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– Cardiac tamponade: restricted card iac filling as a result o f h aem o p ericard ium o r
p ericard itis.
R equires im m ed iate p ericard ial tap after resto ratio n o f circulating vo lum e.
– Tension pneumothorax: d rainage o f the p neum o tho rax.
– Symptomatic pulmonary embolism: treat with an antico agulant in a ho sp ital setting.
A d m inistratio n o f dopamine o r epinephrine at a co nstant rate requires the fo llo wing co nd itio ns:
– clo se m ed ical sup ervisio n in a ho sp ital setting;
– use o f a d ed icated vein (no o ther infusio n/ injectio n in this vein), avo id the antecubital
fo ssa if p o ssible;
– use o f an electric sy ringe p um p (o r infusio n p um p );
– p ro gressive increase and ad ap tatio n o f d o ses acco rd ing to clinical resp o nse;
– intensive m o nito ring o f d rug ad m inistratio n, p articularly d uring sy ringe changes.
Example:
dopamine: 1 0 m icro gram s/ k g/ m inute in a p atient weighing 6 0 k g
H o urly d o se: 1 0 (m icro gram s) x 6 0 (k g) x 6 0 (m in) = 3 6 0 0 0 m icro gram s/ ho ur = 3 6
m g/ ho ur
In a 5 0 m l sy ringe, d ilute o ne 2 0 0 m g-am p o ule o f d o p am ine with 0 .9 % so d ium chlo rid e to
o btain 5 0 m l o f so lutio n co ntaining 4 m g o f d o p am ine p er m l.
F o r a d o se o f 3 6 m g/ ho ur, ad m inister the so lutio n (4 m g/ m l) at 9 m l/ ho ur.
If there is no electric syringe pump, d ilutio n in an infusio n bag m ay be co nsid ered .
H o w ever, it is im p o rtant to co nsid er th e risk s related to th is ty p e o f ad m inistratio n
(accid ental bo lus o r insufficient d o se). T he infusio n m ust be co nstantly m o nito red to p revent
any , even sm all, change fro m the p rescribed rate o f ad m inistratio n.
Example for epinephrine:
– In ad ults:
D ilute 1 0 am p o ules o f 1 m g ep inep hrine (1 0 0 0 0 m icro gram s) in 1 litre o f 5 % gluco se
or
0 .9 % so d ium chlo rid e to o btain a so lutio n co ntaining 1 0 m icro gram s o f ep inep hrine p er
•m 0l. .1 m icro gram / k g/ m inute = 5 m icro gram s/ m inute = 1 0 d ro p s/ m inute
K no wing that 1 m l = 2 0 d ro p s, in an adult weighting 50 kg:
• 1 m icro gram / k g/ m inute = 5 0 m icro gram s/ m inute = 1 0 0 d ro p s/ m inute, etc.
− In child ren:
D ilute 1 am p o ule o f 1 m g ep inep hrine (1 0 0 0 m icro gram s) in 1 0 0 m l o f 5 % gluco se o r
0we.9ig%hting 10 kg:
so d ium chlo rid e to o btain a so lutio n co ntaining 1 0 m icro gram s o f ep inep hrine p er m l.
F o r ad m inistratio n, use a paediatric infusion set; k no wing that 1 m l = 6 0 d ro p s, in a child
• 0 .1 m icro gram / k g/ m inute = 1 m icro gram / m inute = 6 d ro p s/ m inute
• 0 .2 m icro gram / k g/ m inute = 2 m icro gram s/ m inute = 1 2 d ro p s/ m inute, etc.
Note: acco unt fo r all infused vo lum es when reco rd ing ins and o uts.
– Cardiac tamponade: restricted card iac filling as a result o f h aem o p ericard ium o r
p ericard itis.
R equires im m ed iate p ericard ial tap after resto ratio n o f circulating vo lum e.
– Tension pneumothorax: d rainage o f the p neum o tho rax.
– Symptomatic pulmonary embolism: treat with an antico agulant in a ho sp ital setting.
A d m inistratio n o f dopamine o r epinephrine at a co nstant rate requires the fo llo wing co nd itio ns:
– clo se m ed ical sup ervisio n in a ho sp ital setting;
– use o f a d ed icated vein (no o ther infusio n/ injectio n in this vein), avo id the antecubital
fo ssa if p o ssible;
– use o f an electric sy ringe p um p (o r infusio n p um p );
– p ro gressive increase and ad ap tatio n o f d o ses acco rd ing to clinical resp o nse;
– intensive m o nito ring o f d rug ad m inistratio n, p articularly d uring sy ringe changes.
Example:
dopamine: 1 0 m icro gram s/ k g/ m inute in a p atient weighing 6 0 k g
H o urly d o se: 1 0 (m icro gram s) x 6 0 (k g) x 6 0 (m in) = 3 6 0 0 0 m icro gram s/ ho ur = 3 6
m g/ ho ur
In a 5 0 m l sy ringe, d ilute o ne 2 0 0 m g-am p o ule o f d o p am ine with 0 .9 % so d ium chlo rid e to
o btain 5 0 m l o f so lutio n co ntaining 4 m g o f d o p am ine p er m l.
F o r a d o se o f 3 6 m g/ ho ur, ad m inister the so lutio n (4 m g/ m l) at 9 m l/ ho ur.
If there is no electric syringe pump, d ilutio n in an infusio n bag m ay be co nsid ered .
H o w ever, it is im p o rtant to co nsid er th e risk s related to th is ty p e o f ad m inistratio n
(accid ental bo lus o r insufficient d o se). T he infusio n m ust be co nstantly m o nito red to p revent
any , even sm all, change fro m the p rescribed rate o f ad m inistratio n.
Example for epinephrine:
– In ad ults:
D ilute 1 0 am p o ules o f 1 m g ep inep hrine (1 0 0 0 0 m icro gram s) in 1 litre o f 5 % gluco se
or
0 .9 % so d ium chlo rid e to o btain a so lutio n co ntaining 1 0 m icro gram s o f ep inep hrine p er
•m 0l. .1 m icro gram / k g/ m inute = 5 m icro gram s/ m inute = 1 0 d ro p s/ m inute
K no wing that 1 m l = 2 0 d ro p s, in an adult weighting 50 kg:
• 1 m icro gram / k g/ m inute = 5 0 m icro gram s/ m inute = 1 0 0 d ro p s/ m inute, etc.
− In child ren:
D ilute 1 am p o ule o f 1 m g ep inep hrine (1 0 0 0 m icro gram s) in 1 0 0 m l o f 5 % gluco se o r
0we.9ig%hting 10 kg:
so d ium chlo rid e to o btain a so lutio n co ntaining 1 0 m icro gram s o f ep inep hrine p er m l.
F o r ad m inistratio n, use a paediatric infusion set; k no wing that 1 m l = 6 0 d ro p s, in a child
• 0 .1 m icro gram / k g/ m inute = 1 m icro gram / m inute = 6 d ro p s/ m inute
• 0 .2 m icro gram / k g/ m inute = 2 m icro gram s/ m inute = 1 2 d ro p s/ m inute, etc.
Note: acco unt fo r all infused vo lum es when reco rd ing ins and o uts.
