Medication Administration in Cardiac Arrest: Calculations and Concentrations

QUESTION

You are treating a 74 kg male who is in cardiac arrest.  The patient is in ventricular fibrillation and CPR is started including defibrillation. You follow standing order protocols, and administer epinephrine 1 mg IV push.  Your pre-filled syringe of epinephrine comes packaged as 1 mg/10 ml.

What is the concentration of the epinephrine?  mg/ml

How much epinephrine do you push?  ml

After shocking again, without rhythm change, you are to administer amiodarone, 300 mg IV push. Your vials of amiodarone are packaged 150 mg in 3 ml.

What is the concentration of each vial?  mg/ml

How many vials will you need?  vials

You continue to work the code, and soon it’s time for more Amiodarone, 150 mg this time.

How much do you push?  ml

Your standing orders allow you, at this point, to administer sodium bicarbonate IV push at a dosage of 1 mEq/kg.  Your pre-filled syringes comes packaged as “50 mEq/50 ml.”

What is the concentration of the sodium bicarbonate?  mEq/ml

How much sodium bicarbonate do you push?  ml

ANSWER

Medication Administration in Cardiac Arrest: Calculations and Concentrations

Introduction

During a cardiac arrest, prompt administration of appropriate medications is crucial to restore and maintain a stable cardiac rhythm. This essay focuses on the calculations and concentrations of medications commonly used in cardiac arrest scenarios. Specifically, we will address the concentrations and dosages of epinephrine, amiodarone, and sodium bicarbonate, highlighting their importance in resuscitation efforts.

Administration of Epinephrine

The concentration of the pre-filled syringe of epinephrine is 1 mg/10 ml, indicating that there is 1 mg of epinephrine in each 10 ml of solution.

To determine the amount of epinephrine to push, we follow the standing order protocol of administering 1 mg. Therefore, we need to administer 1 ml of epinephrine since the concentration of the solution is 1 mg/ml.

Administration of Amiodarone

The vials of amiodarone are packaged as 150 mg in 3 ml, which means that each milliliter of solution contains 50 mg of amiodarone.

To administer 300 mg of amiodarone, we divide the total dosage by the concentration per milliliter:
300 mg / 50 mg/ml = 6 ml

Therefore, we will need 6 vials of amiodarone, as each vial contains 3 ml, totaling 150 mg per vial.

Administration of Additional Amiodarone:
For the subsequent dose of 150 mg of amiodarone, we follow the same calculation as before:
150 mg / 50 mg/ml = 3 ml

Hence, we administer 3 ml of amiodarone for the second dose.

Administration of Sodium Bicarbonate

The pre-filled syringe of sodium bicarbonate is packaged as “50 mEq/50 ml,” indicating that there are 50 milliequivalents (mEq) of sodium bicarbonate in each 50 ml of solution.

To calculate the amount of sodium bicarbonate to push based on the patient’s weight, we need to know the patient’s weight in kilograms. Let’s assume the patient weighs 74 kg.

According to the standing orders, we administer 1 mEq/kg of sodium bicarbonate. Therefore, we calculate the dosage as follows:
1 mEq/kg x 74 kg = 74 mEq

To convert the dosage to milliliters, we divide the dosage by the concentration per milliliter:
74 mEq / 50 mEq/ml = 1.48 ml

Hence, we administer approximately 1.48 ml of sodium bicarbonate.

Conclusion

During a cardiac arrest, accurate medication administration is critical for successful resuscitation. Calculating concentrations and dosages ensures that appropriate amounts of medications are delivered promptly. In this scenario, we determined the concentrations and amounts of epinephrine, amiodarone, and sodium bicarbonate. These calculations play a vital role in providing optimal care and improving outcomes for patients experiencing cardiac arrest.

Note: It is essential to adhere to specific institutional protocols and guidelines when administering medications. The calculations provided in this essay are for illustrative purposes and may not reflect the exact dosages or concentrations required in a real-life scenario. Always consult appropriate references, medication guidelines, and medical professionals for accurate and safe medication administration.