This document discusses various medical treatments used in intensive care units, including pressors, sedatives, analgesics, and paralytic agents. It provides details on medications like norepinephrine, epinephrine, dopamine, dobutamine, vasopressin, nitroglycerine, benzodiazepines, propofol, haloperidol, morphine, atropine, amiodarone, lidocaine, and sodium bicarbonate. For each drug, it outlines their uses, dosages, side effects, precautions, and indications for treatments like cardiac arrest, shock, hypertension, arrhythmias, pain management, intubation, and acidosis in critically ill patients.

1. Medical Treatment In Intensive Care Unit

2.  Pressors
 NG
 Sedative
 Analgesic
 Paralytic agents

4. Norepinephrine
Potent alpha ,some beta agonist
Vasocontriction
Dose: 1-2microgram /min

5. EPINEPHRINE
 Beta with very low dose ,alpha with higher dose
 Uses:cardiac arrest ,anaphylactic shock and
bronchial asthma
 S/E: arrythmia ,coronary ischemia,renal vc
 Dose:1ml iv

6. DOPAMINE
Renal dose :5micro/Kg /min
Cardiac dose:5-10micro/min
Vasopressor dose :10-20micro/min
S/E:tachyarrythmia

7. DOBUTAMINE
 Beta 1,mild beta 2
 Used in cardiogentic shock
 May decrease peripheral vascualr resistance

8. VASOPRESSIN
 Vasoconstriction in septic shock
 May be used alternative to epinephrine in
refractory VF

9. NITROGLYCERINE
 Venodilator in dose less than 40micro/min
 Arteriodilator in dose higher than 200micro/min
 Rapid onset ,short duration
 S/E increase ICT headache

10. SEDATION
 To relieve pain
 To decrease anxiety
 To decrease patient -ventilator dysynchrony

11. BENZODIAZEPINE
 Sedative hypnotics
 Anticonvulsant
 Anxiolytic
 Metabolized in liver excreted in urine
 Interact with erythromycin ,inderal

12.  Diazepam
 Larozepam
 Midazolam

14. PROPOFOL
 Sedative
 Anesthetic
 Anticonvulsant
 Rapid onset: less than 1 min
 Clearance not changed in liver or kidnet disease

15.  S/E:
 Respiratory depression
 Hypotension
 Increase TG

16. HALOPERIDOL
 Tranquillizer
 No respiratory depresion or hypotension
 S/E: QT prolongation, NMS

17. PAIN IN THE ICU
 Pain cause:
 Catabolism
 Ileus
 ADH relsease
 Immune disturbance
 Hypercoagulability
 Increase cardiac work

18. PAIN CAUSES
 Lines
 Tubes
 Underlying illness

19. MORPHINE
 Metabolized by liver
 Cause Histamine relsease
 Fentanyl more potent .no histamine release
 S/E:
 Respiratory depression
 Hypotension
 Decrease GI motility
 Pruritis

20. PARALYTICS
 Used in intubation
 Facilitation of mechanical ventilation

21. COMPLICATIONS
 Neuromuscular blockade
 Muscle weakness
 Post paralytic syndrome

22. ATROPINE
 Parasympatholytic
 Increase heart rate ,AV conduction
 Use in resuscitation,bradycardia,HB
 Dose: 0.5-1mg

23. AMIODARONE
 Sodium,potassium and calcium channel blocker
 Alpha ,beta blocking action
 S/E: Prolong QT interval

24. INDICATION
 Refractory VF,VT
 Hemodynamically stable VT
 Resistant tachycardia

25.  Dose:
 300mg in 200ml G5% iv bolus
 1mg /min for 8 hour then 0.5mg /min for 16
 Max 2.2gm/d

26. PRECAUTIONS
 Cardiogenic shock
 Bradycardia ,HB
 Hypotension is the most common side effect

27. LIDOCAINE
 Used in VT,VF
 Best in IHD
 Dose:1mg/kg bolus
 Drip: 2mg/min

28. SODIUM BICARBONATE
 Used in severe metabolic acidosis,Hyperkalemia
 Dose:1-2mmol/kg iv
 S/E:
 Intracelluar acidosis,
 Increase co2
 Hypoxia
 Decrease myocardial contractility
 Hypernatemia

29. Dr.Abdelrahman Youssif
#THECARDIOLOGIST