Page 691 - ACCCN's Critical Care Nursing

668 S P E C I A LT Y P R A C T I C E I N C R I T I C A L C A R E

Adverse events Hypotension with rapid administration. Use with caution if renal failure present. Muscle weakness, paralysis and respiratory failure. Tachycardia and excitement. Calcium is incompatible with a range of medications and may precipitate in IV lines. Tissue necrosis with extravascation may occur. Should not be routinely administered. Alkalosis, hypernatraemia, hyperosmolality, paradoxical cerebral acidosis, depressed card

IV or IO bolus of 0.1–0.2 mmol/kg. Maybe followed by an infusion of 0.3 mmol/kg over 4 hours. 0.2 mL/kg 10% calcium chloride, or 0.7 mL/kg 10% calcium 0.5–1 mmol/kg via IV or IO administered over 2–3 min. 0.03–0.07 mmol/kg via slow administration IV or IO. Periarrest: 0.2 mmol/kg/hr as a continuous infusion; dilute with at least 50 times its volume and mix well, as can be fatal. 0.2–0.5 mmol/kg/h to a maximum of 1 mmol/kg if hypo

Paediatric gluconate via IV

Dose

Bolus of 5 mmol. Periarrest: May be followed by infusion of 20 mmol infused over 4 hours. A bolus dose of 5–10 mL 10% calcium chloride (6.8 mmol). A bolus dose of 1 mmol/kg administered over 2–3 min. As NaHCO 3 is incompatable with many medications, it should be administered by a separate line or flushed before and after administration. 5 mmol via slow bolus. ARC & NZRC = Australian Resuscitation Council and New Zealand Resuscita

Adults

Torsades de pointes with or without a pulse; cardiac arrest associated with digoxin toxicity. Failure of defibrillation and adrenaline to reverse VF and Documented hypokalaemia or hypomagnesaemia. Hypocalcaemia, hyperkalaemia, overdose of calcium blockers. Correcting a metabolic acidosis (pH <7.1), or base deficit of ≤10 or after 15 min; pre-existing hyperkalaemia; tricyclic antidepressant overdose and urinary alkalinisation in ov

Indications pulseless VT. acidosis. toxicity.

TABLE 24.8, Continued Action Magnesium is a major intracellular cation resulting in smooth muscle relaxation and membrane stabilisation. Calcium is essential to nerve and muscle impulse formation and excitation. Sodium bicarbonate (NaHCO 3 ) is an alkaline agent that may be used to correct an acidosis. Routine administration of sodium bicarbonate for treatment of in-hospital and out of hospital cardiac arrest is not recommended. Potassium i