Endotracheal Intubation NTG 2-20mcg/min Criteria: Follows commands; Good cough & gag; PaO2 ≥ 60

-Blade: Mac 3 or 4; Tube: F:7-8 mm; M:7.5-8.5; depth:21-23 Nitroprusside 0.5-8mcg/kg/min mmHg; FiO2 ≤ 0.4-0.5; PEEP ≤ 5, RR<30
cm Sedation:
-Preoxygenate 3-5mim Midazolam 1-4mg IV bolus, then 1-2mg/hr (max 10mg/hr) AG Met Acid: Methanol, Uremia, DKA/EtOH KA, Paraldehyde,
-Paralysis with induction Lorazepam 1-4mg IV bolus, then 1-2mg/hr (max 10mg/hr) Isoniazid, Lactate, Etoh/Ethylene Glycol, Rhabdo/Renal
-Etomidate: 0.3 mg/kg (20/30), 15-45sec, 3-12min Propofol 5 mcg/kg/min IV (max 80mcg/kg/min) Failure, ASA
-Midazolam: 0.1 to 0.3 mg/kg (7/10), 30-60s, 15-30m Haldol 2-10 mg q 20-30 min (for acute agitation; monitor Non AG Met Acid: Hyperalimentation, Acetazolamide, RTA,
-Propofol: 1.5 to 3mg/kg (100/150), 15-45s, 5-10m QTc) Diarrhea, Uretero/Pelvic Shunt, Post-Hypocapnia,
-Succinylcholine: 1.5 mg/kg (100/150),45-60s, 6-10m Spironolactone
-avoid: CVA,HyperK+,Rhabdo,MG Analgesia Resp Acid: CNS Depression, Airway Obstruction, PNA, Pulm
-Rocuronium: 1 mg/kg (70/100), 45-60s, 45min Morphine 2-4mg IV bolus, then 1-5mg/hr (max 10-15mg/hr) Edema, PTX, Myopathy
-Vecuronium: 0.1 mg/kg (7-10), 75-90s, 45min Fentanyl 25-50mcg IV bolus, then 25-100mg/hr Met Alk: Contraction, Licorice, Endo, Vomiting, Excess Alkali,
ACLS (max 300-500mg/hr) Refeeding, Post-Hypercapnia, Diuretics
VF/ pulseless VT A-a Gradient Resp Alk: CNS disease, Hypoxia, Anxiety, Mech Ventilators,
200 J biphasic defibrillator (360 for mono) Normal ≤ (Age/4) + 4 OR 0.3 x Age Progesterone, ASA/Sepsis
Epinephrine 1mg (10 ml of 1:10,000) q3-5min DA-aO2 = (713 x FiO2) – (PaO2 + 1.25PaCO2)
Vasopressin 40 U 713 x .21 = 150 Toxicology
Amiodarone 300mg ± 150mg in 3-5min or 713 x .35 = 250 Gastric lavage if within 1 hr or if TCA
Licodaine 1-1.5 mg/kg Activated charcoal 50g orally
Mg++: 1-2g Deciding to Intubate Β-blocker: Glucagon 0.05 mg/kg IV then 0.07 mg/kg/hr
Asystole/PEA failure of airway protection: GCS ≤ 8, pooling secretions Calcium channel blocker: Calcium Chloride 10% sol 5-10ml
Epinephrine 1mg (10 ml of 1:10,000) q3-5min failure of ventilation IV
Atropine 1mg q3-5min failure of oxygenation: restlessness, agitation, cyanosis Cocaine: Benzos; severe HTN: phentolamine 5-10mg IV
Narrow-Tachycardia anticipated need for intubation q10m
Sinus Massage / Vagal maneuvers pulse ox, vs, mental status, resp status or nitroprusside or labetalol
Adenosine 6mg, then 12mg Benzo: flumazenil 0.2 mg IV over 30s (watch for seizure)
Diltiazem 15-20mg, 5-15mg/h Recognize the Difficult Airway Opioid: naloxone 0.2mg IV (up to 2mg)
