Critical Care Medication List[115].pdf

Critical Care Medication List Pain Control Morphine: 2-5mg IVP Q5 min (over 2 min) or 2-5mg IM Q15 min Fentanyl: 50-100mcg IVP (over 2 min) may be repeated in 5 min total of 100mcg or 50mcg IM can be repeated x1 in 15 minutes total of 100mcg Hydromorphone: 0.5-1mg IVP can...

Critical Care Medication List Pain Control Morphine: 2-5mg IVP Q5 min (over 2 min) or 2-5mg IM Q15 min Fentanyl: 50-100mcg IVP (over 2 min) may be repeated in 5 min total of 100mcg or 50mcg IM can be repeated x1 in 15 minutes total of 100mcg Hydromorphone: 0.5-1mg IVP can be repeated x1 only Ketamine: 30mg IVP (secondary to prior opioid) may repeat in 15 min Zofran: 4mg IVP/IM (over 2 min) can be repeated in 15 min for total 8mg Need Narcan on hand for all pain med administration Sedation Conscious Patient Midazolam: 2.5-5mg IVP/IN/IM repeat in 5 min Lorazepam: 1-4mg IVP Q15 min Diazapam: 2-10mg IVP/IM Q10 min Intubated Patient Propofol: continue @rate from transferring facility; increase 5-10mcg Q5-10 min Parameters 5-55mcg/kg/min Midazolam: 2.5-5mg IVP/IN/IM repeat in 5 min Rocuromium (if paralytic needed): 0.6-1.2mg/kg Q30 min Excited Delirium Ketamine: 1mg/kg IVP, 2mg/kg IM may repeat x1 only Blood Reaction Diphenhydramine (allergic reaction): 25-50mg IVP/IM Furosemide (signs CHF): 20mg IVP/IO Q each unit Bronchospasm Albuterol: 2.5mg/3ml Neb may repeat PRN Ipratropium: 0.5mg/2.5ml Neb (may give as DuoNeb) may repeat x4 Prednisone: 60mg PO Methylprednisolone: 125mg IVP Dexamethasone: 10mg IVP Racemic Epi 2.25%: Max single dose 0.5ml may repeat Q20 min Magnenium Sulfate (severe asthma exacerbation): 2g IVP over 20 min Epi 1:1,000: 0.3mg IM Terbutaline: 0.25mg SQ/IM RSI Premedication Fentanyl: 0.5-1mcg/kg IVP Lidocaine (head injury): 1mg/kg Sedation Etomidate: 20mg IVP Midazolam: 5mg IVP Watch for hypotension Paralytic Rocuronium: 100mg IVP Succinylcholine: 100mg IVP Consider contraindications (burns, major trauma, motor neuron injury) Hypertensive Emergencies HTN d/t cocaine/methamphetamine use Midazolam: 2.5-5mg IVP/IM Repeat Q3-5 min Lorazepam: 1-4mg IVP Repeat Q15 min Diazepam: 2-10mg IVP/IM Repeat Q10 min HTN with tachycardia, HA, N/V, confusion Labetalol: 10-20mg IVP(over 2 min) May double dose & repeat PRN. Max 300mg Hydralazine: 10mg slow IVPMay repeat Q20 min Max 40mg Nicardipine: Start @ 5mg/hr Increase by 2.5mg Q15 min Max 15mg/hr Esmolol: Bolus 500mcg/kg over 1 min Infuse 50mcg/kg/min Increase by 50mcg/kg/min Q5-10 min Max 200mcg/kg/min Caution with Brady Nitroglycerin: Start @ 10mcg/min Titrate as needed Max 20mcg/min No response to above Medications *Nitroprusside: 0.3mcg/kg/min Increase by 0.5mcg/kg/min Max 3mcg/kg/min May increase up to 10mcg/kg/min for 10 min but then must reduce Pulmonary Edema/CHF Nitroglycerin: 0.4mg SL Q3-5 min with SBP > 90mmHg Nitroglycerin: Start @ 10-200mcg/min Titrate by 10mcg/min per sx Q5-10 min Max 300mcg/min Furuosemide: 40mg or1mg/kg or current daily dose IVP Enalapril: 1.25mg IVP Only with no indication of inferior wall damage *Milrinone: 0.25-0.75mcg/kg/min cardiogenic shock ACS/STEMI Aspirin: 324mg PO Nitrogylcerin: 