I: Re-Entry SVT

Dose: 6mg IV/IO push followed by 20ml saline

1-2min later 12mg IV/IO Push(up to 2 times)
Then move on to other therapy(ie Cardioversion)

I: Shock Resistant Ventricular Fibrillation
Dose: 300mg IV/IO,

Second does of 150mg if VF recurs

24hr maximum is 2.2gm

Indication: Sympomatic Bradycardia,2nd &3rd degree heart block.

Dose: .04mg/kg or 1mg IV for PEA or Asystole

Sequence for Bradycardia is: Atropine, TCP, Epinephrine, Dopamine.  If no IV access go straight to TCP.

Calcium Chloride

Indication: Magnesium Toxicity or Calcium Channel blocker Over Dose
500-100mg IV

Be careful with patients on Digitalis

Indication: Slow Rapid Ventricular Response associated with A. Fib/A. Fluter

Dose: 0.25mg/kg

After 15 min 0.35mg/kg,

Infusion: 5-15mg/hr titrated to heart rate

Function: Cardio Genic Shock(Increases Cardiac Output and BP)

Dose:

1-5mcg/kg/min(Renal and Splanchnic Dilation)

5-10mcg/kg/min(Beta Effects(inotropy))

10-20mcg/kg/min(Alpha Effects(vasoconstriction))

↑Myocardial and CNS blood Flow d/t α effects

Dose: 1mg IV push Q3-5 min

2-2.5mg down the ET tube

May need higher doses with ß blockers or CCB

Ind: Pharmacologic conversion of A. Fib/Flutter

When Adenosine and Beta Blockers ineffective.

Alternative therapy for refractory VF/pulseless VT

Dose:

1-1.5mg/ KG IV followed by

1-4mg/min infusion

Magnesium

Torsade De Pointe VT

Hypomagnesmia hinders the cellular movement of K+ and thereby makes the heart prorrhythmic.

Dose: 1-2gm IV push over 1-2 minutes.

Torsade with pulse = 1-26mg in 100ml D5W over

5-60 minutes

Analgesic of Choice for ischemic pain w/ ACS that is not relieved by Nitroglycerin.

Also good for treating pulmonary edema as it decreases venous return to the heart and has a mild bronchodilatory effect.

2-4mg IV push

Indication: Chest Pain

relaxes vascular smooth mucscle.

Can be given topical, spray, sublingually, IV

Ind: Stable Monomorphic VT with preserved ventricular function, Controlling rate in A.Fib/flutter, controlling rate in re-entry SVT.

 Not to be used in Pulseless arrest.

Four endpoints: 1)QRS width ↑ by 50%, 2) hypotension develops 3) 20-50mg/min total of 1.2gm(70kg pt) 4) Dysrhytmia subsides

Indication: Acidosis reversal.

Initial dose without a blood gas: 1meq/kg IV push

w/ half dose administered q10min

Mainlyh used for TCA OD, Hyperkalemia, pre-existing metabolic acidosis

Shock refractory VF or pulesless VT & Asystole in place of initial or second dose of epinephrine.  Has powerful vasoconstrictive effects.

Dose: 40u IV one time then return to epinephrine