1412 Cardiology

( )

ICU
Dopamine DobutamineLevophed Adrenaline
?
Dopamine
immediate precursor norepinephrine (NE)
drip push

dopamine ampule
1 amp 250mg

1:1 2:1
mg:mL

1:1 250mg 1 amp 250 mL

2:1 2 amp 250 mL

D5W, D10W NSS, D5NSS RLS

Levophed

dopamine

10 mcg/kg/min

50 kg 500 mcg/min
60 x 500 = 30,000 mcg/h

1:1
1 ml 1000 mcg
30,000/1000 = 30 ml/h

alpha 1 receptor
dopamine
reuptake norephinephrine (NE) sympathetic

synapse

endogenous NE
dopamine
>10 mcg/kg/min

intermediate dose 3 - 10 mcg/kg/min alpha

beta 1 receptor
1

myocardial contractility heart rate volume

heart dose
alpha 1

 Dopaminergic receptor
3 mcg/kg/min
D1 D2 synapse vasodilation

renal dose

urine output

dopamine heart rate beta 1 dobutamine

drip dobutamine
symptomatic bradycardia dopamine

dopamine shock vasodilatory

cardiogenic HF symptomatic
bradycardia
20 - 30 mcg/kg/min
max 50 mccg/kg/min

endogeneous NE sympathetic synapse 30

Dobutamine
catecholamine

beta 1 beta 2 receptor

3:1 dopaminergic receptor

alpha 1 receptor
beta 1

contractility cardiac outout

vasodilatory effect
beta 2

15 - 20 mcg/kg/min

alpha 1 beta 2 SVR

dopamine
dobutamine vial

1 vial 20ml 250 mg dopamine 1 amp

dopa dopa

dobu
shock HF LV systolic function dobutamine
augment cardiac output pressors

Levophed

alpha 1 receptor
norepinephrine exogenous NE
potent beta receptor

heart rate contractility

distributive vasodilatory shock sepsis

dopa levo

levophed vial 1 vial 4 mg

2 8 mg 250 ml saline
1:31

100 ml
1:12

1:10
12

1:10
0.01 - 3 mcg/kg/min

range
0.2 mcg/kg/min 10 mcg/min

1:31 20 ml/h

levophed 2 vial 250 ml

drip 15-20 ml/h
Adrenaline
Epinephrine alpha beta receptor
drip arrest

adrenaline 1 amp 1 ml 1 mg

arrest adrenaline 1 amp

1 amp 1 ml NSS 9ml

10 ml 1 mg

drip post resuscitation

adrenaline push CPR

10 amps 10mg saline 100 ml

rate 0.01 - 0.10 mcg/kg/min

dopamine

epinephrine

 VT/VF

scenario post arrest anaphylactic shock

1. Lancet 2000;356:2139-2143
2. Am J Med Sci 1987;294:244-248
3. Am J Med 1980;69:262-266
4. Circulation 2008;118:1047-1056
5. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine 10th edition
6. The ICU Book. Paul L. Marino. 3rd edition