Summary: Finally a non-intubation topic!Bolus dose pressors and inotropes have been used by the anesthesiologists for decades, but they have not penetrated into standard emergency medicine practice. I don’t know why. They are the perfect solution to short-lived hypotension, e.g. post-intubation or during sedation.They also can act as a bridge to drip pressors while they are being mixed or while a central line is being placed.Click Here for printable sheet with mixing instructions Epinephrine Do not give cardiac arrest doses (1 mg) to patients with a pulseHas alpha and beta-1/2 effects so it is an inopressorOnset-1 minuteDuration-5-10 minutesMixing Instructions:Take a 10 ml syringe with 9 ml of normal salineInto this syringe, draw up 1 ml of epinephrine from the cardiac amp (amp contains Epinephrine 100 mcg/ml)Now you have 10 mls of Epinephrine 10 mcg/mlDose:0.5-2 ml every 2-5 minutes (5-20 mcg)No extravasation worries!Mixing Video:Phenylephrine Phenyl as a bolus dose is clean, quick, and never causes trouble. But...It is pure alpha, so no intrinsic inotropy; it may increase coronary perfusion which can improve cardiac output. I only use this in tachycardic patients.Onset-1 minuteDuration- 20 minutesMixing Instructions:Take a 3 ml syringe and draw up 1 ml of phenylephrine from the vial (vial contains phenylephrine 10 mg/ml)Inject this into a 100 ml bag of NSNow you have 100 mls of phenylephrine 100 mcg/mlDraw up some into a syringe; each ml in the syringe is 100 mcgDose:0.5-2 ml every 2-5 minutes (50-200 mcg)No extravasation worries!Mixing Video:http://vimeo.com/29856931 Ephedrine I don’t use this one, listen to the podcast to hear why. I put it here solely for the anesthesiologists on the blog.Onset-Near InstantDuration-1 hourMixing Instructions:Take a 10 ml syringe with 9 ml of normal salineInto this syringe, draw up 1 ml of ephedrine from the vial (vial contains Ephedrine 50 mg/ml)Now you have 10 mls of Ephedrine 5 mg/mlDose:1-2 ml every 2-5 minutes (5-10 mg)No extravasation worries!
