Infusions

30mcg/kg = 3mg 100kg Xml/hr=Xmcg/min: AIO - adrenaline, noradrenaline, 1soprenaline, octreotide NOTE: a 1mcg/kg bolus will be approx 1.5mL of solution. 300mcg/kg 30mg 100kg Xml/hr=10Xmcg/min: SNG sa1butamol, GTN, sodium nitroprusside, milrinone (3 smooth mm relaxers) 3mg/kg 300mg 100kg Xml/hr = 100Xmcg/min: DAK dobutamine + dopamine (2.5D/5B1/10alpha), aminophylline/theophylline, ketamine (3 heart racers) ; Xml/hr = Xmcg/kg/min 30mg/kg 3g=3000mg 100kg Xml/hr = Xmg/min: LA am1odarone, lignocaine(6/1,3/2,1.5/-), esmolol (3 antiarrhythmics) 150mg/kg 15g for 100kg: M magnesium Magnesium at 10ml/hr Start everything at 5ml/hr and head for 10ml/hr except 1soprel 1ml/hr can go to 50ml/hr am1odarone and sa1butamol at 1ml/hr start GTN at 20mcg/min Isoprenaline vial = 200mcg in 1mL or 1000mcg in 5mL Salbutamol vials = variable, 500mcg/mL or 5mg/5mL GTN = 50mg/10mL SNP = 50mg powder to 5% glucose Milrinone = 10mg run at 5ml/hr for 0.5mcg/kg/min Dobutamine/Dopamine = 250mg/20mL Aminophylline = 250mg/10mL 6mg/kg loading dose 30mins (ie double dose infusion)! Amiodarone = 150mg/3mL so only make 25mL cos 1ml/hr Esmolol = 100mg/10mL 50mcg/kg/min = 3mg/kg/hr; 300mg/hr for 100kg guy = 30ml/hr Magnesium = 5g/10mL Glucagon is bolus 3mg then 5mg/hr infusion Naloxone/flumazenil is 200mcg then 100mcg/hr Full anticoagulation with heparin is 16000U bd eg for MVR Anticoag heparin is 80U/kg bolus then 18U/kg/hr

LMA Size Weight 1 0-5kgu 1.5 5-10kg 2 10-20kg 2.5 20-30kg

 3 >30kg
Weight: 9+a/2, 2a+10, 3a Adrenaline = naloxone = 0.1ml or 10mcg per kilo = 1/10 weight; ETT: a/4+4 = past cords, 3xETT at lips Suxamethonium = 2w; 0.5w Atropine/Fluid bolus = 20w 2ml/kg 10% dextrose Start with air for resus, then 100% 0.1ml/kg of 0.5% bupivacaine

Management of cardiac arrest associated with LA injection: Start cardiopulmonary resuscitation (CPR) using standard protocols Manage arrhythmias using the same protocols, recognising that they may be very refractory to treatment Prolonged resuscitation may be necessary; it may be appropriate to consider other options: o Consider the use of cardiopulmonary bypass if available o Consider treatment with lipid emulsion Treatment of cardiac arrest with lipid emulsion: (approximate doses are given in red for a 70-kg patient) Give an intravenous bolus injection of Intralipid 20% 1.5 ml.kg-1 over 1 min o Give a bolus of 100 ml Continue CPR Start an intravenous infusion of Intralipid 20% at 0.25 ml.kg-1.min-1 o Give at a rate of 400 ml over 20 min Repeat the bolus injection twice at 5 min intervals if an adequate circulation has not been restored

o Give two further boluses of 100 ml at 5 min intervals After another 5 min, increase the rate to 0.5 ml.kg-1.min-1 if an adequate circulation has not been restored o Give at a rate of 400 ml over 10 min Continue infusion until a stable and adequate circulation has been restored Blood 4ml/kg will increase by 1g/dL and Hc by 2% 1 unit = 250mL Platelets 5ml/kg are given if platelet count falls below 50 will raise platelets by 50x10^9/L. So use 10ml/kg to boost, 1U/10kg or 1 pool/50kg After 1.5 blood volumes unless trauma DIC. 1 pool = 4 units = 200ml; 1 unit = 50mL Fresh frozen plasma 15ml/kg is administered if PT or PTT are running higher than 1.5 times control levels. Good source for FIX. This will make 30% clotting factor concentration which is minimum need for normal coag. Can be done every 3 hours. 1 unit = 250ml Cryoprecipitate 1pack=15ml/10kg) is given for Fibrinogen levels < 0.8g/l. Also source for FVIII+vWF. Will raise fibrinogen by 0.5g/L. After 1.5 blood volumes unless trauma DIC. Lacks factor V. 1 unit = 15ml MTP pack 1: 4u PRBC MTP pack 2:

4U PRBC 4U FFP 10U cryp MTP pack 3: 4u PRBC = 250ml each 4U FFP = 300mL each 1 pooled plts = 6 Units = 300mL 10mL/kg FFP (enough to raise factors to 30%) 1 unit / 10kg Cryo (to raise fibrinogen 0.5) 1 unit / 10kg platelets (increases platelets by 5 - 10 x 10^9)