Code Blue Cheat Sheet

Supraventricular tachycardia - narrow complex tachycardias

Cardiac arrest - vf - pulseless vt

Epinephrine	1 mg q3-5 min. Drip: 0.1- 0.5 mcg/kg/min	Drip: 1mg/250ml --> (ml/hr) = wt x mcg/kg x 15. 1mg/100ml --> wt x mcg/kg x 6. Endotracheal: 2-2.5 mg diluted with 10ml NS
Vasopressin	40 units IV x 1	0.01 - 0.03 units/min. Drip: 40 units/100ml NS 0.01 units/min = 1.5 ml/hr; 0.03 units/min = 4.5 ml/hr.
Amiodarone	300mg IV over 1-2 seconds May repeat 150 mg IV x 1.	Drip: 1 mg/min x 6 hrs, then 0.5 mg/min x 18 hrs.
Lidocaine	1 - 1.5 mg/kg over 2-3 min, then may repeat 0.5-0.75 mg/kg in 5-10 min. Max: 3 mg/kg.	Drip: 1 - 4 mg/min. 1 gram/250 ml (ml/hr) = mg/min x 15
Calcium Chloride	5-10 ml (0.5-1 gm) over 2-5min	Calc gluc: 15-30 ml over 2 to 5 minutes.
Dopamine	5 - 10 mcg/kg/min.	Drip: 400mg/250ml (ml/hr)= (wt) x (mcg/min) x 0.0375
Norepinephrine	0.1 - 0.5 mcg/kg/min	Drip: 4 mg/250ml (ml/hr) = (wt) x (mcg/min) x 3.75
Magnesium	VF/pulseless VT: 1-2 grams/ 10ml D5W over 2-5 minutes.

Ventricular tachycardia (vt)

Procainamide	25-50 mg/min until arrhy suppressed or hypoten or QRS prolonged by 50%	Max cumulative dose: 17 mg/kg,.. Alt: 100mg q5min until arrhythmia is controlled or side effects listed. Hemodynamically stable monomorphic VT
Amiodarone	150mg/100 ml D5W IV over 10 min. Repeat if necessary.	F/b 1 mg/min IV x 6hrs, then 0.5 mg/min IV x 18hr. (900mg/500 ml D5W).
Lidocaine	See above.
Magnesium	Polymorphic VT: 1-2 grams/50-100ml D5W over 15 min.

Supraventricular tachycardia - narrow complex tachycardias

Adenosine	6mg rapid iv, may repeat after 1-2 min 12mg rapid IV	2nd 12mg dose may be given if needed in 1-2 minutes. Max cumulative dose: 30 mg.
Diltiazem	15 to 20 mg (0.25 mg/kg) IV over 2 minutes; additional 20 to 25 mg (0.35 mg/kg) IV in 15 minutes if needed; 5 to 15 mg/hour IV maintenance infusion (titrated to AF heart rate if given for rate control)
Verapamil	2.5 to 5 mg IV over 2 minutes; may repeat 5 to 10 mg q15-30 min to total dose of 20-30 mg
Esmolol	500 mcg/kg (0.5 mg/kg) IV over 1 min, f/b 50 mcg/kg/min; if response is inadequate, repeat load, f/b 100 mcg/kg/min. Max rate of 300 mcg/kg/min.
Metoprolol	5 mg over 1 to 2 min repeat as needed q5min to max dose of 15 mg
Amiodarone	See under VT
Digoxin	8 to 12 mcg/kg total loading dose, give 50% IV over 5 min, then 25% of dose x 2 at 4-8hr intervals

Bradycardia

Atropine	0.5 mg rapid IV. May repeat q3-5min as needed up to max cumulative dose of 3 mg.
Dopamine	Refractory hypotension: IV infusion: 2-10 mcg/kg/minute- titrate dosage to desired effect.
Epinephrine	Continuous IV infusion: 2-10 mcg/min - titrate dosage to desired effect.

