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UNIVERSITY HOSPITAL EMERGENCY CARTS PROCEDURE
ADULT EMERGENCY DRUGS (Based on ACLS guidelines)
ADENOSINE	Antiarrhythmic in PSVT: 6 mg rapid IV push, if no response in 1-2 minutes, administer dose of 12mg, repeat 12 mg dose a second time if required
AMIODARONE	Antiarrhythmic: Loading dose: 150mg Amiodarone IVP (up to 300mg IVP for cardiac arrest from VF/VT after multiple shocks) for life threatening arrhythmia.  150mg Amiodarone may be mixed in 100cc D5W and infused over 10 minutes or given IVP.  Follow with IV infusion upon arrhythmia resolution IV infusion: 450mg. Amiodarone in 250ml D5W.  Initial infusion 1mg/min-x 6 hours (33ml/hr x 6 hours).  Decrease infusion to maintenance dose of 0.5mg/min (17ml/hr).
ATROPINE	Agent used for symptomatic bradycardia, PEA:  0.5-1 mg IV push, repeat at 3-5 min. Intervals to max. Total dose of .04 mg/kg.  May be given via endotracheal route. Stocked 1 mg/10 ml.
DEXTROSE	Antihypoglycemic: 10 to 25 gms. IVP.  Repeat dose as required in severe cases depending on symptoms and blood glucose levels.
DOBUTAMINE	Vasopressor: IV infusion: 500 mg Dobutamine in 250 ml IV solution.  Usual dose 2-5mcg/kg/min.  May titrate to upper dose of 20mcg/kg/min. Primarily stimulates B-1 receptors in the heart and is used for inotropic support with mild chronotropic effect.  Adequate hydration of patient imperative in blood pressure support.  When mixing more than 500 mg. Dobutamine in IV solution, equal volume must be removed (e.g. 1gm/40ml Dobutamine, remove 40ml from IV solution).
DOPAMINE	Vasopressor, IV infusion: Usual dose in code situation is 5-20mcg/kg/min.  Renal perfusion dosing 2-5mcg/kg/min, increase of cardiac output 5-10mcg/kg/min and peripheral vasoconstriction 10-20mcg/kg/min.  As approaching 20mcg/kg/min assess urine output.  Extravasation treatment is with phentolamine.  Adequate hydration of patient imperative in blood pressure support. Premix drip of 400 mg Dopamine in 250 ml IV solution.
EPINEPHRINE	Adrenergic agent of choice for cardiac arrest, vasopressor used in Pulsless VT/VF, Asystole and PEA: 1 mg IV every 3-5 min. Or more frequently.  May be given endotracheal route. Stocked 1 mg/10 ml 1:10,000.  If using for hypersensitivity reaction 0.1-0.25mg SQ, SIVP.  IV infusion, mix 1 mg in 250 ml IV solution.  Start at 1 mcg/min.  (15 cc/hr.), each 15 cc/hr. = mcg/min. Stocked 1 mg/1 ml in 1ml single dose ampules and 30ml multidose vials.  Bristojects are 1mg/10ml.
ETOMIDATE	Induction of rapid hypnosis (non-barbiturate) usual dose 0.2-0.6mg/kg IVP immediately prior or during intubation.
FLUMAZENIL	Antidote for benzodiazepine: Initial dose 0.2mg administered IV over 15 seconds.  If desired level of consciousness is not obtained after waiting additional 45 seconds, second dose of 0.2mg may be administered.  Repeat at 60-second intervals as necessary to a maximum total dose of 1mg.  Individualize the dose based on patient response.
LIDOCAINE	Antiarrhythmic: Bolus: 1-1.5 mg/kg IV push initial bolus.  Repeat doses of 0.5-1 mg/kg at 5-10 min. intervals if needed until total dose of 3 mg/kg for cardiac arrest from VF/VT that persists after multiple shocks.  May be given via endotracheal route.  Follow with IV infusion if effective in arrhythmia resolution.  IV infusion: use-premixed bag of 2 Gm in 500 cc D5W. 1-4 mg/min. (1mg/min = 15cc/hr of premix Lidocaine drip).
MAGNESIUM	In cardiac arrest: 1-2 gm. (diluted in 10ml D5W or NS) IVP in torsades de pointes or when it is suspected that the arrhythmia is caused by a hypomagnesemic state.
NALOXONE	Antidote for opiate narcotics: Initial dose of 0.4mg to 2mg. IV; may repeat IV at 2 to 3 minute intervals.  If no response is observed after 10mg has been administered, question the diagnosis of narcotic induced or partial narcotic induced toxicity.  Can also be given IM, SQ
NOREPINEPHRINE	Vasopressor, IV infusion: mix 4 mg in 250-cc IV solution (in D5W only).  Usual dose 2-12 mcg/min to titrate for blood pressure control.  Monitor urine output.  Adequate hydration imperative in blood pressure control.
PROCAINAMIDE	Antiarrhythmic: Bolus: 100 mg IV every 5 min. (or at a rate of 20mg/minute IVSP) until one of the following observed: 1) arrhythmia suppressed; 2) hypotension ensues; 3) QRS complex is widened by 50% of its original width; 4) a total of 17 mg/kg.  If effective administer IV infusion.  IV infusion: 1 gm Procainamide in 250 ml IV solution. Stocked 1 gm/10 ml. Range: 1-4 mg/min.  (1mg/min = 15cc/hr).
SODIUM BICARBONATE	Alkalinizer used in metabolic acidosis: Should be used, if at all, only after application of definitive and better substantiated interventions and drugs.  1 mEq/kg IV push. Repeat doses are usually 0.5 mEq/kg, based on ABG results. Stocked 1 mEq/1 ml 10ml and 50ml Bristojects.
VASOPRESSIN	Antidiuretic hormone, vasoconstrictor: 40U as a single, one-time bolus.  Alternative agent to epinephrine, vasopressin is used in persistent or recurrent VT/VF for vasoconstriction and increasing blood flow to the brain and heart during CPR. Use epinephrine to follow up in 10 minutes if there is no response to vasopressin.
VERAPAMIL	Calcium channel blocker: 5 mg IV push given over 1 min. Repeat in 30 min. if needed, increasing to 10 mg. Stocked 5 mg/2 ml.