Cardiac Dysrhythmias

Question 1

M5toprolol

Answer 1

Dosage:
5mg slow IV, IO over 2:00
Peds: Oral

Indications:
Acute Coronary syndrome, Hypertension, SVT (Supraventricular tachycardia), Atrial Flutter, A-Fib, Thyrotoxicosis

AKA: Lopressor, Toprol XL

Question 2

Atr0.5ine

Answer 2

Dosage:
Symptomatic bradycardia
Adult: 0.5 mg IV, IO every 3-5 minutes to a max dose of 3mg
Nerve agent or organophosphate poisoning
Adult: 1 – 6 mg IV, IM; repeat if needed every 5:00 until symptoms dissipate

Indications: Symptomatic bradycardia, nerve agent exposure, organophosphate poisoning.

Question 3

Epinephrine

Answer 3

Dosage:
Cardiac arrest
* Adult: 1mg (1:10,000 solution) IV, IO; may repeat every 3 to 5 minutes
Bradycardia
* Adult: 2 to 10mcg/min (1:10,000 solution) as a continuous IV infusion; usual dosage range: 2 to 10 mcg/min IV; titrate to effect.
Asthma
* Adult: 0.3 to 0.5 mg (1:1,000 solution) IM or subcutaneous; may repeat every 10 to 15 minutes. Max dose 1mg.
Anaphylactic Shock
* Adult: 0.5 mg (1:1,000 solution) IM repeated as needed every 5 to 15 minutes or transition to IV infusion of 1 to 4mcg/min, titrated to affect.

Indications: Bronchospasm, allergic and anaphylactic reactions.

Question 4

Dopamine

Answer 4

Dosage:
Adult: 2 to 20mcg/kg per minute IV, IO infusion. Starting dose 5mcg/kg per minute; may gradually increase the infusion by 5 to 10 mcg/kg per minute to desired effect.

Cardiac dose is 5 to 10 mcg/kg per minute; vasopressor dose is usually 10 to 20 mcg/kg per minute. Little benefit is gained beyond 20mcg/kg per minute.

Indications: Hypotension and decreased cardiac output associated with cardiogenic shock and septic shock, hypotension after return of spontaneous circulation following cardiac arrest, symptomatic bradycardia unresponsive to Atropine.

AKA: Intropin

Question 5

Adeno6ine

Answer 5

Dosage:
Should be delivered only by rapid IV bolus with peripheral IV or directly into a vein, in a location as close to the heart as possible, prefer the antecubital fossa. Must be immediately followed by a saline flush, and then extremity should be elevated.
* Adult: initial dose 6mg rapid IV, IO (over a 1-3 second period) immediately followed by a 20-ml rapid saline flush. If the first dose does not eliminate rhythm in 1-2 minutes, admin second dose of 12 mg rapid IV, IO.

Indications: Stable reentry SVT (Supraventricular tachycardia). Does not convert Atrial Fibrillation, atrial flutter, or VT (Ventricular tachycardia)

AKA: Adenocard

Question 6

Diltiazem

Answer 6

Dosage:
Adult: 0.25mg/kg IV, IO over a 2:00 period to control rapid AF; 20 mg is reasonable dose for the average adult patient. A second, higher dose of 0.35 mg/g IV, IO (25mg is a typical second dose) may be administered over a 2:00 period if rate control is not obtained with the lower dose. For continued reduction in heart rate, a continuous infusion can be started at a dose range of 5 to 15mg/hr.

Indications: Ventricular rate control in rapid AF (Atrial fibrillation is a type of arrhythmia, the heart beats in an irregular fashion

AKA: Cardizem

Question 7

Esmolo1

Answer 7

Dosage:
Adult: 0.5 to 1mg/kg IV, IO, over a 1:00 period, followed by a 50-mcg/kg per minute (0.05 mg/kg) infusion over a 4:00 period (max total: 200 mcg/kg). If patient response is inadequate, administer a second bolus 500 mcg/kg(0.5 mg/kg) over a 1:00 period, and then increase infusion to 100 mcg/kg per minute. Max infusion rate: 300 mcg/kg per minute.

Indications: ACS, myocardial infarction, acute hypertension, supraventricular tachyarrhythmias, thyrotoxicosis. (Acute coronary syndrome is a term for a group of conditions that suddenly stop or severely reduce blood from flowing to the heart muscle. Heart attack and unstable angina)

AKA: Brevibloc

Question 8

Amiodarone

Answer 8

Dosage:
Ventricular fibrillation and pulseless ventricular tachycardia
* Adult: 300 mg IV, IO. May be followed by one dose of 150 mg in 3 to 5 minutes.
Relatively stable patients and arrhythmias Such as Premature Ventricular Contractions or Wide-complex Tachycardias with a strong pulse.
* Adult: 150 mg in 100 mL D5W IV, IO over a 10 minute period; once returned of spontaneous circulation is accomplished, begin an infusion of 1mg/min for 6 hours, then decrease to 0.5 mg/min; may repeat in 10 minutes up to a max dose of 2.2 over 24hours.

Indications: Ventricular arrhythmias; second line agent for atrial arrhythmias

AKA: Cordarone

Question 9

L1.5ocaine

Answer 9

Dosage:
Pulseless ventricular tachycardia and ventricular fibrillation
* Adult: 1 to 1.5mg/kg IV, IO; may repeat at half the original dose (0.5 to 0.75 mg/kg) every 5 to 10 minutes to a max dose of 3 mg/kg. If a maintenance infusion is warranted, the rate is 1 to 4 mg/min
Perfusing Ventricular Rhythms
* Adult: 0.5 to .75 mg/kg IV, IO (up to 1 t o1.5 mg/kg may be used) Repeat 0.5 to 0.75 mg/kg every 5 to 10 minutes to a max total dose of 3mg/kg.

Indications: Ventricular arrhythmias, when amiodarone is not available: cardiac arrest from VF/VT, stable monomorphic VT with normal baseline QT interval and preserved left ventricular function (when ischemia and electrolyte imbalance are treated), stable polymorphic VT with baseline QT prolongation suggestive of torsades de pointes.

AKA: Xylocaine

Question 10

Mag Sulfate

Answer 10

Dosage:
Pulseless ventricular fibrillation/ventricular tachycardia with torsades de pointes or hypomagnesemia
* Adult: 1 to 2g in 10 mL D5W, IV, IO administered over 15 minutes or faster with cardiac arrest.
Torsades de Pointes with a pulse or cardiac arrhythmias with Hypomagnesemia
* Adult: 1 to 2 g in 50 to 100mL D5W IV, IO administered over 5 to 60 minutes. Follow with 0.5 to 1G/hr IV, IO titrated to control torsades de pointes
Eclampsia and seizure prophylaxis in Preeclampsia
* Adult: 4 to 6 IV, IO over 20 to 30 minutes, followed by an infusion of 1 to 2g/hr
Status asthmaticus
* Adult: 1.2 to 2g slow, IV, IO (over 20:00)

Indications: Torsades de pointes, cardiac arrhythmias associated with hypomagnesemia, eclampsia and seizure prophylaxis in preeclampsia, status asthmaticus.