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Drug Formula - (update 2010)

Drug formula
ATROPINE , ADRENALINE AMINOPHYLINE AMIODARONE ANTIVENOM ADENOSINE CALCIUM GLUCONATE DOBUTAMINE DOPAMINE DIGOXIN FRUSEMIDE POTASIUM CHLORIDE LABETOLOL LYTIC COCKTAIL LIGNOCAINE MAGNESIUM SULPHATE MIDAMORPHINE OMEPERAZOLE PHENYTOIN NORCURON TRAMADOL SALBUTAMOL SLIDING SCALE STREPTOKINASE SOLUMEDROL ISORSORBIDE DINATRADE ISOPRENALINE ANTIDOT DRUG FORMULA MG/ML TO MCG/ML ANTIVENOM 2 4 5 6 7 8 8-11 12 13 14 15 16 17 18 1920 21 22 23 24 25 26 27 28 29 30 31 32 33 34 36

J Jabatan Kecemasan Hospital Sultan Haji Ahmad Shah 2010

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Drug Formula - (update 2010)

Adrenaline 1mg/mL
a. single dose

3mg + 47ml Normal Saline : 50ml 1ml/hr : 1ug/mnt


b. double dose

6mg +44ml N/S : 50 ml 1ml/hr :2ug/mnt


Anaphylaxis *stable (IM administration @ Lateral Thigh) Adrenaline IM dose adults
0.01ml - 0.5 mg IM (= 500 micrograms = 0.5 mL of 1:1000) adrenaline

Adrenaline IM dose children


(The equivalent volume of 1:1000 adrenaline is shown in brackets) > 12 years: 500 micrograms IM (0.5 mL) i.e. same as adult dose 300 micrograms (0.3 mL) if child is small or prepubertal > 6 12 years: 300 micrograms IM (0.3 mL) > 6 months 6 years: 150 micrograms IM (0.15 mL) < 6 months: 150 micrograms IM (0.15 mL) *Unstable Dilute 1:1000 into 10mls NS => 1:10,000 dilution IV access : 0.1ml 5ml * repeated after 5min if patient not responsive In Paeds : To consult with paediatric team/specialist

J Jabatan Kecemasan Hospital Sultan Haji Ahmad Shah 2010

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Drug Formula - (update 2010)

J Jabatan Kecemasan Hospital Sultan Haji Ahmad Shah 2010

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Drug Formula - (update 2010)

Aminophyline 250mg/10ml
250mg +90ml N/S : 100 ml Run in chamber over 20 mnt or as order by doctor
Contraindications:Known allergies/ peptic ulcer/ severe renal or liver impairment Careful in Pregnancy, elderly and children

Dosage: 6mg/kg over 30min and maintenance 0.5 -0.9mg/kg/hr

Therapeutic plasma concentration is narrow Cimetidine/propanolol/Erythromycin => increase plasma concentration Alcohol/barbiturates/ phenytoin => decrease plasma concentration

J Jabatan Kecemasan Hospital Sultan Haji Ahmad Shah 2010

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Drug Formula - (update 2010)

Amiodarone 150mg/5ml
150mg in 20ml N/S give by bolus over 10 Minutes (may be repeated another cycle if non resolving ) Follow by maintainence infusion 1mg/min for first 6 hours
Contraindications/Precautions:Severe sinus bradycardia/ Advance AV block/ Severe liver disease and porphyria Cautious in thyroid dysfuction, pre-existing lung disease and electrolytes imbalance

J Jabatan Kecemasan Hospital Sultan Haji Ahmad Shah 2010

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Drug Formula - (update 2010)

Antivenom
1 vail dilute in 10cc water for injection 4 vail = 40 cc + 200 ml NS run over 1 hour

J Jabatan Kecemasan Hospital Sultan Haji Ahmad Shah 2010

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Drug Formula - (update 2010)

Adenosine 6mg/3ml
Should be given in large bore line ie - brachial region and after bolus NS raised the arm high above the heart. Kindly remind the patient that he will feel his heart stop/heaviness on his chest prior to administration. attached the cardiac monitoring before administration of this drugs.

