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What is the classification of Atropine Sulfate?
Anticholinergic (antimuscarinic)
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What are the actions of Atropine Sulfate?
- Competes reversibly w/ acetylcholine @ site of the muscarinic receptor
- Receptors affected, in order from most to least sensitive: salivary, bronchial, sweat glands, eye, heart, & GI tract
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What are the indications of Atropine Sulfate?
Symptomatic bradycardia, asystole or PEA, nerve agent exposure, organophosphate poisoning
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What are the adverse effects of Atropine Sulfate?
decreased secretions resulting in dry mouth & hot skin temp, intense facial flushing, blurred vision or dilation of pupils w/ subsequent photophobia, tachycardia, restlessness; may cause paradoxical bradycardia if admin. is too low or too slow
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What are the contraindications of Atropine Sulfate?
Acute MI; myasthenia gravis; GI obstruction; closed-angle glaucoma; known sensitivity to atropine, belladonna alkaloids, or sulfites. Not effective for infranodal (type II) AV block & new third-degree block w/ wide QRS complex
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What are the dosages for Atropine Sulfate?
- Symptomatic Bradycardia: ADULT: 0.5mg IV/IO every 3-5 min to max dose of 3mg; ADOLESCENT: 0.02mg/kg (range 0.1-1mg/dose)IV/IO up to total dose of 2mg; PEDI: 0.02mg/kg (range 0.1-0.5mg/dose)IV/IO to total dose of 1mg
- Asystole/PEA: 1mg IV/IO every 3-5 min, to max dose of 3mg. May admin ETT @2-2.5mg dilute in 5-10mL NS
- Nerve Agent/Organophosphate Poisoning: ADULT: 2-4mg IV/IM repeat if needed every 20-30 min til symptoms dissipate, severe cases, initial dose can be as large as 2-6mg admin IV, repeat doses of 2-6mg can be admin IV/IM every 5-60 min; PEDI: 0.05mg/kg IV/IM every 10-30 as needed until symptoms dissipate; INFANTS <15LBS: 0.05mg/kg IV/IM every 5-20 min as needed til symptoms dissipate
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What is the classification of Epinephrine?
Adrenergic agent, inotropic
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What are the actions of Epinephrine?
Binds strongly w/ both alpha & beta receptors, producing increased BP, increased HR, bronchodilation
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What are the indications of Epinephrine?
Bronchospasm, allergic & anaphylactic reactions, restoration of cardiac activity in cardiac arrest
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What are the adverse effects of Epinephrine?
Anxiety, headache, cardiac arrhythmias, HTN, nervousness, tremors, chest pain, nausea/vomiting
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What are the contraindications of Epinephrine?
Arrhythmias other than VF, asystole, PEA; cardiovascular disease; HTN; cerebrovascular disease; shock secondary to causes other than anaphylactic shock; closed-angle glaucoma; diabetes; pregnant women in active labor; known sensitivity to epinephrine or sulfites
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What are the dosages for Epinephrine?
- Cardiac Arrest: 1:10000 solution. ADULT: 1mg IV/IO; may repeat every 3-5 min; PEDI: 0.01mg/kg IV/IO repeat every 3-5 min as needed (max dose 1mg)
- Symptomatic Bradycardia: 1:10000 solution. ADULT: 1mcg/min as cont. IV infusion, usually 2-10mcg/min IV, titrate to effect; PEDI: 0.01mg/kg IV/IO may repeat every 3-5 min (max dose 1mg), if ETT admin 0.1mg/kg
- Asthma Attacks and Certain Allergic Reactions: 1:1000 solution. ADULT: 0.3-0.5mg IM/SC may repeat every 10-15 min (max dose 1mg); PEDI: 0.01mg/kg IM/SC (max dose 0.5mg)
- Anaphylactic Shock: 1:10000 solution. ADULT: 0.1mg IV slow over 5 min or IV infusion 1-4mcg/min titrate to effect; PEDI: cont. IV infusion rate 0.1-1mcg/kg/min titrate to respone
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What is the classification of Dopamine (Intopin)?
Adrenergic agonist, inotropic, vasopressor
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What are the actions of Dopamine?
Stimulates alpha & beta adrenergic receptors, @ moderate doses (2-10mcg/kg/min) stimulates beta1 receptors resulting in inotropy & increased cardiac output while maintaining dopaminergic-induced vasodilatory effects, @ high doses (>10mcg/kg/min)alpha adrenergic agonism predominates & increased peripheral vascular resistance & vasoconstriction result
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What are the indications of Dopamine?
hypotension & decreased cardiac output associated w/ cardiogenic shock & septic shock, hypotension after return of spontaneous circulation following cardiac arrest, symptomatic bradycardia unresponsive to atropine
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What are the adverse effects of Dopamine?
