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Abdominal Aortic Aneurysm
Establish 2 large bore IVs of Normal Saline or Lactated Ringers as necessary, to maintain a blood pressure greater than 90 mm/Hg systolic.
If systolic BP greater than 120, initiate antihypertensive
- Labetalol IV bolus dose is 0.25 mg/kg. This may be doubled in 10 minutes and then doubled again in 10 minutes with repeat doubling until a desired effect is reached or until cumulative dose of 300 mg has been given.
- Cardene 5mg/hr (50 ml/hr) may increase q 15 min by 2.5 mg/hr. No more than 15 mg/hr
- o If systolic BP is < 90, only initiate vasopressors if evidence of altered mental status or imminent cardiac arrest.
Fentanyl 1-2 mcg/kg IV every 10 minutes as needed for pain management. Hold if systolic BP <90.
Acute Aortic Dissection
Confirm dissection with CT of Chest/Abdomen, If unable to confirm dissection via CT do not follow this protocol
- Target systolic BP of < 120
- If systolic BP greater than 120, initiate Cardene 5mg/hr (50 ml/hr) may increase q 15 min by 2.5 mg/hr. No more than 15 mg/hr
If noted tachycardia or HR > 100 may administer 5mg of IV Lopressor, may repeat every 5 minutes; hold if systolic blood pressure is <90 or a heart rate <60 bpm
If systolic BP is < 90, Only Initiate Vasopressors if evidence of altered mental status or imminent cardiac arrest
May use Fentanyl 1-2 mcg/kg IV every 10 minutes as needed for pain management. Hold if systolic BP <90.
- Criteria for suspected sepsis and 2 or more of the following:
- Fever >100.5
- HR > 100
- RR >20 or PaCO2 < 32
- WBC <4000 or > 12000
Dopamine or Levophed
- Fluid bolus 20 mg/kg in the first 2 hrs
- Repeat 500 ml boluses and reassess
Versed 1-2 mg IV repeat as necessary.
Ativan 2 mg IV/IM and 50 mg IV/IM Benadryl
Glucose > 250 mg/dL
Insulin 0.1 unit/kg IV followed by infusion of 0.1 unit/kg/hr
Mix 25 units in 250 ml NS= 1 unit/10 ml
Valium 2.5-5 mg IV for shivering
Cool NS 125 ml/hr unless hypotensive
lab value present > 6.0 or clinical suspicion
fluid replacement as needed
- 10 units insulin IV with 1 amp D50
- hold D50 if glucose > 250 mg/dL
10-20 mg in 4 ml inhalation
1 amp Sodium Bicarb, may repeat if QRS > 120 or absent p wave
1 gram Calcium Gluconate IV over 3 minutes with QRS > 120 or loss of P wave. May repeat every 5 min x 3 until ECG resolves....first line in unstable pts.
Hypotension of undetermined origin
10-20 ml/kg LR or NS WO, repeat to maintain BP > 90.
In the setting of pulmonary edema consider vasopressors, refrain from fluid
Dopamine 5-30 mcg/kg/min
Levophed 2-30 mcg/min
ETCO2, monitor, SpO2, definitive airway
Normotensive BP >90
Hypotensive BP < 90
- Zemuron 1 mg/kg, IV x 1
- Fentanyl 1 mcg/kg IV every 10 as needed
- Versed 1-2 mg IV every 5, max 8mg in 1 hr
- Zemuron 1 mg/kg IV x 1
- Fentanyl 1 mcg/kg every 10 unless decrease in BP > 6 mmHg
- Ketamine 1 mg/kg every 10 as needed
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