Ppf-Treatment of Shock

250-500 mL (12.5-25 g of protein) IV PRN based on response

Monitor for signs of hypervolemia

Available forms
Available by prescription only
Injection: 5% solution in 50-ml, 250-ml, 500-ml vials
Indications and dosages
Shock. Adults: Varies with patients condition and response, but usually 250 to
500 ml (12.5 to 25 g protein) I.V., not to exceed 10 ml/minute.
Children and infants: 22 to 33 ml/kg I.V. infused at rate of 5 to 10 ml/minute.
Hypoproteinemia. Adults: 1,000 to 1,500 ml I.V. daily. Maximum infusion rate is
8 ml/minute (500 ml infused in 30 to 45 minutes).
Use opened solution promptly, discarding unused portion after 4 hours; solution
contains no preservatives and becomes unstable.

Hypovolemia
250-500 mL (12.5-25 g of protein) IV PRN based on response
Store at room temperature (NMT 30C)
Do not freeze
Do not use if protein colloid appears turbid, vial is damaged or if 4 hr passed since container was first entered

Lidocaine injection is a local anesthetic (numbing medication). It works by blocking

nerve signals in your body.
Lidocaine injection is used to numb an area of your body to help reduce pain or
discomfort caused by invasive medical procedures such as surgery, needle punctures,
or insertion of a catheter or breathing tube.
Lidocaine injection is sometimes used to treat irregular heart rhythms that may signal a
possible heart attack.
Lidocaine injection is injected into a vein through an IV to treat heart rhythm problems.
When used as a numbing medicine, lidocaine injection is injected through the skin
directly into the body area to be numbed.

Your breathing, blood pressure, oxygen levels, and other vital signs will be watched
closely while you are receiving lidocaine injection in a hospital setting.
Adrenaline
ICU INDICATIONS:
1. cardiac arrest
2. anaphylaxis
3. upper airway obstruction
4. inotrope/vasopressor

Adrenaline ampoules:
o 1mg in 1ml (1:1000)
o 1mg in 10ml (1:10000).
Mini-jets contain 1mg in 10ml are also available.

Compatible with the following IV fluids:

Normal saline, D5W, Glucose and Sodium Chloride, Hartmanns

No dosage adjustment is required in renal failure or renal replacement therapy.

Atropine ROUTES:
ICU INDICATIONS:
1. To temporarily increase heart rate or decrease AV-block until definitive
intervention can take place

2. Bradycardia: 0.5mg IV maximum of 3mg

Endotracheal route(only if IV access cannot be obtained) The recommended
adult dose : 1 to 2 mg diluted to a total not to exceed 10 ml of sterile water or
normal saline.
Dilution
Adults: Dilute dose in 510 mL of NS or sterile water.
Dilution
For administration via a nebulizer, the dose as a 0.2 or 0.5% solution has been diluted
with 35 mL of 0.45 or 0.9% NS
Calcium chloride
ICU INDICATIONS:
1. Hypocalaemia (particularly if there is refractory shock or bleeding)
2. ECG abnormalities caused by hyperkalemia (acts as a membrane stabiliser)
3. Magnesium toxicity
PRESENTATION AND ADMINISTRATION:

IV:
Preferably give via a central line (if this is present)

Compatible with the following IV fluids:

D5W, normal saline, glucose and sodium chloride, Hartmanns
.
Sodium Bicarbonate

ICU INDICATIONS:
1. Correction of normal anion gap acidosis
2. Correction of severe metabolic acidosis
IV:
8.4% (1mmol/ml) 10ml ampoule and 8.4% 50 & 100ml glass bottles

Do not use solutions which are cloudy or have visible precipitate

In ICU, it is usual to administer sodium bicarbonate undiluted over an hour or
less; in an emergency situation it can be administered undiluted by direct IV
injection.
Ephedrine
ICU INDICATIONS:
1. Drug-induced hypotension
2. bronchospasm
Note: used commonly in Anaesthesia but of limited utility in the ICU setting
IV:
Ampoules contain 30mg in 1ml
Dilute 30mg to a total of 10ml using normal saline (giving a concentration of
3mg/ml)
Protect from light with the following IV fluids:
Normal saline, 5%dextrose, 10%dextrose, Glucose and sodium chloride,
Hartmanns
Isoprenaline Hydrochloride
ICU INDICATIONS:

1. bradycardia
Note: current international guidelines DO NOT recommend isoprenaline as the
first line agent to treat any condition.

