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Class I
A therapeutic option that is usually indicated, always acceptable and considered useful and effective
Class II
A therapeutic option that is acceptable, is of uncertain efficacy and may be controversial
Class II A - A therapeutic option for which the weight of evidence is in favor of its usefulness and efficacy Class II B - A therapeutic option that is not well established by evidence but may be helpful and probably is not harmful
Class III
A therapeutic option that is not well established by evidence but may be helpful and probably is not harmful
DRUG THERAPY
Administration of drug during Cardiac Arrest Central vs. Peripheral Infusion Endotracheal drug administration Intraosseous access
Pediatrics
10X the recommended IV dose diluted in 1 - 2 ml of Normal or half normal saline
Neonates
optimal dosage in newborn unknown
Pedia:
Age in years divided by 2 + 12
NALOXONE
Pedia
10 mcg (0.01mg)/kg/dose
Adults
400 mcg (0.4 mg)
ATROPINE
Pedia
10 mcg/kg/dose
Adults
250 mcg - 2 mg (antispasmodic) in single or divided doses 300 - 600 mcg IM, IV immediately before induction of anesthesia and in incremental doses for the treatment of bradycardia
VALIUM
Pedia
0.2 - 0.3 mg/kg/dose
Adult
5 - 10 mg
EPINEPHRINE
Pedia
0.01 mg/kg/dose First Dose:
1:10,000 = 0.1 cc or 0.01 mg/kg
EPINEPHRINE
Adults
1.0 mg in cardiac arrest
IV Dose
Standard (Class I) 0.5 - 1 mg q 3 - 5 min Intermediate Dose 2 - 5 mg q 3 - 5 min Escalating Dose 1 - 3 - 5 mg q 3 - 5 min
EPINEPHRINE
Infusion Drip
1 mg in 100 ml D5Water Initiate infusion at 2 and max. of 10 ug/min and titrated
EPINEPHRINE
Modified Rule of Six
weight in kg X 0.6 = mg to be incorporated in 100 cc IVF Stock Dose: 1 ml = 0.1 ug/min Infusion Dose: 0.1 ug/min titrated up to 1 ug/kg/min
Example: 5 kg Bwt 5 X 0.6 = 3 mg in 100 cc IVF or 7.5 mg in 250 cc Stock Dose : 1 ml = 0.1 ug/min Desired Dose : 0.2 ug 1ml = 60 ugtts :: 0.1 ug/min 1ml = 60 ugtts :: 0.2 ug/min : x = 12 ugtts/min
LIDOCAINE
Pedia
20 - 50 ug/kg/min
Adult
2 - 4 mg/min
INTRAOSSEOUS ACCESS
used to deliver rapid infusion
pressure infusion devices administering a bolus with a syringe attached to a three-way stopcock
INTRAOSSEOUS ACCESS
Intraosseous infusion needles
18 to 20 gauge spinal needle 14 - 20 gauge needle bone marrow needle
anterior tibial area 1-2 cm distal and medial to the tibial tuberosity
(proximal anterior tibial or distal femur bone marrow)
INTRAOSSEOUS ACCESS
avoiding the epiphysis not employed in a fractured extremity
Intravenous Fluids
Adults
Volume Expanders
whole blood crystalloid solutions colloid solutions
KVO = D5Water
Intravenous Fluids
Adults
PNSS
preferred infusion solution during cardiac arrest Hyperglycemia in cardiac arrest patients who survive is associated with worse neurological outcome Sodium overload is rarely encountered in normal saline
Intravenous Fluids
Adults
Volume administration is not recommended in routine cardiac arrest without indications of volume depletion
it may diminish blood flow to the cerebral and coronary circulation
Intravenous Fluids
Pediatrics
Volume Expanders
crystalloid solution colloid solution blood for severe acute hemorrhage
Intravenous Fluids
Pediatrics
Dextrose solutions should not be used in children (Class III) large volume of glucose containing IV solutions will result in:
hyperglycemia secondary osmotic diuresis potentially worse neurologic outcome.
Intravenous Fluids
Neonates
Volume expanders (Class I) - indicated when there is evidence or suspicion of acute blood loss with poor response to resuscitation Dosage : 10 ml/kg
NSS or PLR 5% Albumin saline or other plasma substitute O negative blood crossmatched with mothers blood