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CORDARON AMIODARON

ACTION
Anti arrhythmic properties
Reduce sinus automaticity
Anti angina properties
INDICATONS
Treatment of severe rhythm disorders not responding to other therapies both
atrial and ventricular rhythm disorders
Tachycardia associated with Wolff Parkinson White Syndrome
Ventricular rhythm disorders
DOSE
IV infusion loading dose 5 mg/kg administed in 250 mls of 5% Dextrose over
a period of 20 minutes 2 hours
Rate of infusion is adjusted on basis of results
Maintenance dose : 10 20 mg/kg/24 hours
(usually 600 800 mg/24 hours and up to 1200 mg/kg/24 hours)
IV close is usually followed up with oral dose
ROUTE
IV
Oral
PRECAUTIONS
Patients must be monitored when given IV Amiodaron
Hypotension
Severe Respiratory insufficiency
Hyperthyroidism

GTN NITROCINE
ACTION
Veno dilation
INDICATONS
Angina Pectoris
Rapid control of hypertension during cardiac surgery
Maintain controlled hypotension during surgical procedures
DOSE
Dilution 10 mg in Normal Saline or 5% Dextrose in 50 mls
Peri Operative myocardial ischemia 15 20 mcg/min
UAP : 10 mcg/min
ROUTE
IV
PRECAUTIONS/SIDE EFFECTS
Headache
Hypotension
Tachycardia
Palpitation

DOPAMINE
ACTION
Stimulate 1 adrenergic cardiac receptors
Stimulate adrenergic effect
Increase Cardiac Output (medium to high dose)
INDICATONS
Hypotension
Septic shock
DOSE
50 mls Dextrose with 200 mg Dopamine
1 20 mcg/kg/min
ROUTE
IV
CVP access preferred
PRECAUTIONS
Increased Heart Rate
Arrhythmia
Nausea and Vomiting

DOBUTAMINE
ACTION
Synthetic sympathomimetic amine
Stimulate 1 and 1 adrenergic receptors
Increase Cardiac Output
Minimize myocardial oxygen demand
INDICATONS
Decreased Cardiac Output
Pulmonary congestion
Hypotension
DOSE
50 mls 5% Dextrose or Normal Saline with 250 mg Dobutamine
1 mcg 20 mcg/kg/min
ROUTE
IV
PRECAUTIONS
Tachycardia
Myocardial ischemia
Nausea and Vomiting
Headache

NOR ADRENALIN
LIDOCAINE
ACTION
ACTION
Stimulate 1 adrenergic cardiac receptors
Suppress ventricular arrhythmias by decreasing automaticity
Stimulate adrenergic effect
Its local anesthetic properties help to suppress ventricular ectopy after AMI
Arterial and venous vasoconstriction
Increase myocardial contractibility
INDICATONS
Treatment of VT and VF that is refractory to electrical DC shocks
INDICATONS
Hypotension
DOSE
Septic
shockstart then 1 4 mg/min
1 2 mg/kg
Infusion 500 mg in 500 mls Normal Saline ICCU
DOSE
Infusion 500 mg in 50 mls Normal Saline - ICU
50 mls Dextrose or Normal Saline with 8 mgs Nor Adrenaline: 50 mls with 8
ROUTEmgs (160 mcs/ml)
o Infusion 0,005 0,5 mcg/kg/min
IV
ETT use 2 2,5 times the IV dose (emergency use only)
ROUTE
IV
PRECAUTIONS
Must have CVP inserted
Excessive dose can cause neurological changes
o e.g. Fitting
PRECAUTIONS
o Drowsiness
Peripheral vasoconstriction
o Psychosis
Increased myocardial oxygen demand
o Twitching
Arrhythmia

ATROPINE
ACTION
Is a parasympatholytic drug. That enhances both sinus node automaticity and
atroventricular conduction via its direct vagolytic action
INDICATONS
Symptomatic bradycardia
DOSE
Cardiac arrest 0,5 1,0 mg IV
Repeat approximately every 3 5 minutes
ROUTE
IV
ETT 1 -2 mg diluted with approximately 5 mls Normal Saline
SIDE EFFECTS
pulse
Flushed and panus skin
Blurred vision
Dilated pupils

FENTANYL
ACTION
Is a potent, lipid soluble synthetic opioid that is rapidly and widely
distributed to tissues
INDICATONS
Pain relief
Sedation
DOSE
Infusion dilution: 50 mls Normal Saline with 500 mcg Fentanyl
1 4 mcg/kg/dose (adult 200 mcg) IM or IV
Infuse 2 4 mcg/kg/hr
o < 25 kg: 100 mcg/kg in 50 ml
o > 25 kg: 50 mcg/ml at 0,04 0,08 ml/kg in 50 ml/hr
Ventilated 5 10 mcg/kg start or 50 mcg/kg IV over 1 hour
Infusion 5 10 mcg/kg/hr (amp. 50 mcg/ml at 0,1 0,2 ml/kg/hr)
ROUTE
IV
PRECAUTIONS
Respiratory depression
Hypotension