1 vail = 6mg --give bolus in 3-5 second +(followed) 20ml NS push fast If still not revert... 2 vail = 12mggive bolus in 3-5 second +(followed) 20 ml NSpush fast If still not revert.... 2 vail =12mg(max dose) + (followed) 20ml NS
Contraindication in:Sick sinus syndrome/ 2 nd +3 rd degree heart block => asystole

J Jabatan Kecemasan Hospital Sultan Haji Ahmad Shah 2010

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Drug Formula - (update 2010)

Calcium Gluconate 1g/10ml


1 ampul = 1g/10ml + 20ml NS run over 1-2 hour or as order by doctor
Uses: Treatment ve Calcium balance, hypoparathyroidism, vit D deficiency, MgSO4 toxicity. Contraindications:Ventricular fibrillations, metastatic bone disease, intracardiac/IM/SC routes, renal calculi, predispose to hypercalcemia ie -hyperparathyroidism Cautious in digitalized patient, renal/cardiac insufficiency and sarcoidosis.

Side Effects:Tinggling sensation at injection site / heat wave (va sodilatation), hypotension, bradycardia, arrythmias, cardiac arrest, local irritation, cellulitis (narcosis if extravasation), constipation, increase inotropic effect of digoxin

J Jabatan Kecemasan Hospital Sultan Haji Ahmad Shah 2010

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Drug Formula - (update 2010)

Dobutamine 250mg/20ml
a)single dose Body weight x 3 Eg; Bw(50kg)x3 = 150mg

150mg ---------250mg 12ML Dobutamine + 38 ml NS 1ml/hr = 1ug/kg/mnt x 20 = 12 ML Dobutamine

J Jabatan Kecemasan Hospital Sultan Haji Ahmad Shah 2010

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Drug Formula - (update 2010)

Dobutamine 250mg/20ml
b)double dose Body weight x 3 Eg; Bw (50kg)x3=150mg x 2 = 300mg

300mg ---------500mg 24 ML Dobutamine + 26 ml NS 1ml/hr = 2 ug/kg/mnt x 40 = 24 ML Dobutamine

J Jabatan Kecemasan Hospital Sultan Haji Ahmad Shah 2010

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Drug Formula - (update 2010)

Dobutamine 250mg/20ml
c)in 100 ml NS Body weight x 6 Eg; Bw (50kg)x 6= 300mg

300mg ---------500mg 24 ML Dobutamine + 76 ml NS 1ml/hr = 1 ug/kg/mnt x 40 = 24 ML Dobutamine

J Jabatan Kecemasan Hospital Sultan Haji Ahmad Shah 2010

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Drug Formula - (update 2010)

Dopamine 200mg/5ml
a)single dose Body weight x 3 Eg; Bw(50kg)x3 = 150mg

150mg ---------200mg 3.75ml Dopamine + 46.25ml D5% 1ml/hr = 1ug/kg/mnt x 5 = 3.75 ML Dopamine

J Jabatan Kecemasan Hospital Sultan Haji Ahmad Shah 2010

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Drug Formula - (update 2010)

Dopamine 200mg/5ml
b)double dose Body weight x 3 Eg; Bw(50kg)x3 = 150mg x 2 =300mg

300mg ---------400mg 7.5ML Dopamine + 42.5 ml D5% 1ml/hr = 2ug/kg/mnt x 10 = 7.5 ML Dopamine

J Jabatan Kecemasan Hospital Sultan Haji Ahmad Shah 2010

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Drug Formula - (update 2010)

Dopamine 200mg/5ml
c)in 100 ml D5% Body weight x 6 Eg; Bw(50kg)x6 = 300mg

300mg ---------400mg 7.5ml Dopamine +82.5 ml D5% 1ml/hr = 1ug/kg/mnt x 10 = 7.5 ML Dopamine

J Jabatan Kecemasan Hospital Sultan Haji Ahmad Shah 2010

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Drug Formula - (update 2010)

Digoxin 0.5mg/2ml
0.5mg in 100ml NS run over 30 minutes to 1 hour @ 0.25mg in 50 ml NS run over 30 minutes to 1 hour (in elderly or patient with other serious ongoing illness ie:- sepsis)
Adverse effects; Arrythmias, SVT/VT, heart block, GIT, Visual distrubances, gynaecomastia, confusion, restless. REMEMBER:Quinidine, verapamil, nifedipine, amiodarone increase plasma level of digoxin

J Jabatan Kecemasan Hospital Sultan Haji Ahmad Shah 2010

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Drug Formula - (update 2010)

Frusemide 20mg/ml
40mg Frusemide in 40ml NS

run 5ml/hr = 5mg

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Drug Formula - (update 2010)

Potasium Chloride (KCL) 10mg/10ml


Dilute in 40ml NS run over 1-3 hour @ as order by doctor
Caution in:Severe renal impairment, haemolytic reactions, untreated addisons disease, crush syndrome, digitalis intoxication with AV block.

