Today’s resource is an outstanding brief resource (16:31). The best way to rapid review is to read the auto-generated transcript (so you’ll need to double check that the computer hasn’t made any mistakes). To view the transcript, watch the video on YouTube and follow along on the transcript.
Today, I reviewed and embedded the excellent YouTube video, Push Dose Pressors for EMS: Epinephrine and Norepinephrine.
Mar 9, 2022Sometimes a small dose of epinephrine or norepinephrine can keep a patient from becoming hypotensive during intubation, or may help bridge the patient to a continuous infusion. Dr. Pickett talks about simple methods for mixing and administering push doses of these pressors and how to administer the infusion. NOTE: It is ASSUMED you already know the indications, contraindications, and side effects of these drugs. This video is NOT a comprehensive review of these medications.
Making a push dose epinephrine syringe:
Take a 1:10,000 cardiac epi syringe (1 mg of epinephrine in 10 cc). We’re not going to push this because this is way too much.
This syringe has 1 mg of epinephrine in 10 ml of saline which is 0.1 mg per ml.
Again, the above concentration is way too high to use as a push dose pressor. And badness could happen (like a fatal arrythmia).
So, I’m going to waste 9 cc of the syringe so there is only one cc in the syringe. The concentration is in the syrine is still 0.1 mg per 1 ml, just like it was when there was 10 ml in the syringe. The concentration hasn’t changed yet; we’re about to do that.
I’m going to draw out 9 ml of saline from the bag into the syringe with the one ml of epinephrine, 0.1 mg/ml.
I will draw [up 9 cc of normal saline into the syringe] and now I’ve got 10 cc’s again.
So my concentration in that syringe right there [now] 0.1 milligrams in 10 ml.
So it is [now] .01 milligrams or 10 micrograms per ml 10
mics per ml epinephrine.Summary Slide:
So now when i push this mixture . . .
I’m going to push 2 ml at a time that will give me 20 micrograms or 0.02 milligrams of epinephrine.That’s enough to kind of bump that pressure for just a fewparalytics and so forth or it gets me a chance to mix up whatever infusion of a presser that i’m going to use. . .
