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Mannitol
trade name
Osmitrol
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Mannitol
class
osmotic diuretic
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Mannitol
mechanism of action
- Inhibits sodium and water absorption in the kidneys
- Promotes fluid movement from the intracellular into the extracellular space
- Dehydrates brain tissue to decrease ICP
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Mannitol
indications
- Acute cerebral edema
- Blood transfusion reactions
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Mannitol
contraindications
- Acute pulmonary edema
- Severe pulmonary congestion
- Hypovolemia
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Mannitol
side effects
- Cardiovascular: chest pain
- Neurological: mental status change
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Mannitol
precautions
- May cause transient increase in intravascular volume
- May cause CHF
- May cause sodium depletion (hyponatremia)
- Will crystallize in low temperatures
- Should be used with in-line filters
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Mannitol
interactions
Should not be administered during blood transfusions
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Mannitol
routes
IV, IO, IVPB
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Mannitol
onset and duration
Onset in 15 minutes to reduce ICP, 1-3 hours for diuresis; may last 3-8 hours
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Mannitol
dosages
- Adult: 1.5 – 2 gm/kg slow IVPB/IV
- Pediatric: 0.25 – 0.5 gm/kg over 60 minutes
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Dopamine
trade name
Intropin
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Dopamine
class
- Sympathomimetic
- Catecholamine
- Vasopressor
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Dopamine
mechanism of action
- Low Dose or Renal/Mesenteric Dose (1-5 mcg/kg/min):
- Dilates renal and mesenteric arteries by stimulating dopaminergic receptors
- May decrease blood pressure due to vasodilation
- Increases urinary output
- Moderate Dose or Inotropic Dose (5-10 mcg/kg/min):
- Increases inotropy without increasing chronotropy
- Increases blood pressure by stimulating the beta1 receptors
- High Dose or Vasopressor Dose (10-20 mcg/kg/min):
- Causes vasoconstriction
- Increase inotropy and chronotropy
- Increases blood pressure by stimulating the alpha and beta1 receptors
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Dopamine
indications
- Cardiogenic shock
- Distributive shock after fluids
- Hemodynamically significant hypotension
- Symptomatic bradycardia (second line drug)
-
Dopamine
contraindications
- Hypovolemia
- Tachydysrhythmias
-
Dopamine
side effects
- Cardiovascular: tachycardia, hypertension/hypotension, chest pain, ventricular irritability
- Respiratory: dyspnea
-
Dopamine
precautions
- Cannulate largest vein possible and ensure IV patency (necrotic)
- Start a second IV line if additional medications are needed (Dopamine infusion should not be interrupted to ensure adequate therapeutic blood levels)
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Dopamine
interactions
- Flush tubing before and after administration of Sodium Bicarbonate as Dopamine will be inactivated by the change in pH
- Actions may be intensified if patient is also taking antidepressants
- May cause hypotension if patient taking phenytoin (Dilantin)
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Dopamine
onset and duration
Onset in 5 minutes and will last 3-5 minutes
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Dopamine
dosages
- Adult: Add 400 mg into 250 ml Normal Saline solution (creating1600 mcg/ml solution)
- Low dose: 1-5 mcg/kg/min
- Moderate dose: 5-10 mcg/kg/min
- High dose: 10-20 mcg/kg/min
- Pediatric: Add 400 mg into 250 ml Normal Saline solution (creating1600 mcg/ml solution)
- Low dose: 1-5 mcg/kg/min
- Moderate dose: 5-10 mcg/kg/min
- High dose: 10-20 mcg/kg/min
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Dopamine
notes
- Flow rate determines which receptor sites are stimulated and results in a graded response
- Frequent vital signs are required for all patients with a Dopamine infusion
- Once appropriate blood pressure is achieved, infusion may need to be slowed but should not be stopped
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Sodium Bicarbonate
trade name
NaHCO3
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Sodium Bicarbonate
class
Alkalinizing Agent
-
Sodium Bicarbonate
mechanism of action
- Increases blood pH by neutralizing excess buildup of acids
- Decreases precipitation of myoglobin in renal tubules
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Sodium Bicarbonate
indications
- Cardiopulmonary Arrest with:
- unsuccessful drug therapy and defibrillation
- suspected tricyclic overdose (acidosis)
- suspected hyperkalemia (elevated potassium in dialysis patients)
Crush syndrome or crush injury greater than 4 hours
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Sodium Bicarbonate
contraindications
none
-
Sodium Bicarbonate
side effects
- Neurological: headache, confusion, tetany (intermittent tonic spasms), seizures
- Respiratory: pulmonary edema
- Other: metabolic alkalosis, hypokalemia, hypocalcemia, tissue acidosis
-
Sodium Bicarbonate
precautions
- Use with caution in patients with CHF
- Administer for crush syndrome prior to removal of entrapped patient
-
Sodium Bicarbonate
interactions
Flush IV before and after administration as it will precipitate with calcium chloride and inactivates catecholamines
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Sodium Bicarbonate
routes
IV, IO
-
Sodium Bicarbonate
onset and duration
Onset is immediate and may last 1-2 hours
-
Sodium Bicarbonate
dosages
- Adult: 1 mEq/kg IV/IO
- Pediatric: 1 mEq/kg IV/IO
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Sodium Bicarbonate
notes
Verify IV patency before administration as it will cause tissue necrosis
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Calcium Chloride
trade name
none
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Calcium Chloride
class
electrolyte
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Calcium Chloride
mechanism of action
- Necessary for the proper function of the nervous, muscular, skeletal, digestive and endocrine systems
- Positive inotropic activity increases the strength of the myocardial contractions
- increases ventricular automaticity
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Calcium Chloride
indications
- Calcium Channel Blocker or Beta blocker overdose
- Acute hyperkalemia or cardiac arrest when hyperkalemia is suspected
- Hypocalcemia
- Suspected hypermagnesemia
-
Calcium Chloride
contraindications
- Digitalis toxicity
- Hypercalcemia
- Ventricular fibrillation
-
Calcium Chloride
side effects
- Cardiovascular: hypotension, dysrhythmias, cardiac arrest
- Neurological: syncope, tingling sensations
- Gastrointestinal: metallic taste
- Other: sense of heat waves, necrosis/cellulitis upon infiltration of IV
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Calcium Chloride
precautions
- Use with caution in patients with renal insufficiency or history of cardiac disease
- May cause cerebral or coronary vasospasm
- Can cause bradycardia if administration is too rapid
- Safe use in children, pregnant mothers or nursing mothers has not been established.
