醫學筆記匯整 ED Notes

Levophed 為 septic shock 第一線 vasopresser
若不足者才加上 Bosmin
Dopamine 因為會造成心跳過快

所以只用於 tachyarrythmia risk 非常低
或 absolute or relative bradycardia

Levophed: 0.5-30(mcg/min) on CVP
泡法 : 2amp(8mg) in 250 D5W
(ml/hr) = 1.875 (mcg/min)
用法:自 4ml/hr開始,最高60ml/hr
小心extravasation會local necrosis

Bosmin: 1-4(mcg/min)
泡法: 5amp(5mg) in 250 D5W
1amp/50ml for syringe pump
(ml/hr) = 3 (mcg/min)
用法: 3-12 ml/hr 用syringe pump
小心extravasation會local necrosis

Dopamine premix:
Dose: 
Renal vasodilate : 2-5 mcg/kg/min
Inotrope: 5-10 mcg/kg/min
vasoconstriction: 10-20 mcg/kg/min
(ml/hr) = 2.25 (mcg/kg/min)
用法: 自10ml/hr開始, 每10-30min check並調高5-10ml/hr一次,最高可達40ml/hr

Dopamine 2 amp/250mL (premix)
Dobutamine (dobutrex) 2 amp/250mL
Epinephrine (bosmin) 5 amp/250mL 1 amp/50 mL for syringe pump
Norepinephrine (levophed) 2 amp/250mL
Isoproterenol (isuprel) 10 amp/250mL 4 amp/100mL, 2amp/50mL

NTG 2 amp/250mL
Nitroprusside (nipride) 2 amp/250mL
Lidocaine 10 amp/250mL 4 amp/100mL

Milrinone (primacor0 5 amp/50 mL
amiodarone 6 amp/50 mL

Dopamine premix 是現成的
Amiodarone (cordaron), milrinone (primacor) have a long half life. 
Amiodarone 6amp/50 mL, 20ml/hr x 1 hr or after rhythm control,

shift to 2 mL/hr to maintain for one day then shift to oral dosage if possible.

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