Other meds

Cisatracurium (Nimbex)	100 mg/250 mL D5W or NS. Loading dose: 0.1 to 0.2 mg/kg IV f/b infusion at 1-3 mcg/kg/min (0.06-0.18 mg/kg/hour) and adjust rate accordingly
Etomidate	Peak effect: 1 min. Duration: 3-5 min. Procedural sedation (unlabeled use): I.V.: Initial: 0.1-0.2 mg/kg, followed by 0.05 mg/kg q3-5 min prn. Other: 0.2-0.6 mg/kg IV over 30-60 sec for induction
Phenylephrine	Shock/hypotension: I.V. bolus: 100- 500 mcg/dose q 10-15min prn as needed I.V. infusion: Ini dose: 100-180 mcg/min, or alt 0.5 mcg/kg/min; titrate. Dosing ranges between 0.4-9.1 mcg/kg/min.
Propofol	*Induction: Healthy adults <55 yrs: I.V.: 2-2.5 mg/kg (~40 mg q10 sec). [Elderly, debilitated: 1-1.5 mg/kg (~20 mg q10 sec). ICU sedation: 5 mcg/kg/min ( 0.3 mg/kg/hour); inc by 5-10 mcg/kg/min (or 0.3-0.6 mg/kg/hour) q5-10 min desired sedation. usu maint: 5-50 mcg/kg/min (or 0.3-3 mg/kg/hr)*
Fentanyl	Pain management: Adults: Bolus at start of infusion: 1-2 mcg/kg or 25-100 mcg/dose; continuous infusion rate: 1-2 mcg/kg/hour or 25-200 mcg/hour. Severe: I.M, I.V.: 50-100 mcg/dose every 1-2 hours as needed; patients with prior opioid exposure may tolerate higher initial doses
Succinylcholine	Duration: I.V.: 4-6 minutes. I.V.: Intubation: 0.6 mg/kg (range: 0.3-1.1 mg/kg).
Vecuronium(Norcuron®)	Ini bolus dose: 0.08-0.1 mg/kg, f/b cont IV infusion 0.8-1.7 mcg/kg/min (0.048-0.102 mg/kg/hr)

Mi / stroke

Alteplase

Any quantity of drug not to be administered to the patient must be removed from vial(s) prior to admin of remaining dose.

ST-elevation MI (STEMI): I.V. Accelerated regimen: Maximum total dose: 100 mg.
Patients >67 kg: Total dose: 100 mg over 1.5 hours --> [15 mg I.V. bolus over 1-2 minutes] then   [50 mg over 30 min], then [ 35 mg over 1 hour].
Patients ≤67 kg: [15 mg I.V. bolus over 1-2 minutes] then   [0.75 mg/kg (not to exceed 50 mg) over 30 minutes] then [0.5 mg/kg (not to exceed 35 mg) over 1 hour]. Note: Thrombolytic should be administered within 30 minutes of hospital arrival. Administer concurrent aspirin, clopidogrel, and anticoagulant therapy (ie, unfractionated heparin, enoxaparin, or fondaparinux) with alteplase

Acute ischemic stroke: Alteplase within 3-4.5 hrs of sx onset. Note: Perform noncontrast-enhanced CT or MRI prior to admin. Recommended total dose: 0.9 mg/kg (max total dose: 90 mg)
Patients ≤100 kg: Load with 0.09 mg/kg (10% of 0.9 mg/kg dose) as an I.V. bolus over 1 minute, f/b 0.81 mg/kg (90% of 0.9 mg/kg dose) as a cont infusion over 60 min.
Patients >100 kg: Load with 9 mg (10% of 90 mg) as an I.V. bolus over 1 min, f/b 81 mg (90% of 90 mg) as a continuous infusion over 60 min.

Reference(s)

National Institutes of Health, U.S. National Library of Medicine, DailyMed Database.
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