0.4mg SL Q3-5 min for SBP > 90mmHg Nitro Infusion: 10-200mcg/min titrate to SBP/Sx Max 300mcg/min Pain Management Protocol Heparin: 60units/kg Max 4,000 units Heparin Infusion: 12units/kg/min Max 1,000 units/hr Ranitidine: 150mg PO Metoprolol: 5mg IVP Q5 min Max total 15mg Brilinta: 180mg PO or Plavix: 300mg PO Glycoprotein IIb/IIIa Inhibitors: may be continued if started by transferring facility Thrombolytic Therapy: may be continued if started by transferring facility Induced Hypothermia Chilled 0.9% NS 30ml/kg over 1 hour Max 2 liters V-Fib/Pulseless V-Tach Epi 1:10,000: 1mg IVP/IO or 2mg ETT Q3-5 min Amiodarone: 300mg IVP/IO Lidocaine: 1.5mg/kg IVP/IO May repeat 1.5mg/kg in 3-5 min Max total of 3mg/kg Mag Sulfate: 2g IVP (over 2 min) for Torsades, Dig toxicity or Hypomagnesemia Atropine: 1mg IVP/IO repeat Q3-5 min Max 0.04mg/kg considered for vagal-induced arrest Conversion Drips Amiodarone: 60mg/hr for 6 hours Reduce to 30mg/hour for 18 hours Lidocaine: 2-4mg/min; if one dose IVP 2mg/min, 2 or 3 doses IVP 3mg/min PEA Epi 1:10,000: 1mg IVP/IO or 2mg ETT Q3-5 min Asystole Transcutaneous Pacing Epi 1:10,000: 1mg IVP/IO or 2mg ETT Q3-5 min Unstable Bradycardia 500ml NS bolus for SBP < 100mmHg Initiate TCP Atropine: 0.5mg IVP Repeat 0.5mg IVP Q5 min total 0.4mg/kg Initiate Vasopressor PRN Dopamine: 2-10mcg/kg/min Levophed: 1mcg/min Titrate by 2mcg/min Q5 min PRN Max 40mcg/min Epinephrine: 2-10mcg/min *Isoproterenol: 2-10mcg/min Glucogon: 3mg IVP and infuse @ 3mg/hr for BB/CCB overdose Narrow Complex Tachycardia Adenosine: 6mg rapid IVP Repeat 12mg IVP in 2 min Diltiazem: 0.1-0.25mg/kg IVP (over 2 min) Repeat 0.35mg/kg Q15 min Max 25mg Diltiazem Infusion: 5-15mg/hr if used to convert rhythm Amiodarone: 150mg IV over 10 min (filter must be used) Amio Infusion: 1mg/min for 6 hours, then 0.5mg/min for 18 hours Metoprolol: 5mg IV over 10 min May repeat x2 Max of 15mg Esmolol: 500mcg/kg bolus, Infusion @ 50mcg/kg/min increase by 50mcg/kg/min Q5 min Max 200mcg/kg/min A-Fib/A-Flutter Diltiazem: 0.1-0.25mg/kg IVP (over 2 min) Repeat 0.35mg/kg Q15 min Max 25mg Diltiazem Infusion: 5-15mg/hr if used to convert rhythm Metoprolol: 5mg IV over 10 min May repeat x2 Max of 15mg Amiodarone: 150mg IV over 10 min (filter must be used) Amio Infusion: 1mg/min for 6 hours, then 0.5mg/min for 18 hours Esmolol: 500mcg/kg bolus, Infusion @ 50mcg/kg/min increase by 50mcg/kg/min Q5 min Max 200mcg/kg/min Wide Complex Tachycardia Amiodarone: 150mg IV over 10 min (filter must be used) Synchronized Cardioversion Lidocaine: 1.5mg/kg Repeat Q5 min to max dose 3mg/kg Mag Sulfate: 2g IVP for suspected Torsades or Hypomagnesemia *Promcainamide: 2-4mg/min IV Vasopressor/Hypotensive Emergency 500ml NS bolus for SBP < 100mmHg Repeat 20ml/kg PRN Dopamine: 2-10mcg/kg/min Titrate to target BP Levophed: 2-10mcg/min Maintenance infusion 2-30mcg/min to obtain target BP  First choice in Septic Shock Dobutamine: 2-20mcg/kg/min Titrate to target BP Epinephrine: 2-10mcg/min *Isoproterenol: 2-10mcg/min *Phenylephrine: 100-180mcg/min Titrate to target BP First choice in Neurogenic Shock *Vasopression: 0.04 units/min Titrate to target