ED HSDG

2. Adrenaline infusion
• Preparation
• 1 amp 1ml (1:1000 = 1mg/ml)
• Dilute 3.0mg (3mls) adrenalin with 47mls of NS in 50mls syringe.
• Rate : 1ml/hr = 1mcg/min
• Dose : 1-10mcg/min. Titrate accordingly to desired BP
• Calculation:
• 50mls = 3mg = 3000mcg
• 1ml = 3000mcg/50mls = 60mcg/ml
• 1ml/hr = 60mcg/hr = 60mcg/60min = 1mcg/min
• 1ml/hr = 1mcg/min

3. Adrenaline infusion (peadiatric)
• Refer Frank Shann
• 0.3mg/kg in 50mls
• Eg 10kg
• 10 x 0.3 = 3mg (add 3mg in D5% to make 50mls
• 10ml/hr = 1mcg/kg/min
• IV infusion 0.05-1mcg/kg/min (ie 0.5-10mls/hr)

4. Atropine infusion
• Preparation 1mg / 1ml
• Dilute 10mg of atropine (10mls = 10ampulse) in 40mls NS  50mls
• 5mls / hr = 1mg / hr to titrate with effect

5. Magnesium sulphate
• For severe asthma
• Preparation : 2.47gm (1amp) / 5mls
• Dilute 2gm (4mls) in 20cc NS
• Give using syringe pump over 20min

6. Aminophyline infusion
• Preparation : 250mg/10mls
• Loading dose : 5mg/kg in 100mls NS over ½ hr
• Eg : 250-500mg in 100ml NS (or 5mg/kg)
• Run over 20-30min
• Do not give bolus to pt already on oral theophylline
• Infusion : 0.5 – 0.9 mg/kg/hr
• Dilute 250mg in 50mls syringe with NS
• 1ml = 250/50 = 5mg
• 1ml/hr = 5mg/hr
• Eg : 70kg
• 0.5mg/kg/hr = 0.5 x 70 = 35mg/hr
• 35mg/hr = 35/5 = 7mls / hr (usual dose at 6-7mls/hr

7. Amiodarone
• Preparation : 150mg / 3mls
• Loading dose
• Dilute 2 amp of amiodarone (300mg / 6mls) in 100mls D5% (not compatibale
with NS)
• Use microchamber run over 1hr
• Maintainance dose
• Dilute 6 amp of amiodarone (900mg / 18mls) in 500mls of D5%
• Run over 24hr ~ 20mls/hr

8. Cocktail regime (for hyperkalemia)
• IV slow bolus 10mls of 10% calcium gluconate
• 1st medication to be given immediately
• Must be given by doctor – given over 2-5min
• Cardiac (ECG) monitoring
• Can be repeated once/twice if necessary – titrate against ECG changes
• Avoid used in hyperK 2ndary to digoxin toxicity
• IV bolus 50mls of D50% (glucose not required in hyperglycemic state)
• IV bolue insulin 10iu
• IV Sodium Bicarb (IV NaHCO3) – consult EP. Given only if pt is acidotic
• IV / Neb salbutamol
• Resonium – orally or rectally every 6hr. Effect take 1-2hr
• HD

9. DIVC regime
• 6 cryoprecipitate
• 4 platelet
• 2 FFP

10. Dopamine
• Preparation : 1 vial = 200mg = 5mls
• Syringe pump : no bolus doses
• Method 1 (dilution dose is adjusted according to pt weight. The rate is
fixed)
• Eg pt weight 60kg
• 3x BW = 3x 60kg
• 180mg in 50mls NS
• 1ml = 180/50 = 3.6mg
• 1ml/hr = 3.6mg/hr = 3.6mg/60min = 3600mcg/60min = 60mcg/min =
1mcg/kg/min
• Rate 1ml/hr = 1mcg/kg/min

11. Dopamine
• Method 2 (dilution dose is fixed, but rate is adjusted according to
weight
• 200mg dopamine in 50mls NS = 200/50 = 4mg/1ml = 4000mcg/ml
• 1ml/hr = 4000mcg/60min = 66.6mcg/min
• 1ml/hr = 66.6mcg/min
• In 70kg person, 1ml/hr = 66.6mcg/min = 66.6mcg/70kg/min =
1mcg/kg/min
• Refer table