PENTHOTAL
ACTION
Acts on the brain and CNS to cause drowsiness
INDICATONS
Assist to reduce intracranial pressure
DOSE
Infusion dilution: 50 mls Normal Saline with 1000 mg Penthotal
3 5 mg/kg slowly start
Then 1 5 mg/kg/hr
ROUTE
IV
PRECAUTIONS
Hypotension

TRACRIUM
IMPORTANT
NO PATIENT SHOULD BE PARALYSED WITHOUT FIRST BEING
SEDATED TOM THE POINT OF UNROUSABILITY
PATIENT MUST BE VENTILATED
DOSE
Infusion dilution: 50 mls Normal Saline with 500 mg Tracrium
0,3 0,6 mg start, then 5 10 mcg/kg/min IV
INDICATIONS
To facilitate ventilation when adequate sedation alone is unable to:
o Increase chest wall compliance
o Reduce peak airway pressure
o Reduce the risk of barotraumas
o Allow optimal gas exchange
o Facilitate permissive hypercapnia
To ensure physiological control in patient with raised intracranial pressure
To control muscle spasm in Tetanus
PRECAUTIONS
Histamine release, producing vasodilatation or bronchospasm (bolus dose
MUSCLE
RELAXANTS
only) not seen with infusion
of atracurium
Protective reflexes abolished, risk of corneal abrasions, deep vein thrombosis
Prolonged muscle weakness
Neurological assessment is unreliable

MIDAZOLAM
ACTION
Produce sleepiness or drowsiness and to relieve anxiety
Used to maintain unconscious state in ICU
INDICATIONS
Hypnotic
Sedation
DOSE
Infusion dilution: 50 mls Dextrose or Normal Saline with 90 mg Midazolam
Sedation: 0,01 0,2 mg/kg/IV or IM up to 0,5 mg/kg
Anesthesia: 0,5 mg/kg, then 2 mcg/kg/min
ROUTE
IV
PRECAUTIONS
Respiratory depression and over sedation
Hypotension
May impair verbal contact and cooperation

MORPHINE
ACTION
Analgesic effect
Reduces systemic vascular resistance
Reduces myocardial oxygen requirement
INDICATIONS
Treatment of cardiac related pain and anxiety
Useful in treating acute cardiogenic pulmonary oedema
DOSE
Infusion dilution: 50 mls Normal Saline with 20 mg Morphine
Administered in small incremental doses slowly over 1 -5 minutes until
desired effect achieved
0,1 0,2 mg/kg dose (adult 5 10 mg) IV
0,2 mg/kg/dose (10 20 mg adult) IM
Infusion: 10 60 mcg/kg/hr
ROUTE
IV
PRECAUTIONS
Respiratory depression
Hypotension

PRECEDEX Dexmedetomedine HCL


ACTION
Provide sedation and analgesia without respiratory depression
Additional symphatolytic properties include less anxiety hemodynamic
stability
Alpha 2 adrenoreceptor agonist
INDICATIONS
Sedation with analgesic
DOSE
Infusion dilution: 200 mcg Precedex in 48 mls of Normal Saline or water for
injection
Loady dose I mcg/kg over 10 minutes
Then followed by maintenance infusions : 0,2 to 0,7 mcg/kg/hr
ROUTE
IV
PRECAUTIONS
Hypotension
Bradycardia

LASIX
ACTION
Rapidly acting diuretic that inhibits reabsorption of sodium and chloride in
ascending loop of Henle
Promotes a diuresis
INDICATIONS
Treatment of acute renal failure
Treatment of pulmonary congestion associated with left ventricle dysfunction
DOSE
Infusion dilution: 50 mls Normal Saline with 400 mg Lasix
Initial dose usually is: 0,5 1 mg/kg (adult 20 40 mg) IV 6 24 hr
IV infusion at rate of 0,25 0,75 mg/kg/hr
ROUTE
IV
PRECAUTIONS
Dehydration
Hypotension
Electrolyte imbalance
Metabolic alkalosis

SUXAMETHOIMUM
ACTION
Paralysis short acting
INDICATIONS
For intubation inductive
DOSE
1 2 mg/kg BW bolus
o Neonate 3 mg/kg dose
o Child 2 mg/kg dose
o Adult 1 mg/kg dose
o IM: double IV dose
ROUTE
IV or IM
PRECAUTIONS
Increase potassium
Tachycardia