BP Secondary to Levophed for Septic Shock Nausea & Vomiting & Bowel Obstruction Zofran: 4mg IVP/IO/IN Repeat Q10 min PRN Promethazine: 12.5-25mg slow IVP/IM Reglan: 10mg IVP GI Bleeding Protonix: 80mg IV over 5 min Protonix Infusion: 8mg/hr Octreotide: 50mg IVP Upper GI bleed Octreotide Infusion: 50mcg/hr Ranitidine: 50mg IV over 5 min Famoditine: 20mg IVP Blood Products: 1-2 units PRBCs or Platlets Hypoglycemia Thiamine: 100mg IVP (over 2 min) for malnutrition or hx alcohol abuse D10W: 250ml over 15 min titrate to BS > 60 Glucagon: 1mg IVP/IO/IM If BS >60 but still symptomatic D10W: 125ml/15 min until sx resolve Glucagon: 0.5mg IVP/IO/IM Hyperglycemia/DKA BS 400ml/dL 0.9% NS: 2000ml/hr for 1st hour, 500ml/hour next 4 hours D5NS: 250ml/hr when BS 250ml/dL Insulin Infusion 100units/100ml NS: 0.1 units/kg/hr Seizures Thiamine: 100mg IVP (over 2 min) for malnutrition or hx alcohol abuse Lorazepam: 2mg IVP Repeat Q2-5 min Max 10mg Midazolam: 2mg IVP, 5mg IM, 10mg IN Repeat Q2-5 min Max 15mg Diazepam: 5-10mg IVP Repeat Q10-15 min Max 30mg If more than 1 Benzo required Fosphenytoin: 15-20mg/kg in 100ml NS over 30 min Max infusion 150mg/min Phenobarbital: 10-20mg/kg (not to exceed 60mg/min) every 20 min until seizure has stopped Max 30mg/kg If advanced airway & Seizure continues Propofol: 10-20mcg/kg/min slow infusion Maintenance infusion 5-55mcg/kg/min Altered Mental Status Thiamine: 100mg IVP/IM for chronic alcohol abuse Narcan: 2mg IVP/IM/IN if drug abuse suspected or signs narcotic intoxication Stroke Ischemic Stroke Thrombolytic Therapy Alteplase: 0.9mg/kg Max 100mg 10% of dose given as bolus Remaining 90% as infusion over 60 min Hypertensive SBP >180 or DBP >110 during or after Alteplase Labetalol: 20mg slow IVP Repeat Q10 min Next dose 40mg then all repeated doses 80mg Max 300mg Nicardipine: 5mg/hr IV Increase by 2.5mg/hr Q5-15 min for target BP Max 15mg/hr Hemmorraghic Stroke Nicardipine: 5mg/hr IV Increase by 2.5mg/hr Q5-15 min for target BP Max 15mg/hr Labetalol: 10-20mg slow IVP Repeat Q10 min Next dose 40mg then all remaining dose 80mg Max 300mg *Mannitol: 0.5-1g/kg IV over 5-10 min (filter must be used) Subarachnoid Hemorrhage Nicardipine: 5mg/hr IV Increase by 2.5mg/hr Q5-15 min for target BP Max 15mg/hr Once target BP achieved, slowly reduce by 3mg/hr Labetalol: 10-20mg slow IVP Repeat Q10 min Next dose 40mg then all remaining dose 80mg Max 300mg *Mannitol: 0.5-1g/kg IV over 5-10 min (filter must be used) Toxin Exposure OD result of anesthesia Romazicon: 0.3mg over 30 min Repeat to Max of 1.0mg Beta Blockers Normal Saline: 500ml bolus Repeat PRN up tp 2L Calcium Channel Blockers & Mag Sulfate Calcium Gluconate 10%: 1000mg over 5-10 min Repeat in 5-10 min Contraindicated Dig Toxicity Glucagon: 3-10mg IVP Carbon Monoxide Cyanokit: Continue if initiated by transferring facility Cocaine/Methamphetamine OD Lorazepam: 1mg IVP/IM Haloperidol: 5mg IVP/IM Versed: 2mg IVP, 5mg IM, 10mg IN Repeat 10 min max of 2 doses Digoxin OD Digibind: Vials to be given = dig level x wt in kg/100 Must be initiated by transferring facility No Calcium Gluconate for dig toxicity Eye Exposures Normal