Metoprolol 5mg q5min Look externally: facies, unusual anatomy, or significant APAP: Mucomyst 140 mg/kg, then 70 mg/kg q4hr
Sync Cardiovert 100 J biphasic obesity ASA: AC 50g, sodium bicarbonate keep urine pH>8, HD
Wide- Tachycardia (Regular) Evaluate: 3-3-2; fingers btwn incisors, mandible, laryngeal TCA: NaHCO3- 2 amps in 1 L D5W ~ 100 cc/h keep pH >7.5
Amiodarone 150mg notch
Licodaine 1-1.5 mg/kg Mallampati score: inability to visualize uvula predicts Pulmonary Artery Catheter
Sync Cardiovert 100 J biphasic difficulty Normal Values
Mg++: 1-2g (if torsades) Obstruction of airway: mass, hematoma, injury RAP pressure 1-7 mm Hg
Brady Neck mobility: ability to achieve the sniffing position RVP systolic 15-25 mm Hg
Atropine 0.5mg q3-5min RVP diastolic 8-15 mm Hg
Transcutaneous pacing (Mobitz 2 or 3rd °) NIPPV: Uses: HF (acute cardiogenic pulmonary edema), COPD PAP systolic 15-25 mm Hg
Dopamine 2-10 mcg/kg/min Eligibility: Alert, able to protect airway/clear sections PAP diastolic 8-15 mm Hg
Epinephrine 2-10 mcg/kg/min RR<24, pH<7.35, PaCO2>45mmHg, SpO2<90% PAP mean 10-20 mm Hg
Contraindications: Arrest, arrhythmia, airway obstruction
Shock: SBP<90, pH<7.2, FiO2>0.5 Aneurysmal SAH
Norepinephrine 1-30mcg/min (α1 > β1) IPAP: 8-20 cmH2O; EPAP: 5 cmH2O; Rate ≥ 4 Intubate if GCS ≤ 8 w/ etomidate
Vasopressin 0.04units/min (V1) Nimodipine 60mg PO q4° x 21d
Phenylephrine 10-100mcg/min (α1) Vents: NS 3-5 L/day
Epinephrine 2-10mcg/min (α1, α2, β1, β2) Initial Settings: SCD/TEDs
Dopamine 2-20mcg/kg/min (D → β → α) Mode: Pressure/Volume/Dual Control +/- steroids, AEDs, statin
Dobutamine 2-20mcg/kg/min (β1 > β2) Volume: 6-8ml/kg IBW Tx BP w/ labetalol or hydralazine prn or nicardipine
FiO2: titrate for Sp O2 > 90% Tx vasospasm w/ HHT: ↑ MAP by 15-20%
Arrhythmias: Rate: 12-20
Amiodarone 150mg bolus → 1mg/min x6h → 0.5mg/min PEEP: 0-5cmH2O A-fib
Diltiazem 5mg bolus, then 5-15mg/h Improve ventilation: (↓ CO2): Increase frequency or VT 11% of pts w/ AMI develop AF during hospital stay 11868060
Esmolol 500mcg/kg bolus, then 50-200mcg/kg/min Improve oxygenation: (↑ O2): Increase FiO2 or PEEP Cardiovert: ongoing CP, pulm edema, hemodynamics
unstable
HTN: Vent Weaning Sync Cardiovert Biphasic 100-200J (25-50 AFlutter)
Nicardipine 5-15mg/h Metoprolol 2.5-5mg IV q5-10 min good for post op
 Diltiazem 0.25mg/kg IV (15mg), then 5-15mg/hr
Digoxin 0.25mg IV q2hr (max 1.5mg) good for HF, caution
AKI
Amiodarone 150mg IV, then 1mg/min x6h, then 0.5 x18h
(maintenance 200mg/d)
Esmolol 500ug/kg IV, then 60-200ug/kg/min