic impairment, the elderly and nursing mothers.
- DOSAGE/ROUTE: 0.25mg/kg IV over 2 min, may repeat in 15 min with 0.35 mg/kg followed by a drip of 5-10 mg/hr NOT to exceed 15mg/hr over 24 hr period.
- DESCRIPTION: Epi is a naturally occuring catecholamine that increases heart rate, Cardiac Contractile force Myocardial Electrical Activity Systemic Vascular resistance, and Systolic BP and decreases overall airway resistance and automaticity. Through Broncjial Artery Constriction, may reduce Pulmonary Congestion and increase Tidal Volume and Tidal Capacity.
- INDICATIONS: To restore rhythm in cardiac arrest and severe allergic reactions.
- CONTRAINDICATIONS: Hypersensitivity to Sympathomimetic Amnies, Narrow Angle Glaucoma, Hemorrhagic, Tramatic, Cardiac Shock, Coronary Insufficiency, Dysrhythmias, Organic Brain or Heart Disease, or During Labor.
- PRECAUTIONS: Elderly, debilitated patients, HTN, DM, Hyperthyroidism, Parkinson's Disease, TB, Asthma, Emphysema, children 6yrs and under.
- DOSAGE/ROUTE: Arrest: 1mg of 1:10,000 IV 3-5 min (ET 2-2.5mg 1:1,000)
- PED: 0.01mg/kg 1:10,000 IV/IO 3-5 min (ET 0.1mg 1:1,000)
- All subsequent doses, 0.1mg/kg IV/IO.
- ALLERGIC REACTIONS: 0.3-0.5mg of 1:1,000 SQ/IM 5-15 min as needed or 0.5-1mg of 1:10,000 IV, if SQ dose is ineffective or severe reaction.
- PED: 0.01 mg/kg of 1:1,000 SQ (10-15 min or 0.01mg/kg of 1:10,000 IV) if SQ is ineffective or Severe.