Page 257 - Critical Care Notes

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neuromuscular blockade during extended surgery; adjust the rate of adminis-
tration according to the patient’s response as determined by peripheral nerve
stimulation. An initial infusion rate of 3 mcg/g/min may be required to rapidly
counteract the spontaneous recovery of neuromuscular function; thereafter a
rate of 1–2 mcg/kg/min should be adequate to maintain continuous neuro-
muscular block in the 89%–99% range in most patients. Spontaneous recov-
ery from neuromuscular blockade following discontinuation of infusion of
cisatracurium may be expected to proceed at a rate comparable to that fol-
lowing single bolus administration. ICU administration: Follow the principles
for infusion in the operating room. At initial signs of recovery from bolus
dose, begin the infusion at a dose of 3 mcg/kg/min and adjust rates accord-
ingly. If patient is allowed to recover from neuromuscular blockade, readmin-
istration of a bolus dose may be necessary to re-establish neuromuscular
block quickly before reinstituting the infusion.
cosyntropin, Cortrosyn: Pituitary hormone. Uses: Testing adrenal cortical
function. Dosage: IM/IV 0.25–1 mg between blood sampling.
dexmedetomidine, Precedex: Sedative, alpha-2-adrenoceptor agonist. Uses:
Sedation in mechanically ventilated, intubated patients in the ICU. Dosages:
IV loading dose of 1 mcg/kg over 10 min, then 0.2–0.7 mcg/kg/hr; do not use
for more than 24 hr.
diltiazem, Cardizem: Calcium channel blocker. Uses: IV: Atrial fibrillation, flut-
ter, paroxysmal supraventricular tachycardia. Dosages: IV bolus 0.25 mg/kg
over 2 min initially, then 0.35 mg/kg may be given after 15 min; if no
response, may give continuous infusion 5–15 mg/hr for up to 24 hr.
dobutamine, Dobutrex: Adrenergic direct-acting beta-1-agonist, cardiac
stimulant. Uses: Cardiac decompensation from organic heart disease or
cardiac surgery. Dosages: IV infusion 2.5–10 mcg/kg/min; may increase to
40 mcg/kg/min if needed.
dopamine, Intropin: Adrenergic. Uses: Shock, increased perfusion, hypotension.
Dosages: Shock: IV infusion 2–5 mcg/kg/min, not to exceed 50 mcg/kg/min,
titrate to patient’s response.
epinephrine: Bronchodilator nonselective adrenergic agonist, vasopressor. Uses:
Acute asthmatic attacks, hemostasis, bronchospasm, anaphylaxis, allergic
reactions, cardiac arrest, adjunction in anesthesia, shock. Dosages: Asthma:
Inhaler 1–2 puffs of 1:100 or 2.25% racemic every 15 min. Bronchodilator:
SC/IM 0.1–0.5 mg (1:1,000 sol) every 10–15 min–4 hr, max 1 mg/dose.
Anaphylactic reaction/asthma: SC/IM 0.1–0.5 mg, repeat every 10–15 min,
max 1 mg/dose; epinephrine suspension 0.5 mg SC, may repeat 0.5–1.5 mg
every 6 hr. Cardiac arrest (ACLS): IV 1 mg every 3–5 min; endotracheal
2–2.5 mg; intracardiac (IC) 0.3–0.5 mg.
eptifibatide, Integrilin: Antiplatelet agent. Uses: Acute coronary syndrome
including those undergoing PCI. Dosages: Acute coronary syndrome: IV
bolus 180 mcg/kg as soon as diagnosed, then IV Continuous 2 mcg/kg/min
until discharge or CABG up to 72 hr. PCI in patients without acute coronary
syndrome: IV bolus 180 mcg/kg given immediately before PCI; then
CC MEDS