As emergency physicians, it's our job to know our way around the code cart. In this installment of Carolinas Core Concepts, Dr. Trigonis breaks down the common meds, indications, and doses for what we can find in your standard code cart. Note, this may vary from the formulations you have available at your hospital, so make sure you check your concentrations!
Med: CALCIUM
Indication: Stabilize Cardiac Membranes (hyperK)
Dose: CaCl2: 1g in 10mL syringe = 14mEq ("Code Calcium" - don't give peripherally!)
Calcium Gluconate: 2g = 9mEq. *This CAN be given peripherally
Med: EPINEPHRINE
Indication: Cardiac Arrest
“Code Epi” Dose: 1mg in 1mg/10mL syringe (1 dose per syringe)
"Push-dose Epi": 1mL Code Epi in 9mL NS flush (10mcg/mL). Push 1mL q2min PRN for hypotension or bradycardia in peri-arrest scenario
"Dirty Epi Drip": 1mg "Code Epi" in 1L NS (1mcg/mL conc.). Running wide open thru 18ga IV in AC is roughly 20mcg/min.
Med: NOREPINEPHRINE
Indication: Hypotension. (Vasopressor - primarily ⍺ agonist)
Dose: 4 – 30 mcg/min. Comes in 4mg / vial. 1 vial in 250cc D5W = 16mcg/mL.
Med: ATROPINE
Indication: Bradycardia (Muscarinic antagonist)
Dose: 0.5 mg. Vial comes in 1mg/1mL (2 doses per syringe).
Repeat q 1-3 minutes. Max dose 3mg.
Med: DOPAMINE
Indication: Bradycardia (chronitropic, inotropic agent)
Dosing:
Low doses: < 2mcg/kg/min –dopamine receptors (vasodilate)
Mid dose: 5-10mcg/kg/min – β1 (contractility/HR)
High dose: > 10 mcg/kg/min – ⍺1 (vasoconstriction)
Med: ADENOSINE
Indication: SVT
Dose: 6-12mg FAST PUSH. Comes in 6mg/2mL vial. 1-2 vials/dose.
Med: AMIODARONE
Indication: Arrhythmia
Dose:
Refractory Vfib/Vtach Arrest = 300mg (2 vials)
Repeat bolus 150mg (1 vial)
Tachycardia = 150mg (1 vial)
Amio gtt @ 1mg/min
Med: LIDOCAINE
Indication: Arrhythmia (Vfib/VTach Arrest, Stable VTach)
Dose: 1.5mg/kg. Comes in 100mg per syringe (1 dose per syringe)
Can repeat q5-10 minutes (0.5mg/kg)
Med: MAGNESIUM SULFATE
Indication(s): Arrhythmia, ecclamptic seizures
Dose: Torsades: 1-2g IV Push (1 – 2 vials)
Ecclampsia: 5g IM per buttcheek or 6g IV load
Med: SODIUM BICARBONATE
Indication: Metabolic acidosis
Dose: “1 amp” = 50mEq NaHCO3 in 50cc (Recommended 1mEq/kg)
• 1 amp raises pH 0.1 à Goal pH 7.2ish
• 8.4% NaHCO3 ≅ 6% HTS
• 2 amps bicarb = 100cc 6% = 200cc 3% (can substitute for HTS in a pinch for reducint ICP in TBI)
Med: D50
Indication: Hypoglycemia
Dose: 1 amp = 25g dextrose in 50mL (1 – 2 amps slow push for hypoglycemia)
The meds below may not be in your code cart, but they can still get you out of trouble:
Med: NALOXONE
Indication: Opioid overdose
Dose: 0.4 – 2 mg (Titrate to effect) Comes in syringe 2mg/2mL. or vial 0.4mg/mL
Med: PHENYLEPHRINE (NEOSTICK)
Indication: Hypotension (pure alpha adrenergic)
Dose: 200-300mcg q2-3 minutes. Comes in syringe: 800mcg/10mL (2-3mL q2-3min)
Med: CALCIUM
Indication: Stabilize Cardiac Membranes (hyperK)
Dose: CaCl2: 1g in 10mL syringe = 14mEq ("Code Calcium" - don't give peripherally!)
Calcium Gluconate: 2g = 9mEq. *This CAN be given peripherally
Med: EPINEPHRINE
Indication: Cardiac Arrest
“Code Epi” Dose: 1mg in 1mg/10mL syringe (1 dose per syringe)
"Push-dose Epi": 1mL Code Epi in 9mL NS flush (10mcg/mL). Push 1mL q2min PRN for hypotension or bradycardia in peri-arrest scenario
"Dirty Epi Drip": 1mg "Code Epi" in 1L NS (1mcg/mL conc.). Running wide open thru 18ga IV in AC is roughly 20mcg/min.
Med: NOREPINEPHRINE
Indication: Hypotension. (Vasopressor - primarily ⍺ agonist)
Dose: 4 – 30 mcg/min. Comes in 4mg / vial. 1 vial in 250cc D5W = 16mcg/mL.
Med: ATROPINE
Indication: Bradycardia (Muscarinic antagonist)
Dose: 0.5 mg. Vial comes in 1mg/1mL (2 doses per syringe).
Repeat q 1-3 minutes. Max dose 3mg.
Med: DOPAMINE
Indication: Bradycardia (chronitropic, inotropic agent)
Dosing:
Low doses: < 2mcg/kg/min –dopamine receptors (vasodilate)
Mid dose: 5-10mcg/kg/min – β1 (contractility/HR)
High dose: > 10 mcg/kg/min – ⍺1 (vasoconstriction)
Med: ADENOSINE
Indication: SVT
Dose: 6-12mg FAST PUSH. Comes in 6mg/2mL vial. 1-2 vials/dose.
Med: AMIODARONE
Indication: Arrhythmia
Dose:
Refractory Vfib/Vtach Arrest = 300mg (2 vials)
Repeat bolus 150mg (1 vial)
Tachycardia = 150mg (1 vial)
Amio gtt @ 1mg/min
Med: LIDOCAINE
Indication: Arrhythmia (Vfib/VTach Arrest, Stable VTach)
Dose: 1.5mg/kg. Comes in 100mg per syringe (1 dose per syringe)
Can repeat q5-10 minutes (0.5mg/kg)
Med: MAGNESIUM SULFATE
Indication(s): Arrhythmia, ecclamptic seizures
Dose: Torsades: 1-2g IV Push (1 – 2 vials)
Ecclampsia: 5g IM per buttcheek or 6g IV load
Med: SODIUM BICARBONATE
Indication: Metabolic acidosis
Dose: “1 amp” = 50mEq NaHCO3 in 50cc (Recommended 1mEq/kg)
• 1 amp raises pH 0.1 à Goal pH 7.2ish
• 8.4% NaHCO3 ≅ 6% HTS
• 2 amps bicarb = 100cc 6% = 200cc 3% (can substitute for HTS in a pinch for reducint ICP in TBI)
Med: D50
Indication: Hypoglycemia
Dose: 1 amp = 25g dextrose in 50mL (1 – 2 amps slow push for hypoglycemia)
The meds below may not be in your code cart, but they can still get you out of trouble:
Med: NALOXONE
Indication: Opioid overdose
Dose: 0.4 – 2 mg (Titrate to effect) Comes in syringe 2mg/2mL. or vial 0.4mg/mL
Med: PHENYLEPHRINE (NEOSTICK)
Indication: Hypotension (pure alpha adrenergic)
Dose: 200-300mcg q2-3 minutes. Comes in syringe: 800mcg/10mL (2-3mL q2-3min)