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Calcium Chloride
interactions
- Do not mix with sodium bicarbonate (forms precipitate crystals in blood)
- Potentiates the effects of digitalis
- Antagonizes the effects of calcium channel blockers
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Calcium Chloride
routes
IV, IO push
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Calcium Chloride
onset and duration
Onset is immediate with an unknown duration
-
Calcium Chloride
dosages
- Adult:
- Known or suspected hyperkalemia or Beta Blocker OD: 500-1000 mg slow IV/IO (may repeat in10 minutes). Max single dose 1 gram
- Calcium channel blocker (prophylaxis):2-4 mg/kg
Pediatric: 20 mg/kg (0.2ml/kg) slow IV/IO
Riverside County: not included in the Riverside County protocol
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Calcium Chloride
notes
Always flush IV after administration of any drug, in particular those that could form a precipitate like sodium bicarbonate.
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Insulin
mechanism of action
- Necessary for carrier mediated transport of glucose into body’s cells
- Promotes conversion of glucose to glycogen to lower blood glucose levels
-
Insulin
indications
hyperglycemia
-
Insulin
contraindications
none
-
Insulin
side effects
Neuological: hypoglycemia
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Insulin
interactions
beta blockers amy mask certain signs of hypoglycemia
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Insulin
onset and duration
Onset in 30 minutes to 1 hour and may last 2-3 hours
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Insulin
dosages
Adult: 10-25 units infused at a rate of 0.1 U/kg/hr
Pediatric: 10-25 units infused at a rate of 0.1 U/kg/hr
Riverside County: not included in the Riverside County protocol
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Insulin
notes
Obtain blood glucose level prior to administering. Insulin must be refrigerated if kept for greater than one month so when checking for home medications, check in the refrigerator as well
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Lidocaine Hydrochloride
trade name
-
Lidocaine Hydrochloride
class
- Antidysrhythmic Agent
- Local Anesthetic
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Lidocaine Hydrochloride
mechanism of action
- Suppresses ventricular ectopy
- Increases ventricular fibrillation threshold
- Decreases speed of electrical impulse through the conduction system
-
Lidocaine Hydrochloride
indications
- Ventricular dysrhythmias: symptomatic PVCs and VTach
- Cardiac arrest: VFib/pulseless VTach
- Post conversion from a ventricular dysrhythmia (with pulses or pulseless) into a perfusing rhythm
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Lidocaine Hydrochloride
contraindications
- Second degree heart block, Mobitz II
- Third degree heart block
- Junctional bradycardia
- Ventricular ectopy associated with bradycardia
- Idioventricular rhythm
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Lidocaine Hydrochloride
side effects
- Cardiovascular: bradycardia, hypotension, arrest
- Neurological: paresthesia, disorientation, slurred speech, seizures, lightheadedness, muscle twitching, tinnitis, blurred vision
- Respiratory: dyspnea, depression, apnea
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Lidocaine Hydrochloride
precautions
Due to reduced ability to excrete the drug and the resulting accumulation of the drug in the body, reduce dose in: suspected liver disease, suspected kidney disease, cardiogenic shock, pulmonary edema and the elderly
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Lidocaine Hydrochloride
interactions
- Increased effects in patients taking beta blockers, cimetidine (Tagamet), quinidine, and phenytoin (Dilantin)
- Decreases effects when mixed with barbiturates
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Lidocaine Hydrochloride
routes
IVP, IO, IVPB, ET
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Lidocaine Hydrochloride
onset and duration
Onset in 1-3 minutes and may last 10-20 minutes
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Lidocaine Hydrochloride
dosages
- Adult:
- VFib/Pulseless VTach: 1.0-1.5 mg/kg slow IVP/IO (over 1 minute) or 3 mg/kg ET. May repeat 1.5 mg/kg IVP/IO once (no repeat for ET). Maximum dose of 3 mg/kg
Ventricular Ectopy/Post Conversion:1 mg/kg slow IVP/IO (50 mg/minute) or 2 mg/kg ET. May repeat 0.5 mg/kg slow IVP/IO (50 mg/minute) every 5-10 minutes to a maximum of 3 mg/kg. May repeat 1 mg/kg ET once
- Pediatric:
- VFib/Pulseless VTach:1 mg/kg slow IVP/IO (over 1 minute) or 2 mg/kg ET. May repeat 1 mg/kg IVP/IO every 3-5 minutes or 1 mg/kg ET. Maximum dose of 3 mg/kg
Ventricular Ectopy/Post Conversion:1 mg/kg slow IVP/IO (50 mg/minute) or 2 mg/kg ET. May repeat 1 mg/kg slow IVP/IO (50 mg/minute) or 1 mg/kg ET Maximum dose of 3 mg/kg
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Lidocaine Hydrochloride
notes
Signs of Lidocaine Toxicity: vision disturbances (blurred or double vision), tinnitus, trembling, dyspnea, dizziness/syncope, seizures, chest pain, palpitations and bradycardic dysrhythmias
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