Tachycardia, arrhythmias, skin & soft tissue necrosis, severe HTN from excessive vasoconstriction, angina, dyspnea, headache, nausea/vomiting
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What are the contraindications of Dopamine?
Pheochromocytoma, VF, VT, or other ventricular arrhythmias, known sensitivity (including sulfites); correct any hypovolemia w/ volume fluid replacement before admin.
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What are the dosages of Dopamine?
ADULT AND PEDI: 2-20mcg/kg/min IV/IO infusion, starting dose 5mcg/kg/min, may gradually increase infusion by 5-10mcg/kg/min to desired effect. Cardia dose usually 5-10mcg/kg/min, vasopressor dose usually 10-20mcg/kg/min. little benefit beyond 20mcg/kg/min
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What is the classification of Adenosine (Adenocard)?
Antiarrhythmic
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What are the actions of Adenosine?
Slows conduction of electrical impulses @ AV node
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What are the indications of Adenosine?
Stable reentry SVT. Does not convert AF, atrial flutter, or VT
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What are the adverse effects of Adenosine?
Generally mild and short-lived: sense of impending doom, complaints of flushing, chest pressure, throat tightness, numbness. Patients will have a brief episode of asystole after admin.
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What are the contraindications of Adenosine?
Sick sinus syndrome, second- or third-degree heart block, poison-/drug-induced tachycardia
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What are the dosages of Adenosine?
- ADULT & CHILDREN >50KG: initial 6mg rapid IV/IO (over 1-3 sec) immediately followed by 20mL NS flush, if rhythm not eliminated after 1-2 min 12mg rapid IV/IO, repeat a second time if required
- PEDI<50KG: initial 0.1mg/kg IV/IO (max dose 6mg) immediately followed by at least 5mL NS flush, may repeat @ 0.2mg/kg (max dose 12mg)
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What is the classification of Diltiazem (Cardizem)?
Calcium channel blocker, class IV antiarrhythmic
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What are the actions of Cardizem?
Blocks calcium from moving into heart muscle cell, prolonging conduction of electrical impulses through the AV node
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What are the indications of Cardizem?
Ventricular rate control in rapid AF
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What are the adverse effects of Cardizem?
Flushing; headache; bradycardia; hypotension; heart block; myocardial depression; severe AV block; & @ high doses cardiac arrest
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What are the contraindications of Cardizem?
Hypotension, heart block, heart failure
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What are the dosages of Cardizem?
- ADULT: optimum dose is 0.25mg/kg IV/IO over a 2 min period to control rapid AF; 20mg is reasonable for avg. adult patient. A 2nd higher dose of 0.35mg/kg IV/IO (25mg is a typical 2nd dose) may be admin. over a 2 min period if rate control not obtained w/ lower dose. For cont'd reduction in HR, a cont. infusion can be started @ range of 5-15mg/hr
- PEDI: not recommended
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What is the classification of Verapamil (Isoptin)?
Calcium channel blocker; class IV antiarrhythmic
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What are the actions of Verapamil?
Blocks calcium from moving into heart muscle cell, prolonging conduction of electrical impulses through the AV node. Also dilates arteries
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What are the indications of Verapamil?
AF, HTN, PSVT, PSVT prophylaxis
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What are the adverse effects of Verapamil?
Sinus bradycardia; first-, second-, or third-degree AV block; CHF; reflex sinus tachycardia; transient asystole; AV block; hypotension
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What are the contraindications of Verapamil?
Second- or third-degree AV block (unless functioning artificial pacemaker); hypotension (<90mmHg systolic) or cardiogenic shock; sick sinus syndrome ( unless functioning artificial pacemaker); WPW syndrome; LGL syndrome; severe left ventricular dysfunction; known sensitivity to verapamil or any component of the formulation; atrial flutter or AF and an accessory bypass tract; in infants <1yr
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What are the dosages of Verapamil?
- ADULT: 2.5-5mg IV/IO over 2 min (3 min in elderly), may repeat @ 5-10mg every 15-30 min to max dose of 30mg
- PEDI: CHILDREN 1-16yrs: 0.1mg/kg IV/IO (max 5mg/dose) over 2 min, may repeat in 30 min to max dose of 10mg; INFANTS <1yr: not recommended
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What is the classification of Propranolol (Inderal)?
Beta adrenergic antagonist, antianginal, antihypertensive, antiarrhythmic class II
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What are the actions of Propranolol?
