Amiodarone, Lidocaine, Procainamide
Cardizem
Vasopressin Drip
Insulin, Inhaled Nitric Oxide
Amiodarone, Lidocaine, Procainamide:
Amiodarone (Cordarone) Protocol 3/99
**for ventricular arrhythmias, and atrial fibrillation prophylaxis;
**May cause dramatic hypotension with concurrent alpha blockade
- order the solution from the pharmacy:
-150mg /100ml parfill bag
-900mg /500 ml glass bottle (1.8mg/ml)
-multichannel pump, extension set
- BOLUS (Loading) Dose: (Bag)
- 150mg (100ml) over 10 minutes
- MAINTENANCE Dose: (Bottle)
- 33 ml/hr (60mg /hr)
- after 6 hours: decrease rate to 17 ml/hr (30 mg/hr)
Lidocaine Drip
2gm /250 cc (8 mg/ml);1-4 mg/min (7-30 cc/hr)
Procainamide (Pronestyl)
Bolus:100 mg IV q 10 minutes or
Drip: 2 grams/250 ml D5W (8 mg /ml)
-run infusion at 20 mg/min (150 cc/hr) until:
1) QRS or PR widens >50%, or
2) Dysrhythmia suppressed, or
3) Hypotension, or
4) Total of 17 mg/kg or 1000 mg infused
Then 2-6 mg/min (15-45 cc/hr) Back to Top of Page
Cardizem:
Cardizem Drip
(for free radial artery grafts)
-mix 125 mg in 100c NaCl bag with additional 25 cc NaCl
-run @ 2mg/hr (2cc/hr) if started on patient warming
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Vasopressin Drip :
Vasopressin Drip
1/13/99
- often used to provide increased SVR during milrinone administration
- 100 units vasopressin/100 cc
- comes from pharmacy pre-mixed
- run @ 2.4 cc/hr (0.04 units/min)
- dose is NOT weight dependent
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Insulin, Inhaled Nitric Oxide:
Insulin Drip for Heart Cases
2/14/99- Cam Clark
- mix 100 units of reg Insulin in 100 ml NS
- for BS > 350, bolus 15 units and run infusion at 5 units/hr.
- for BS > 270 and < 350, bolus 10 units and run infusion at 4 units/hr.
- Obviously a carrier will be required with the INS infusion.
Nitric Oxide (inhaled)
Cam Clark 7/8/99
-therapeutic range 20-80 ppm; no increased benefit from higher concentration
-once started, must wean gradually to avoid rebound
Toxicity of NO2 - Methemoglobinemia; rarely an issue clinically
- circuit: essentially a modified BAIN
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