VII. Medications used for cardio-respiratory emergencies in moderate sedation in adults

Adenosine:

Indication: Drug of choice for SVT. May use in a stable patient where it is unclear if there is a wide or narrow-complex tachycardia.
Precautions: may cause flushing, chest pain, transient bradycardia or brief asystole
Dosage: initial dose of 6mg rapid Intravenous Push (IVP), if not effective then may repeat with 12 mg X 1 dose

Amiodarone:

Indication: Vtach / VFIB
Precautions: may cause hypotension
Dosage: If cardiac arrest: 300 mg IVP. If stable Vtach then 150 mg in 100mL d5W slow IV infusion over 10 minutes.

Atropine:

Indication: Symptomatic bradycardia.
Precautions: may increase myocardial oxygen demand
Dosage: Bradycardia: 0.5 mg IVP.  Repeat every 3-5min.  Maximum 3mg. Source:  ACLS 2010.  

Calcium Chloride:

Indication: Hyperkalemia, hypocalcemia, over dosage of calcium channel blocker
Dosage: For severe hyperkalemia with hemodynamic instability: 0.5-1 gram slow IV. Push over 2-5min or as slow IV infusion over 30 min.

Diltiazem:

Indication: Control rate in rapid AFIB / Aflutter
Precautions: may cause hypotension, avoid in patients with Wolf-Parkinson-White
Dosage: Initial bolus 15 – 20 mg slow IV Push; may start infusion at 5-15 mg/hr

Dopamine:

Indication: Hypotension not responding to IV fluids, symptomatic bradycardia
Precautions: may cause arrhythmias
Dosage: 5 - 20 mcg/kg/minute – titrate to control BP; ROSC:  2-10mcg/kg/min

Epinephrine:

Indication: Allergic reaction / anaphylaxis, asystole, PEA, pulseless Vtach / Vfib, symptomatic bradycardia
Precautions: may cause myocardial ischemia
Dosage: Allergic Reaction:  0.3 mg SQ/IM. Cardiac arrest with above rhythms: 1 mg IVP repeated every 3-5minutes. Bradycardia: 2-10mcg/min. ROSC: 0.1-0.5mcg/kg/min (7-35mcg/min).   

Flumazenil:

Indication: Reverse benzodiazepine overdose
Precautions: Half-life of benzodiazepine may be longer than flumazenil, may cause seizures
Dosage: 0.2mg IVP over 15seconds. May repeat Q1minute x 4 doses. Usual total dose is 0.6mg-1mg.  

Furosemide:

Indication: Acute pulmonary edema
Precautions: may cause hypotension, hypokalemia
Dosage: 40 – 80 mg IVP

Glucose:

Indication: Hypoglycemia, altered mental status
Precautions: may cause hyperglycemia
Dosage: Dextrose 25 grams (50 ml of D50W)

Lidocaine:

Indication: Vtach / Vfib
Precautions: monitor for mental status changes with continuous infusions
Dosage: 1– 1.5 mg/kg IVP.  Max total dose 3mg/kg. 

Naloxone (Narcan):

Indication: Opiate reversal
Precautions: may precipitate withdrawal in opioid-tolerant patients
Dosage: 0.04-0.4mg IV push over 30seconds.  May repeat prn until ventilation     adequate.  

Nitroglycerin:

Indication: Angina, acute pulmonary edema, hypertensive emergency
Precautions: may cause hypotension, bradycardia, tachycardia
Dosage: 0.4 mg SL, IV infusion 10 mcg/min titrate q 5 minutes

Sodium Bicarbonate:

Indication: Hyperkalemia, metabolic acidosis
Precautions: do not use for Hypercarbic (respiratory) acidosis
Dosage: 1 mEq/kg IVP