J Jabatan Kecemasan Hospital Sultan Haji Ahmad Shah 2010

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Drug Formula - (update 2010)

Labetolol 25mg/5ml
Pure, jadikan 100mg=4ampul=20ml Run as order by doctor Iv bolus 25-50 mg every 5-10 min (max 300mg, effect 50 minutes) @ Infusion rate 0.5-2 mg/min
Contraindications:Known allergies, periphery vasoconstriction, hypertensive following acute myocardial infarction, not normally given with pt on digitalis -> resistant heart failure+Avblock, asthmatic.

J Jabatan Kecemasan Hospital Sultan Haji Ahmad Shah 2010

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Drug Formula - (update 2010)

Lytic Cocktail
1. D50% = 5 ampul 2. Actrapid = 10 unit 3. Calcium Gluconate = 10mg Bagi calcium gluconate dahulu...kemudian D50 50cc akhir sekali actrapid 10 unit

J Jabatan Kecemasan Hospital Sultan Haji Ahmad Shah 2010

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Drug Formula - (update 2010)

Lignocaine 500mg/5ml
Arrythmia : bolus 1-2 mg/kg over 2 minutes Infusion : 1-4 mg/min

J Jabatan Kecemasan Hospital Sultan Haji Ahmad Shah 2010

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Drug Formula - (update 2010)

Lignocaine 500mg/5ml

@ 1G in 50 ml D5% 1ml = 20mg 3ml = 60mg

1 x 60 x 50 1mg/ml = -------------- = 3 ml/mnt 1000

J Jabatan Kecemasan Hospital Sultan Haji Ahmad Shah 2010

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Drug Formula - (update 2010)

Magnesium Sulphate (MgSO4)2.47mg/5ml


FOR ASTHMA PATIENT Dilute in 20 ml NS If order infusion run over 30 mnt 40ml/mnt
Contraindications: Heart block Cautious in renal impairment, digitalized patient, CNS derpessent or neuromuscular blocking agents. Watchout for S&S of toxicity
Effects Deeo tendon reflexes presebt but possibly hypoactive Prolonged P-Q interval; Widened QRS complex Loss of deep tendon reflexes Respiratory paralysis Altered cardiac conduction Cardiac arrest Antidote: Calcium Gluconate (IV CaGluconate 1g slow bolus) Adverse effects: Bradycardia, diplopia, flushing, headache, hypotension, nausea, shortness of breath, slurred speech, vomiting, weakness. Serum Mg (mEq/L) 4-7 5-10 8-10 10-13 15 25

J Jabatan Kecemasan Hospital Sultan Haji Ahmad Shah 2010

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Drug Formula - (update 2010) MgSO4 cont...

FOR SEVERE PRE-ECLAMPSIA/ECLAMPSIA IV Regime (Zuspan) => Loading Dose : 4g MgSO4 => Then 8mls (4gm)+12mls NS => 20mls Give Slow bolus 10-15min Then Maintenance 25gm/50mls (10vial) in infusion pump Run 2cc/hr (1gm/h) For 24H after fits/delivery if recurrent fits occur give 2g/10min IM Regime (Pritchard) Loading dose- Deep IM injection 5gm (10mls) at each buttock (total 10gm-20msl) Maintenance dose deep IM injection 2.5gm (5mls) each buttock every 4H

J Jabatan Kecemasan Hospital Sultan Haji Ahmad Shah 2010

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Drug Formula - (update 2010)

Midamorphine
Midazolam 30mg + Morphine 30mg + 21ml NS = 30ml 1mls = 1mg Midazolam + 1mg Morphine Infusion rate (0.02-0.2mg/kg/hr)

J Jabatan Kecemasan Hospital Sultan Haji Ahmad Shah 2010

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Drug Formula - (update 2010)

Omeperazole 40mg/vail
1 vail(40mg) + 10ml water for injection Give bolus Infusion : 1vail(40mg) +10mls water for injection +30ml NS Run order by doctor.
1ml = 1 mg Omeprazole In UGIB 80mg stat then infusion 8mg/hr

J Jabatan Kecemasan Hospital Sultan Haji Ahmad Shah 2010

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Drug Formula - (update 2010)

Phenytoin 250mg/5ml
750mg(3ampul) +85ml NS = 100ml Run over 1 hour @ as order by doctor
In status epilepticus : 15-20mg/kg (both adult n paeds)Maximum dose 1.5g

J Jabatan Kecemasan Hospital Sultan Haji Ahmad Shah 2010

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Drug Formula - (update 2010)

Nocuron 4mg/ml
Intubating dose 0.1 mg/kg Duration action 20-30 minutes

J Jabatan Kecemasan Hospital Sultan Haji Ahmad Shah 2010

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Drug Formula - (update 2010)