Nonselective beta antagonist that binds w/ both beta1 & beta2 receptors. inhibits the strength of the heart's contractions, as well as HR, resulting in decreased cardiac oxygen consumption
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What are the indications of Propranolol?
Angine; narrow-complex tachycardias that originate from either a reentry mechanism (reentry SVT) or an automatic focus (junctional, ectopic, or multifocal tachycardia) uncontrolled by vagal maneuvers & adenosine in patients w/ preserved ventricular function; AF & atrial flutter in patients w/ preserver ventricular function; HTN; migraine headaches
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What is the classification of Metoprolol (Lopressor, Toprol XL)?
Beta agrenergic antagonist, antianginal, antihypertensive, class II antiarrhythmic
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What are the actions of Metoprolol?
inhibits the strength of heart's contractions, as well as HR decreasing cardiac oxygen consumption. Saturates beta receptors & inhibits dilation of bronchial smooth muscle (beta2 receptor)
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What are the indications of Metoprolol?
ACS, HTN, SVT, atrial flutter, AF, thyrotoxicosis
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What are the adverse effects of Metoprolol?
tiredness, dizziness, diarrhea, heart block, bradycardia, bronchospasm, drop in BP
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What are the contraindications of Metoprolol?
Cardiogenic shock, AV block, bradycardia, known sensitivity. Use caution in hypotension, chronic lung disease (asthma & COPD)
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What are the dosages of Metoprolol?
- Cardiac Indications?
- ADULT: 5mg slow IV/IO over a 5 min period, repeat @ 5 min intervals up to a total of 3 infusions totaling 15mg IV/IO
- PEDI: Not recommended
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What is the classification of Atenolol (Tenormin)?
Beta adrenergic antagonist, antianginal, antihypertensive, class II antiarrhythmic
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What are the actions of atenolol?
inhibits the strength of the heart's contractions & HR, decreasing cardiac oxygen consumption. Saturates the beta receptors & inhibits dilation of bronchial smooth muscle (beta2 receptors)
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What are the indications of atenolol?
ACS, HTN, SVT, atrial flutter, AF
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What is the classification of Esmolol (Brevibloc)?
Beta adrenergic antagonist, class II antiarrhythmic
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What are the actions of Esmolol?
inhibits the strength of the heart's contractions, as well as HR, decreasing cardiac oxygen consumption
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What are the indications of Esmolol?
ACS, MI, acute HTN, supraventricular tachyarrhythmias, thyrotoxicosis
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What is the classification of Amiodarone (Cordarone)?
antiarrhythmic, class III
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What are the actions of Amiodarone?
Acts directly of the myocardium to delay repolarization & increase the duration of action potential
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What are the indications of Amiodarone?
Ventricular arrhythmias; second-line agent for atrial arrhythmias
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What are the adverse effects of Amiodarone?
Burning @ injection site, hypotension, bradycardia
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What are the contraindications of Amiodarone?
Sick sinus syndrome, second- & third-degree heart block, cardiogenic shock, when episodes of bradycardia have caused syncope, sensitivity to benzyl alcohol & iodine
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What are the dosages of Amiodarone?
- VF & pulseless VT:
- ADULT: 300mg IV/IO, may be followed by 1 dose of 150mg in 3-5 min; PEDI: 5mg/kg (max dose 300mg), may repeat 5mg/kg IV/IO up to 15mg/kg
- Relatively stable patients w/ arrhythmias such as PVCs pr wide-complex tachycardia w/ a strong pulse:
- ADULT: 150mg in 100mL D5W IV/IO over a 10 min period, may repeat in 10 min up to a max dose of 2.2g over 24 hr; PEDI: 5mg/kg very slow IV/Io (over 20-60 min), may repeat in 5mg/kg doses up to 15mg/kg (max dose 300mg)
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What is the classification of Lidocaine (Xylocaine)?
Antiarrhythmic, class IB
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What are the actions of Lidocaine?
Blocks sodium channels, increasing recovery period after repolarization; suppresses automaticity in the His-Purkinje system & depolarization in the ventricles
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What are the indications of Lidocaine?
Ventricular arrhythmias, when amiodarone is not available; cardiac arrest from VF/VT, stable monomorphic VT w/ preserved ventricular function, stable polymorphic VT w/ normal baseline QT interval & preserved left ventricular function (when ischemia & electrolyte imbalance are treated), stable polymorphic VT w/ baseline QT prolongation suggestive of torsades de pointes
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What are the adverse effects of Lidocaine?
