EMP 203
Post-Arrest Stabilization
1.) Upon return of a spontaneous pulse:
a. Ensure airway is secured with high concentration of oxygen
b. Assess the patient’s vital signs.
c. If the patient converted from a “shockable” rhythm to a stable rhythm that generates a pulse (NOT a high degree AV Block), you should do the following:
i. Administer a loading bolus of one of the following antidysrhythmic drugs if the loading dose was not administered during the resuscitation.
1. Lidocaine – 1.0mg/kg IVP
2. Amiodarone – 150mg over 10 minutes
3. Procainamide (20 - 50mg/min IVPB until dysrhythmia stops, hypotension develops, 17 mg/kg administered, or QRS widens by 50%)
ii. Establish an IV piggyback infusion of the antidysrhythmic you used for conversion or from the previous step as follows:
1. Lidocaine – Add 2g of lidocaine to a 500mL bag of NS making a 4mg/mL solution and label the bag. Infuse the drug at 1 – 4mg/min using the clock method below and a dial-a-flow or infusion pump. The clock method for this concentration is as follows:
4mg/min
3mg/min 1mg/min
2mg/min
2. Amiodarone: Mixed the same as lidocaine. Give 1mg/min for the first six hours using the clock method as previously described if mixed exactly like the lidocaine infusion. Then, give 0.5mg/min until dysrhythmia is controlled.
3. Procainamide: Mixed the same as lidocaine. Give 1 – 4mg/min using the clock method as above.
iii. Treat the patient’s vital signs as needed to maintain adequate perfusion
1. For hypotension:
a. Administer a fluid challenge if breath sounds are clear at 20mL/kg or 500mL if you suspect cardiogenic shock.
b. If the patient has rales or “wet” breath sounds or the fluid challenge does not produce the desired outcome you should administer a dopamine infusion at 5 – 20mg/kg/min.
i. Dopamine: Infusion can be prepared by adding 800mg of dopamine into a 500mL bag of normal saline. This gives the standard dopamine concentration of 1600mg/mL. You can then calculate the drip rate or use a dopamine chart to set your flow rate (see below).
2. For bradycardia:
a. Administer 0.5mg of atropine IVP to a total of 3mg while preparing for TCP.
b. TCP – provide without delay for high degree AV blocks
c. If above treatment fails – establish dopamine drip as above.
d. Evaluate and treat all of the common causes of cardiac arrest as needed by making a differential diagnosis (6 H’s and 6 T’s).
Hypovolemia Toxins
Hypoxia Tamponade, cardiac
Hydrogen ion acidosis Tension pneumothorax
Hypo-/Hyperkalemia Thrombosis - MI
Hypoglycemia Thrombosis - PE
Hypothermia Trauma
e. Reassess the patient every 5 minutes for ABC’s and increase or decrease drip rates as appropriate.
Dopamine infusion chart for 800mg in 500mL of NS (1600mg/mL)
Note infusion rates are listed in mL/hr
|
____________________ mg/kg/min |
|
||||||
kg
|
lbs |
2 |
5 |
10 |
15 |
20 |
|
|
40 |
88 |
3.0 |
7.5 |
15.0 |
22.5 |
30.0 |
|
|
45 |
99 |
3.4 |
8.4 |
16.8 |
25.2 |
33.6 |
|
|
50 |
110 |
3.8 |
9.4 |
18.8 |
28.2 |
37.6 |
|
|
55 |
121 |
4.1 |
10.3 |
20.6 |
30.9 |
41.2 |
|
|
60 |
132 |
4.5 |
11.3 |
22.6 |
33.9 |
45.2 |
|
|
65 |
143 |
4.9 |
12.2 |
24.4 |
36.6 |
28.8 |
|
|
70 |
154 |
5.3 |
13.1 |
26.2 |
39.3 |
52.4 |
|
|
75 |
165 |
5.6 |
14.1 |
28.2 |
42.3 |
57.6 |
|
|
80 |
176 |
6.0 |
15.0 |
30.0 |
45.0 |
60.0 |
|
|
85 |
187 |
6.4 |
15.9 |
31.8 |
47.7 |
63.6 |
|
|
90 |
198 |
6.8 |
16.9 |
33.8 |
50.7 |
67.6 |
|
|
95 |
209 |
7.1 |
17.8 |
35.6 |
53.4 |
71.2 |
|
|
100 |
220 |
7.5 |
18.8 |
37.6 |
56.4 |
75.2 |
|
|
105 |
231 |
7.9 |
19.7 |
39.4 |
59.1 |
78.8 |
|
|
110 |
242 |
8.3 |
20.6 |
41.2 |
61.8 |
82.4 |
|
Infusion rates as above should be administered with either a Dial-A-Flow or infusion pump. The type of administration set does not matter.
Example: Administer a dopamine infusion to an 80kg (176lbs) individual using the standard dopamine concentration of 1600mg/mL at a rate of 5mg/kg/min. You should prepare this drip by adding 800mg of dopamine to a 500mL bag of 0.9% saline solution (normal saline). What rate should you set your Dial-A-Flow if you are using a 10gtt/mL administration set.
Answer: According to the chart the answer is 15.0mL/hr
Proof:
Step 1:
Calculating gtt/min
gtt/min =
(5mg/kg/min)(80kg)(500mL)(10gtt/mL)
= 2.5gtt/min
800,000
mg
Step 2:
Convert gtt/min into mL/hr
m/hr = (2.5gtt/min)(60min/1hr) = 15mL/hr Like
Magic, It Works!
10gtt/mL