Tramadol 50mg/ml
(1-2 mg/kg stat dose) 100mg + 48ml NS Run as order by doctor
Maximum dose 15mg/hr Dosage: 2-8mcg/kg/min (infusion)

J Jabatan Kecemasan Hospital Sultan Haji Ahmad Shah 2010

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Drug Formula - (update 2010)

Salbutamol 0.5mg/ml
3 mg(6 ampules) in 50cc D5% Loading Dose = 250 mcg = 0.25 mg (0.5 ml) Infusion = 5-20 mcg/min
Contraindications: Known hypersensitivity, threatened abortion during 1 st and 2 nd trimester, toxaemia in pregnancy, antepartum haemorrhage, placentae previa Cautious in thyrotoxicosis, serious heart or circulation disorders, DM, HPT, lactation Side Effects

Headaches, tension, tachycardiac, peripheral vasodilatation, tremors, hypokalemia, transient muscle cramps and paradoxical bronchospasm (inhalers)

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Drug Formula - (update 2010)

Sliding Scale
50 unit Actrapid + 49.5 ml NS = 50ml Plan A = 6ml/hr Plan B = 12ml/hr In infusion pump

J Jabatan Kecemasan Hospital Sultan Haji Ahmad Shah 2010

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Drug Formula - (update 2010)

Streptokinase 1.5m unit/vail


1vail dilute in 10ml NS + 90ml NS =100ml Run over 1 hour

J Jabatan Kecemasan Hospital Sultan Haji Ahmad Shah 2010

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Drug Formula - (update 2010)

Solumedrol (methylprednisolone sodium succinate)


30mg/kg bodyweight over 1 hour Maintain dose= 5.4mg/kg/bw over 23 hour
Contraindications Hypersensitivity, premature infant ( Gasping Syndrome), known hypersensitivity, systemic fungal infections

J Jabatan Kecemasan Hospital Sultan Haji Ahmad Shah 2010

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Drug Formula - (update 2010)

Isosorbide Dinatrate 10mg/10ml


30mg isoket + 20ml NS = 50ml 1 mls/hr=10ug/min Rate : 2-10mg/H
Contraindications In patient with raised ICP Side Effects Hypotension, reflex tachycardia, headaches

J Jabatan Kecemasan Hospital Sultan Haji Ahmad Shah 2010

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Drug Formula - (update 2010)

Sodium Bicarbonate
1-2 mmol/kg in slow iv over 20-30 minutes
Side effects: Local : phlebitis, warm @ injection site, venous thrombosis, extravasation of MgSO4 may cause severe necrosis of the area. Systemic: Metabolic alkalosis, hypokalemia,nausea, vomiting, increase thirst, slow breathing, weakness, irritability

J Jabatan Kecemasan Hospital Sultan Haji Ahmad Shah 2010

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Drug Formula - (update 2010)

Isoprenaline
1- 10mcg/kg/mnt 3mg in 50mls D5% Xml/hr = x mcg/mnt

J Jabatan Kecemasan Hospital Sultan Haji Ahmad Shah 2010

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Drug Formula - (update 2010)

Antidots Fullers earth


15% = 60G Fullers earth dilute in 400cc water give 20 ml

J Jabatan Kecemasan Hospital Sultan Haji Ahmad Shah 2010

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Drug Formula - (update 2010)

ANTI DOT PARACAETAMOL N Acetylcytene 5mg/25ml


150mg/kg in 200ml D5% over 15 min Then 50mg/kg in 500ml D5% over 4 hour Then 100mg/kg in 500ml D5% over 16 hour

J Jabatan Kecemasan Hospital Sultan Haji Ahmad Shah 2010

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Drug Formula - (update 2010)

DRUG CONCENTRATION IN MG/ML OR MCG/ML. 1MG =1000MCG 1GM=1000MG FORMULA MG/ML=AMOUNT OF DRUG IN THE SOLUTION (MG)
VOLUME OF SOLUTION(ML) EX;200MG OF DRUG IN 500 ML TO DETERMINE MG/ML 200 MG / 500ML = 0.4 MG/ML TO DETERMINE MCG/ML, FIRST CHANGE MG TO MCG 200MG X 1000 MCG/MG = 200,000MCG THEN DIVIDE MCG BY ML OF SOLUTION

200000MCG/500ML = 400 MCG/ML.