Toxicity (anxiety, apprehension, euphoria, nervousness, disorientation, dizziness, blurred vision, facial paresthesias, tremors, hearing disturbances, slurred speech, seizures, sinus bradycardia), seizures w/o warning, cardiac arrhythmias, hypotension, cardiac arrest, pain @ injection site
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What are the contraindications of Lidocaine?
AV block; bleeding; thrombocytopenia; known sensitivity to lidocaine, sulfite, or paraben. Use w/ caution in bradycardia, hypovolemia, cardiogenic shock, Adams-Stokes syndrome, WPW syndrome
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What are the dosages of Lidocaine?
- Pulseless VT & VF: ADULT IV/IO: 1-1.5mg/kg, may repeat @ half the original dose (0.5-0.74mg/kg) every 5-10 min to a max dose of 3mg/kg, if maintenance infusion warranted, rate 1-4mg/min; ADULT ETT: 2-10mg/kg diluted in 10mL NS; PEDI IV/IO: 1mg/kg (max 100mg) if maintenance infusion warranted, rate 20-50mcg/kg/min; PEDI ETT: 2-3mg/kg followed by 5 mL NS flush
- Perfusing Ventricular rhythms: ADULT: 0.5-0.75mg/kg IV/IO (up to 1-1.5mg/kg may be used), repeat 0.5-0.75mg/kg every 5-10 min to max total dose 3mg/kg. Maintenance infusion of 1-4mg/min (30-50mcg/kg/min) acceptable; PEDI: 1mg/kg IV/IO, may repeat every 5-10 min to max dose of 3mg/kg. maintenance infusion rate 20-50mcg/kg/min
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What is the classification of Procainamide (Pronestyl)?
Antiarrhythmic, class IA
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What are the actions of Procainamide?
Blocks influx of sodium through membrane pores, consequently suppresses atrial & ventricular arrhythmias by slowing conduction in myocardial tissue
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What are the indications of Procainamide?
Alt. to amiodarone for stable monomorphic VT w/ normal QT interval & preserved ventricular function, reentry SVT if uncontrolled by adenosine & vagal maneuvers if BP stable, AF w/ rapid rate in WPW syndrome
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What is the classification of Magnesium Sulfate?
electrolyte, tocolytic, mineral
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What are the actions of Magnesium Sulfate?
required for normal physiologic functioning, a cofactor in neurochemical transmission & muscular excitability, controls seizures by blocking peripheral neuromuscular transmission, a peripheral vasodilator & an inhibitor of platelet function
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What are the indications of Magnesium Sulfate?
Torsades de pointes, cardiac arrhythmias associated w/ hypomagnesemia, eclampsia & seizure prophylaxis in preeclampsia, status asthmaticus
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What are the adverse effects of Magnesium Sulfate?
Magnesium toxicity (flushing, diaphoresis, hypotension, muscle paralysis, weakness, hypothermia, & cardiac, CNS, or respiratory depression)
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What are the contraindications of Magnesium Sulfate?
AV block, GI obstruction. Use caution w/ renal impairment
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What are the dosages of Magnesium Sulfate?
- Pulseless VF/VT w/ Torsades de Pointes or Hypomagnesemia: ADULT: 1-2g in 10mL D5W IV/IO over 5-10 min; PEDI: 25-50mg/kg IV/IO over 10-20 min, may admin faster for torsades de pointes (max single dose 2g)
- Torsades de Pointes w/ pulse or cardia arrhythmias w/ hypomagnesemia: ADULT: 1-2g in 50-100mL D5W IV/IO over 5-60 min, follow w/ 0.5-1g/hr IV/IO titrate to control torsades.; PEDI: 25-50mg/kg IV/IO over 10-20 min (max 2g/dose)
- Eclampsia & seizure prophylaxis in preeclampsia: ADULT: 4-6g IV/IO over 20-30 min then infusion @ 1-2g/hr
- Status Asthmaticus: ADULT: 1.2-2g slow IV/IO over 20 min; PEDI: 25-50mg/kg dilute in D5W slow IV/IO over 10-20 min
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What is the classification of Vasopressin?
nonadrenergic vasoconstrictor
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What are the actions of Vasopressin?
Causes vasooconstriction independent of adrenergic receptors or neural innervation
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What are the indications of Vasopressin?
Adult shock-refractory VF or pulseless VT, asystole, PEA, vasodilatory shock
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What are the adverse effects of Vasopressin?
cardiac ischemia, angina
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What are the contraindications of Vasopressin?
responsive patients w/ cardiac disease
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What are the dosages of Vasopressin?
- ADULT: 40 U IV/IO may replace either the 1st or 2nd dose of epinephrine
- May be given ET but optimal dose is not known
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