Emergency Calculations

Nikita

doi:10.31440/DFTB.4073

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Emergency Calculations

Team DFTB

Written on 29/06/2021
, Last updated 14/10/2021

Cite this article as:

Team DFTB . Emergency Calculations, Don't Forget the Bubbles, 2021. Available at: https://doi.org/10.31440/DFTB.4073

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Resus Drugs

Drug	Dose	Indication	Side effects/other info
Vasopressin	0.5-0.8 units/kg IV	Alternative vasopressor to adrenaline
Suxamethonium	Neonate: 3mg/kg IVnChild: 2mg/kg IV	Muscle relaxant for RSI	Bradycardia and asystole. Should give with atropine.
Sodium bicarbonate	1 mmol/kg IV (1 ml/kg of 8.4%) over 5 mins	Severe metabolic acidosis (pH <7.1)	S/E - hypernatraemia, hyperosmolality, myocardial dysfunction
Rocuronium	0.6-1.2 mg/kg stat, then 0.1-0.2 mg/kg boluses or 5-15 mcg/kg/min	Muscle relaxant
Procainamide	10-15 mg/kg IV over 30-60 mins	Haemodynamically stable SVT and VT
Potassium	0.03-0.07 mmol/kg IV by slow injection; or infusion of 0.2-0.5 mmol/kg/hr (max 1 mmol/kg/hr)	Hypokalaemia
Naloxone	For post-operative respiratory depression or over-sedation, give 0.002 mg/kg/dose (i.e. dilute 0.4mg to 20ml and then give 0.1ml/kg/dose). Repeat every 2 minutes x4 if required, then commence infusion by adding 0.3mg/kg to 30ml 5% dextrose and running at 0-1ml/hr (0.01mg/kg/hr).nnFor opiate overdose, give 0.01 mg/kg (max 0.4 mg) (i.e. dilute 0.4mg to 10ml and give 0.25ml/kg/dose). Repeat every 2 minutes x4 if required, then commence infusion by adding 0.3 mg/kg to 30ml 5% dextrose and running at 0-1 ml/hr (0.01mg/kg/hr)	For reversal of post-op respiratory depression or opiate overdose
Magnesium	0.1-0.2 mmol/kg IV bolus 25-50 mg/kg n(this is the same as 0.05-0.1 ml/kg of 50% (2 mmol/ml)	Hypomagnesaemia; antidysrhythmic for polymorphic ventricular tachycardia (due to long QT)
Lignocaine	1 mg/kg IV of 1% lignocaine	Only recommended in cardiac arrest if amiodarone is not available (or when IV/IO access is impossible as can be given via ETT)
Flumazenil	5 mcg/kg every 60 seconds to a maximum total of 40 mcg/kg then 210 mcg/kg/hr	Antidote for benzodiazepines
Dextrose	0.5 ml/kg of 50% dextrose IV; or 2 ml/kg of 10% dextrose IV	Hypoglycaemia	Maintenance requirement is usually 5-8 mg/kg/min
Calcium	0.2 ml/kg of 10% calcium chloride IV; or 0.7 ml/kg of 10% calcium gluconate IV (20 mg/kg). For calcium channel blocker antidote.	Management of arrhythmia caused by hyperkalaemia, hypocalcaemia, hypermagnesaemia or calcium channel blocker.	S/E - extravasation; myocardial and cerebral injury, coronary artery vasospasm, bradycardia with rapid administration. Don't give routinely in cardiac arrest.
Atropine	20 mcg/kg IV; 30 mcg/kg via ETT	Bradycardia caused by vagal stimulation or cholinergic drug toxicity	Use adrenaline instead for bradycardia with hypotension.
Amiodarone	5 mg/kg IV bolus (usually diluted with 5% dextrose to a concentration of 15mg/ml over 3 mins)	Good for ventricular arrhythmias - shock-resistant VF and pulseless VT. Also SVT, JET, atrial tachycardias.	S/E - hypotension, bradycardia, heart block. Lignocaine can be used as an alternative.
Adrenaline	10 mcg/kg (0.1 ml/kg of 1 in 10,000) IV; 100 mcg/kg via ETT; or 0.1-0.2 mcg/kg/min infusion into a large vein.	Asystole, bradycardia, VF, EMD.	S/E - vasoconstriction, hypertension, tachdysrrhythmias
Adenosine	0.05-0.1 mg/kg IV bolus; repeat after 1-2 mins if not reverted to sinus increasing the amount given by 0.05-0.1 mg/kg until sinus rhythm or dose of 0.3 mg/kg is reached. Adult dose is 6mg then 12mg	SVT