ACTRAPID (BIOSYNTHETIC HUMAN INSULIN)


ACTION
Reduction of blood glucose level
Time of onset hour. For maximal effect 1 3 hours with duration of action
8 hours
INDICATIONS
Treatment for Insulin Dependent Diabetes Mellitus
DOSE
50 units Actrapid in 50 mls Normal Saline
Infusion 4 units/hr check BLS every 8 hours
SKDIAS SCALE BOLUS
< 100 mg/dL give 8 unit
100 150 mg/dL give 4 unit
151 200 mg/dL give 8 unit
201 250 mg/dL give 12 unit
251 300 mg/dL give 16 unit
>300 mg/dL call doctor
ROUTE
IV, SC
PRECAUTIONS
Hypoglicemia

Check
BLS
every 2 4
hours
or
more
frequently as
required

CARE OF THE INTUBATED PATIENT


REASONS FOR INTUBATION

Several indication for intubation exist:


o Airway obstruction airway oedema, epiglottis
o Secretion management ETT provides a conduit for suctioning
o Airway protection from regurgitation/aspiration due to decreased
LOC/FICS and,
o Need for high concentration oxygenation, ventilation or sedation/general
anesthesia
POSSIBLE COMPLICATION OF INTUBATION

Aspiration
Trauma
Bradycardia Vagal stimulation
Hypoxaemia (attempts limited to 30 sec)
Right main bronchus intubation
Oesophageal intubation
Tube malposition
Tracheal necrosis
Pharyngeal oedema
Mouth, lip or nare preassure sore development
CONTINOUS MANDATORY VENTILATION

CMV (assist/control)
RR, Vt (8 10 mls/kg), FiO2, peak flow and waveform all constant
Breaths initiated can be:
o Mandatory: ventilator/operator initiated
o Assist: patient initiated (retains characteristics of mandatory breath)
If Pt RR = minute volume
CONTINOUS POSITIVE AIRWAY PRESSURE
CPAP
Spontaneous mode
Positive pressure applied to airway throughout respiratory cycle
useful for alveolar recruitment ( FRC) = optimizing oxygenation

SYNCHRONISED INTERMITTENT MANDATORY VENTILATION


SIMV
timed to allow for pt effort
o timing divides each breath cycle into mandatory breath phase and spontaneous
phase
o @ 12 bpm breath cycle = 5 secs
Any breaths taken in excess of RR set, are spontaneous phase
Advantages
o Guarantees minimum minute volume in absence of patient effort
o Assist + mandatory breath = total RR
o Additional respiratory effort = spontaneous breaths
o SIMV rate allows weaning
Disadvantage
o Can still get pt/ventilator dysynchrony
PRESSURE SUPPORT

Only active in SIMV + CPAP


Range = 1 70 cmH2O
When pt initiates breath gas delivered at rate to achieve and maintain PS level above
PEEP
Can be volume or flow triggered
o PS + flowby = flow triggering
o PS (no flowby) = volume triggered
Advantages
o Augment tidal volume
o Overcome resistance of artificial airway
o Reduce work of breathing (controversial)
Disadvantages
o Static
CARE OF THE ICU PATIENT DURING TRANSPORT

Security of the ETT to avoid dislodgement we ensure there is sufficient oxygen in


bottle
Stability of unstable patient may require paralyzing/sedative agents prior to transport
Haemodynamically unstable patient may require inotropic drugs/fluid challenges, ensure

PENGENCERAN OBAT TITRASI

Atropine

16 mcg in 50 mls Normal Saline

Diazepam

100 mcg in 50 mls Normal Saline

Dobutamine

250 mg in 50 mls Dextrose or Normal Saline

Dopamine

200 mg in 50 mls Dextrose

Fentanyl

500 mcg in 50 mls Normal Saline

GTN - Nitrocine

10 mg in 50 mls Normal Saline or 5% Dextrose

Lasix

400 mg in 50 mls Normal Saline

Lidocaine

500 mg in 500 mls Normal Saline ICCU


500 mg in 50 mls Normal Saline ICU

Midazolam

90 mg in 50 mls Dextrose or Normal Saline

Morphine

20 mg in 50 mls Normal Saline

Nor Adrenaline

8 mg in 50 mls Normal Saline or Dextrose

Penthotal

1000 mg in 50 mls Normal Saline

Precedex

200 mcg in 50 mls Normal Saline or water for injection

Soxamethoimum

bolus

Tracrium

500 mg in 50 mls Normal Saline

PEDOMAN TERAPI OBAT EMERGENCY


DI RUANG TERAPI INTENSIF

INSTALASI RAWAT INTENSIF TERPADU


RUMAH SAKIT UMUM PUSAT SANGLAH
DENPASAR
2007