IV:
For IV infusion, add 1mg to 50ml of compatible IV fluid and administer at 060ml/hr (0-20mcg/min)
Compatible with the following IV fluids:

Isoprenaline and adrenaline should not be administered simultaneously because

both drugs are direct cardiac stimulants and their combined effects may induce
serious arrhythmias. Beta receptor blocking agents and isoprenaline inhibit the
effects of each other.

Verapamil/ Isoptin
ICU INDICATIONS:
1. Tachycardias including paroxysmal SVT, AF, atrial flutter with rapid ventricular
response, extrasystoles
2. Hypertension
3. Acute coronary insufficiency

IV:
Isoptin 5mg in 2ml solution

IV: Injection: 5mg undiluted solution slowly over 2 minutes (longer in elderly) with
continuous ECG & blood pressure monitoring
Can repeat if necessary after 5-10 minutes

Adenosine
ICU INDICATIONS:

Conversion to sinus rhythm of paroxysmal supraventricular tachycardia (PSVT

IV: Adenosine comes in a vial containing 6mg in 2mls solution

Compatible with the following IV fluids: Normal Saline Store at room temperature

DO NOT REFRIGERATE as crystallisation may occur. The solution must be clear

at the time of use.

DOSAGE:

Adenosine injection should be given as a rapid bolus by the peripheral IV route. It

should be given as close to the patient as possible and followed by a rapid saline
flush. The recommended IV doses for adults are as follows: Initial dose: 6 mg
given as a rapid IV bolus (administered over a 1-2 second period). Repeat
administration: If the first dose does not result in elimination of the
supraventricular tachycardia within 1-2 minutes, 12 mg should be given as a
rapid IV bolus. This 12 mg dose may be repeated a second time if required.

Aminophylline
ICU INDICATIONS:
1. Management of acute life-threatening asthma (particularly in children)
PRESENTATION AND ADMINISTRATION:

IV:
250mg/10ml (solution). For adult administration dilute 500mg in 500ml of
compatible IV fluid to make a concentration of 1mg/ml.
Compatible with:
normal saline, D5W, D10W, Glucose and Sodium chloride, Hartmanns.

Do not mix with other medications many medications with precipitate if mixed
with aminophylline.
Hydrocortisone
ICU INDICATIONS:
1. relative corticosteroid insufficiency in patients with severeseptic shock
2. adrenal insufficiency
3. steroid responsive inflammatory conditions
PRESENTATION AND ADMINISTRATION:

IV:
100mg/2ml vial plus benzyl alcohol diluents

Calcium gluconate
ICU INDICATIONS:
1. Hypocalaemia (particularly if there is refractory shock or bleeding)
2. ECG abnormalities caused by hyperkalemia (acts as a membrane stabiliser)
3. Magnesium toxicity
PRESENTATION AND ADMINISTRATION:

IV:
Preferably give via a central line
For direct IV injection, inject undiluted solution at a rate not exceeding 2ml/min
For intermittent infusion, add 1gm of calcium gluconate to 50ml of compatible IV
fluid and administer over 10 to 20 minutes.
Compatible with the following IV fluids:
D5W, normal saline, glucose and sodium chloride, Hartmanns

****** note 1 vial of calcium gluconate contains approximately one third of the
amount of calcium that is present in a vial of calcium chloride.)
Amiodarone
ICU INDICATIONS:
1. VT,VF
2. Atrialtachycardias
PRESENTATION AND ADMINISTRATION:
IV:
150mg in 3ml ampoules. Cordarone IV is a sterile clear, pale-yellow solution
visually free from particulates. Compatible with D5W only

Dexamethasone Sodium Phosphate

ICU INDICATIONS:
1. Cerebral edema
2. upper airway edema
3. Shock (other than adrenal crisis)
4. other inflammatory conditions, allergic reactions
PRESENTATION AND ADMINISTRATION:

IV:
4mg/1ml ampoule and 8mg/2ml vial
Inject undiluted over 3-5 minutes
Compatible with the following IV fluids:

0.9% Sodium chloride, glucose and sodium chloride, 5% dextrose

Protect from light and freezing.

Dilute 500mg aminophylline in 500mL sodium chloride 0.9% or glucose

5% (1mg/ml). Administer at a rate that is half the patients weight in
ml/hour. Example: 70kg patient prescribe: 500mg aminophylline in 500ml
sodium chloride 0.9% at rate of 35ml/hour To avoid excessive dosage in
obese patie