CALCULATING MCG/KG/MIN. YOU MUST KNOW ; WT IN KG , INFUSION RATE (ML/HR) DRUG CONCERTRATION FORMULA ; MCG/KG/MIN = MCG/ML X ML/HR KG X 60 MIN /HR

EX AQ 75 KG PATIENT IS RECEIVING DOPA AT 20 ML/HR. THERE IS 250 MG OF DOPA IN 250 ML OF D5W TO DETERMINE DOSAGE BEING GIVEN IN MCG/KG/MIN FIRST CHANGE MG TO MCG ; 250 MG = 250000 MCG

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Drug Formula - (update 2010)

THEN DEVIDE THE DOSE BY THE AMOUNT OF SOLUTION 250000 MCG/250 ML = 1000 MCG / ML NOW ALL THREE PARAMETER ARE KNOWN MCG/KG/MIN = MCG/ML X ML/HR KG X 60

=1000 X 20 75 X 60

= 20,000

= 4.44 MCG/KG/MIN

CALCULATING THE AMOUNT OF FLUID TO INFUSE FORMULA ML/HR = MCG/KG/MIN ORDERED X KG X 60 MCG/ML

EX. 70 KG PATEINT IS TO RECEIVE DOPA AT 6 MCG/KG/MIN THERE IS 400MG OF DOPA IN 250 ML D5W TO DETERMINE THE INFUSION RATE IN ML ; FIRST CHANGE THE MG TO MCG/MG 400 MG = 400,000 MCG

Then devide the dosage by amount of solution ; 400000 mcg = 1600 mcg/ml 250 ml Now all three parameter are known Ml/hr = mcg/kg/min ordered x kg x 60 min Mcg / ml =16 ml/hr = 6 x 70 x x60 = 25200 = 1600 1600

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Drug Formula - (update 2010)

Dilution anti venom GUIDE FOR DOSAGE Grade for envenomation Minimal Moderate Severe Very Severe Dosage Not Indicated 20-40 mls(2-4 vials) 50-90 mls(5-9 vials) 100-150 mls(10-15 vials)

Grades of envenomation
Minimal Moderate Severe Very Severe No pain to moderate pain, erythema, oedema 2.5-15 cm, no systemic involvement Severe pain, tenderness, oedema 25-40cm, erythema, petechia, vomiting, fever and weakness Widespread pain, oedema 40-50cm, ecchymosis, systemic signs, Rapid swelling, ecchymosis, CNS symptoms, visual disturbance, shock, convulsion

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Drug Formula - (update 2010)

FORMULAS USED IN FLUID ADMINISTRATION

BASAL FLUID MAINTENANCE. 1500 ML / M 2 BSA / 24 HRS = ML /24 HR ( CALCULATE AS ML/HRS ) GENERAL GUIDELINES ; UP TO 10 KG = 100 ML / KG/ 24 HRS 11 - 20 KG = 50 ML/KG /24 HRS PLUS 100 ML/KG FOR FIRST 10 KG 20 KG = 20 -25 ML/KG/24 HRS PLUS 50 ML/KG FOR EACH KG 11 THROUGH 20 PLUS 100 ML / KG FOR FIRST 10 KG VOLUME REPLACEMENTWITH CRYSTALLOID

ADMINISTER 3 ML FOR EVERY ML LOST.FOR FLUID CHALLENGES ADMINISTER ;

IV BOLOS 20 ML/KG N/S RL IN CHILDREN IV BOLOS OF 200 300 ML RL IN SURGICAL PATIENT IV BOLOS OF 200 300 ML NS IN ADULT MEDICAL PATIENT VOLUME REPLACEMENT WITH COLLOID0 ADMINISTER 1 ML FOR EVERY CC LOST

J Jabatan Kecemasan Hospital Sultan Haji Ahmad Shah 2010

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Drug Formula - (update 2010)

HAEMODYNAMIC FORMULA AND VALUES


PARAMETER CARDIAC OUTPUT CARDIAC INDEX STROKE VOLUME MAP CVP FORMULA HR X SV CO/BSA CO X 1000 HR 2(DBP) + SBP 3 MEASURED \ NORMAL RANGE 4 8 L/MIN 2.2 4.0 L/MIN/M 2 650 -150 ML / BEAT 70 - 105 MMHG 2 - 6 MMHG

J Jabatan Kecemasan Hospital Sultan Haji Ahmad Shah 2010

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Drug Formula - (update 2010)

NORADRENALINE DILUTION
SINGLE DOSE NORADRENALINE 4MG DILUTE DGN 50 ML D5% (1 AMPULE )

DOUBLE DOSE NORADRENALINE 8MG DILUTE DGN 50 ML D5% (2 AMPULE )

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Drug Formula - (update 2010)

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Drug Formula - (update 2010)

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Drug Formula - (update 2010)

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