12. • Dopamine (200mg in 5mls)
Wt (kg)
Mcg/kg
/min
45kg 50 55 60 65 70 75 80 85 90
2.5 1.6ml/hr 1.8 2.0 2.2 2.4 2.6 2.8 3.0 3.2 3.4
5.0 3.3 3.7 4.1 4.5 4.9 5.3 5.7 6.1 6.5 6.9
7.5 5.0 5.6 6.1 6.7 7.3 7.8 8.4 9.0 9.6 10.1
10.0 6.7 7.5 8.2 9.0 9.7 10.5 11.2 12.0 12.8 13.5
12.5 8.4 9.3 10.3 11.2 12.1 13.1 14.0 15.0 16.0 16.9
15.0 10.1 11.2 12.3 13.5 14.6 15.7 16.8 18.0 19.1 20.3
17.5 11.8 13.1 14.4 15.7 17.0 18.3 19.7 20.1 22.3 23.6
20.0 13.5 15.0 16.5 18.0 19.5 21.0 22.5 24.0 25.5 27.0

13. Hydralazine
• For preeclampsia / eclampsia
• Method 1 :
• Dilute 50mg in 50cc NS (1mg = 1ml)
• Start 5ml/hr
• Increase 1ml/hr every 15-20min
• Max infusion rate – 10ml/hr
• Method 2 :
• Dilute 50mg in 500ml NS
• 10ml = 1mg/hr
• Start infusion at 15ml/hr (1.5mg/hr)
• Increase 15ml/hr every 15min
• Aim decrease diastolic BP 90-100
• Caution when hydralazine if given together with Mgso4 -> BP may drop

14. Fentanyl infusion (for sedation)
• Preparation : 100mcg / 2mls
• Dilute 200mcg (2amp) of fentanyl with NS to become 20ml
• 200mcg = 20ml
• 1ml = 10mcg
• Dose infusion
• Start with 2ml/hr (20mcg/hr)
• Titrate to desired BP

15. GTN infusion
• Preparation : 50mg/10ml
• Syringe pump 50ml
• Method 1 :
• Dilute 50mg (10ml) of nitrobid with 50ml NS
• Rate 0.3mls/hr = 5mcg/min
• Method 2 :
• Dilute 30mg nitrobid (6ml) with NS to become 50ml
• Rate 1ml/hr = 10mcg/min
• Startting dose infusion 10-20mcg/min
• Can increase up to 100mcg/min
• Monitor BP every 5min

16. Isoket (isosorbide dinitrate)
• Preparation 10mg / 10mls
• Dilute 10mg (10ml) of isoket in 40ml NS
• 5ml = 1mg
• Dose 1-5mg/hr
Isoket (mg/hr) Infusion rate (ml/hr)
1.0 5.0
1.5 7.5
2.0 10.0
2.5 12.5
3.0 15.0
3.5 17.5
4.0 20.0
4.5 22.5
5.0 25.0

17. Labetalol
• Preparation: 1amp : 25mg / 5ml
• Bolus dose : IV 5-20mg bolus injected over 2min (max 200mg)
• Infusion dose :
• Dose 20-160mg/hr
• Dilute in D5% or DS
• Method 1 – infusion
• Dilute 200mg (8amp) IV labetalol in NS to make 50cc (1ml = 4mg)
• Start at 5ml / hr = 20mg/hr
• Dose 20 – 160mg /hr
• Double every ½ hr to max 160mg/hr
• Method 2 – infusion
• Dilute 100mg (4amp) IV labetalol in 30ml NS to make 50ml solution
• 50ml  100mg = 1ml  2mg

18. Midazolam morphine sedation
• Preparation
• Morphine 30mg (3ml) + midazolam (dormicum) 30mg (6ml)
• Dilute with 21ml NS in 50ml syringe
• Rate : 1ml/hr = 1mg of midazolam and morphine
• Dose
• Bolus dose may be required for faster effect, followed by infusion dose
• Infusion dose : 3mg / hr (3ml/hr)
• To titrate to desired effect
• Paeds dose :
• Mida : 3mg/kg in 50ml NS ; Morphine : 1mg/kg
• Morphine 30mg + midazolam 90mg dilute in 29ml NS in 50ml syringe

19. Noradrenaline infusion
• Preparation : 4mg/4ml (1 amp)
• Dilute 4mg (4ml) with 46ml NS in 50ml syringe
• Rate : 1ml/hr = 1mcg/min
• Dose : 2-20mcg/min. titrate accordingly to desired effect
• Calculation
• 4mg (4ml) Norad in 50ml NS
• 50m  4mg  4000mcg
• 1ml  4000mcg/50ml  80mcg
• 1ml/hr  80mcg/hr  80mcg/60min  1.3mcg/min
• 1ml /hr = 1.3mcg/min