Saline/Sterile Water: Irrigate with minimum 1000ml Tetracaine Drops: 1-2 drops/eye Repeat Q10-15 minutes PRN Narcotic OD Narcan: 2mg IVP/IN Repeat Q3-4 min Narcan Infusion: 1.5mg/hr Organophosphate/Cholinergic Poisoning Atropine: 1-2mg IVP Repeat Q5-10 min until SLUDGE sx resolve Tricyclic Antidepressants Sodium BiCarb: 50mEq IVP Repeat Q5min x2 for wide QRS or dysrhythmias Normal Saline: 500-1000ml bolus Mag Sulfate: 1-2g over 1-2 min for arrest Repeat in 5-10 min Sepsis Tylenol: 10-15mg/kg PO/PR Max 1gm Normal Saline 0.9%: 30ml/kg bolus Repeat to maintain MAP > 65mmHg Levophed: 2-10mcg/min Maintenance infusion 2-30mcg/min to obtain target BP Epinephrine: 2-10mcg/min *Vasopression: 0.04 units/min Titrate to target BP Secondary to Levophed for Septic Shock Potassium Imbalance Hypokalemia 7.0 Calcium Gluconate: 1gm IVP over 5 min Repeat Q10 min (don’t need C. Line) 1gm/100ml NS over 30 min for patients on Digoxin Calcium Chloride 10%: 1gm over 2 min Repeat Q10 min (C. Line, unless in arrest) 1gm/100ml over 30 min for patients on Digoxin Sodium Bicarb: 50mEq IVP D10W: 25g IVP followed by Regular Insulin 10 units Albuterol: 10mg/3ml NS nebulized Can repeat D10W & Albuterol Q60 min Anaphylaxis Normal Saline 9%: 250ml IV infusion Repeat PRN Albuterol: 2.5mg/3ml nebulizer Diphenhydramine: 50mg IVP (over 2 min) Repeat x1 Epi 1:1,000: 0.3-0.5mg IVP IM Q15 min until sx decrease Methyprenisolone: 125mg IVP Ranitidine: 50mg/50ml NS over 5 min Temperature Related Illnesses Hyperthermia/Heatstroke Normal Saline 9%: 250ml bolus Repeat PRN Hypothermia/Frostbite Normal Saline 9%: 250ml bolus Then reduce to 100ml/hr, fluids warmed to 42C Pulmonary Embolism Thrombolytic therapy continued based on transferring facility orders Heparin: 80 units/kg IVP initial bolus Max 7,500 units Infusion 18 units/kg/hr Max 1,800 units/hr Alteplace: 100mg IVPB over 2 hrs Aortic Aneurysm/Aortic Dissection For Hypertension Esmolol: 500mcg/kg bolus x1 Infusion 50mcg/kg/min Increase by 50mcg/kg/min Q5 min Max 200mcg/kg/min Labetalol: 10-20mg slow IVP Repeat Q10 min Next dose 40mg then all remaining dose 80mg Max 300mg or SBP > 100mmHg Metoprolol: 5mg IVP Q5 min Max 3 doses Nicardepine: 2.5mg/hr Increase Q15 min Max of 15mg/hr If SBP remains > 120 *Nitroprusside: 50mg/250ml D5W Start 0.5mcg/kg/min Increase Q5 min 0.5-1mcg/kg/min Max 10mcg/kg/min Tranexamic Acid/TXA TXA: 1g/100ml NS IV over 10 min TXA: 1g/500ml NS IV over 8 hrs Traumatic Brain Injury *Mannitol: 0.5-1g/kg IV over 5-10 min (filter must be used) Need Med Control Crush Injury Pre-Extrication Normal Saline 9%: 1000ml WO Additional fluid to maintain MAP 65 Sodium Bicarb: 50mEq IVP Infusion 50mEq/1L @ 1000ml/hr Immediately prior to moving patient Sodium Bicarb: 50mEq IVP Burn Trauma Lactated Ringers: 2L/kg/TBSA IV 50% over the 1st 8 hours 50% over the next 16 hours Near Drowning Albuterol: 2.5mg/3ml nebulizer airway constriction Repeat Q15 min Vent/Capnography Current EtCO2 x Current VR = Desired VR to achieve desired CO2 Desired EtCO2 Transcutaneous Pacing Anterior/Posterior placement of pads Target HR 70 bpm Set at minimum current to start, increase until capture