Code Blue (Drug Dosing)    [<<Back]
Drug Standard dose ROSC / Comments

Cardiac arrest - VF - Pulseless VT

Epinephrine 1 mg q3-5 min.
Drip: 0.1- 0.5 mcg/kg/min
Drip1mg/250ml --> (ml/hr) = wt x mcg/kg x 15.  1mg/100ml --> wt x mcg/kg x 6.  Endotracheal: 2-2.5 mg diluted with 10ml NS
Vasopressin 40 units IV x 1 0.01 - 0.03 units/min.  Drip: 40 units/100ml NS
0.01 units/min = 1.5 ml/hr;   0.03 units/min = 4.5 ml/hr.
Amiodarone 300mg IV over 1-2 seconds
May repeat 150 mg IV x 1.
Drip: 1 mg/min x 6 hrs, then 0.5 mg/min x 18 hrs.
Lidocaine 1 - 1.5 mg/kg over 2-3 min, then may repeat 0.5-0.75 mg/kg in 5-10 min. Max: 3 mg/kg. Drip: 1 - 4 mg/min.  1 gram/250 ml (ml/hr) =  mg/min x 15
Calcium Chloride 5-10 ml (0.5-1 gm) over 2-5min Calc gluc: 15-30 ml over 2 to 5 minutes.
Dopamine 5 - 10 mcg/kg/min. Drip: 400mg/250ml (ml/hr)= (wt)  x  (mcg/min)  x 0.0375
Norepinephrine 0.1 - 0.5 mcg/kg/min Drip: 4 mg/250ml (ml/hr) = (wt)  x  (mcg/min)  x 3.75
Magnesium VF/pulseless VT:  1-2 grams/ 10ml D5W over 2-5 minutes.

Ventricular tachycardia (VT)

Procainamide 25-50 mg/min until arrhy suppressed or hypoten or QRS prolonged by 50% Max cumulative dose: 17 mg/kg,.. Alt: 100mg q5min until arrhythmia is controlled or side effects listed.
Hemodynamically stable monomorphic VT
Amiodarone 150mg/100 ml D5W IV over 10 min. Repeat if necessary. F/b 1 mg/min IV x 6hrs,  then 0.5 mg/min IV x 18hr. (900mg/500 ml D5W).
Lidocaine See above.  
Magnesium Polymorphic VT: 1-2 grams/50-100ml D5W over 15 min.

Supraventricular tachycardia -  narrow complex tachycardias

Adenosine 6mg rapid iv, may repeat after 1-2 min 12mg rapid IV 2nd 12mg dose may be given if needed in 1-2 minutes. Max cumulative dose: 30 mg.
Diltiazem 15 to 20 mg (0.25 mg/kg) IV over 2 minutes; additional 20 to 25 mg (0.35 mg/kg) IV in 15 minutes if needed; 5 to 15 mg/hour IV maintenance infusion (titrated to AF heart rate if given for rate control)
Verapamil 2.5 to 5 mg IV over 2 minutes; may repeat  5 to 10 mg q15-30 min to total dose of 20-30 mg
Esmolol 500 mcg/kg (0.5 mg/kg) IV over 1 min, f/b  50 mcg/kg/min; if response is inadequate, repeat load,  f/b 100 mcg/kg/min.   Max  rate of 300 mcg/kg/min.
Metoprolol 5 mg over 1 to 2 min  repeat as needed q5min to max dose of 15 mg
Amiodarone See under VT  
Digoxin 8 to 12 mcg/kg total loading dose, give 50% IV over 5 min, then 25% of dose x 2  at 4-8hr  intervals

Bradycardia

Atropine 0.5 mg  rapid IV. May repeat q3-5min as needed up to  max cumulative dose of 3 mg.
Dopamine Refractory hypotension: IV infusion: 2-10 mcg/kg/minute- titrate dosage to desired effect.
Epinephrine Continuous IV infusion: 2-10 mcg/min - titrate dosage to desired effect.

Other Meds

Cisatracurium (Nimbex) 100 mg/250 mL D5W or NS. Loading dose: 0.1 to 0.2 mg/kg IV f/b  infusion at 1-3 mcg/kg/min  (0.06-0.18 mg/kg/hour) and adjust rate accordingly
Etomidate Peak effect: 1 min. Duration: 3-5 min. Procedural sedation (unlabeled use): I.V.: Initial: 0.1-0.2 mg/kg, followed by 0.05 mg/kg q3-5 min prn. Other: 0.2-0.6 mg/kg IV over 30-60 sec for induction
Phenylephrine Shock/hypotension: I.V. bolus: 100- 500 mcg/dose q 10-15min prn as needed   I.V. infusion: Ini dose: 100-180 mcg/min, or alt  0.5 mcg/kg/min; titrate. Dosing ranges between 0.4-9.1 mcg/kg/min.
Propofol Induction:  Healthy adults <55 yrs: I.V.: 2-2.5 mg/kg (~40 mg q10 sec). [Elderly, debilitated: 1-1.5 mg/kg (~20 mg  q10 sec).  ICU sedation: 5 mcg/kg/min ( 0.3 mg/kg/hour); inc by 5-10 mcg/kg/min (or 0.3-0.6 mg/kg/hour) q5-10 min desired sedation. usu maint: 5-50 mcg/kg/min (or 0.3-3 mg/kg/hr)
Fentanyl Pain management: Adults: Bolus at start of infusion: 1-2 mcg/kg or 25-100 mcg/dose; continuous infusion rate: 1-2 mcg/kg/hour or 25-200 mcg/hour.      Severe: I.M, I.V.: 50-100 mcg/dose every 1-2 hours as needed; patients with prior opioid exposure may tolerate higher initial doses
Succinylcholine Duration: I.V.: 4-6 minutes.   I.V.: Intubation: 0.6 mg/kg (range: 0.3-1.1 mg/kg).  
Vecuronium(Norcuron®) Ini bolus dose: 0.08-0.1 mg/kg, f/b  cont IV infusion  0.8-1.7 mcg/kg/min (0.048-0.102 mg/kg/hr)

MI / Stroke

Alteplase

Any quantity of drug not to be administered to the patient must be removed from vial(s) prior to admin of remaining dose.
ST-elevation MI (STEMI): I.V. Accelerated regimen:  Maximum total dose: 100 mg.     Patients >67 kg: Total dose: 100 mg over 1.5 hours --> [15 mg I.V. bolus over 1-2 minutes] then   [50 mg over 30 min], then [ 35 mg over 1 hour].   Patients </=67 kg: [15 mg I.V. bolus over 1-2 minutes] then   [0.75 mg/kg (not to exceed 50 mg) over 30 minutes]  then  [0.5 mg/kg (not to exceed 35 mg) over 1 hour].  Note: Thrombolytic should be administered within 30 minutes of hospital arrival. Administer concurrent aspirin, clopidogrel, and anticoagulant therapy (ie, unfractionated heparin, enoxaparin, or fondaparinux) with alteplase.

Acute ischemic stroke: Alteplase within 3-4.5 hrs of sx onset. Note: Perform noncontrast-enhanced CT or MRI prior to admin.  Recom total dose: 0.9 mg/kg (max total dose: 90 mg)    Patients </=100 kg: Load with 0.09 mg/kg (10% of 0.9 mg/kg dose) as an I.V. bolus over 1 minute, f/b 0.81 mg/kg (90% of 0.9 mg/kg dose) as a cont infusion over 60 min.  Patients >100 kg: Load with 9 mg (10% of 90 mg) as an I.V. bolus over 1 min, f/b  81 mg (90% of 90 mg) as a continuous infusion over 60 min.