Medication Calculations in Cardiac Arrest: Epinephrine, Amiodarone, and Sodium Bicarbonate

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 Calculations in Cardiac Arrest: Epinephrine, Amiodarone, and Sodium Bicarbonate

Introduction

In the critical setting of cardiac arrest, accurate medication calculations are crucial to ensure the timely administration of life-saving drugs. This essay addresses medication calculations for epinephrine, amiodarone, and sodium bicarbonate in the context of a cardiac arrest scenario. It outlines the steps for determining the concentration of each medication, the amount to be administered, and the necessary vials or syringes.

Epinephrine Administration

Concentration of Epinephrine: The pre-filled syringe of epinephrine is packaged as 1 mg/10 ml. To calculate the concentration, we divide the amount of epinephrine (1 mg) by the volume of solution (10 ml):
Concentration = 1 mg/10 ml
Therefore, the concentration of the epinephrine is 0.1 mg/ml.

Epinephrine Dosage: As per the standing order protocols, 1 mg of epinephrine IV push is administered. To determine the amount to be pushed, we divide the dosage (1 mg) by the concentration (0.1 mg/ml):
Amount = 1 mg / 0.1 mg/ml
Therefore, 10 ml of epinephrine solution should be pushed.

Amiodarone Administration

Concentration of Amiodarone: The vial of amiodarone is packaged as 150 mg in 3 ml. To calculate the concentration, we divide the amount of amiodarone (150 mg) by the volume of solution (3 ml):
Concentration = 150 mg / 3 ml
Therefore, the concentration of each vial of amiodarone is 50 mg/ml.

Number of Vials Needed: The required dosage is 300 mg of amiodarone. To determine the number of vials needed, we divide the dosage (300 mg) by the concentration (50 mg/ml):
Number of Vials = 300 mg / 50 mg/ml
Therefore, 6 vials of amiodarone are required.

Additional Amiodarone Administration

For the subsequent administration of 150 mg of amiodarone, we can use the same concentration as before (50 mg/ml). The amount to be pushed is calculated as:
Amount = 150 mg / 50 mg/ml
Therefore, 3 ml of amiodarone solution should be pushed.

Sodium Bicarbonate Administration

Concentration of Sodium Bicarbonate: The pre-filled syringe of sodium bicarbonate is packaged as “50 mEq/50 ml.” The concentration can be calculated as 1 mEq/1 ml.

Sodium Bicarbonate Dosage: The dosage is determined based on the patient’s weight of 74 kg, with a dosage of 1 mEq/kg. To calculate the amount to be pushed, we multiply the weight (74 kg) by the dosage (1 mEq/kg):
Amount = 74 kg x 1 mEq/kg
Therefore, 74 mEq of sodium bicarbonate should be pushed.

Conclusion

Accurate medication calculations are crucial in cardiac arrest scenarios to ensure the appropriate administration of life-saving drugs. In the case of epinephrine, the concentration is 0.1 mg/ml, and 10 ml is pushed. Amiodarone has a concentration of 50 mg/ml, with 6 vials required for a dosage of 300 mg. An additional 150 mg of amiodarone is administered as 3 ml. Sodium bicarbonate has a concentration of 1 mEq/ml, and 74 ml is pushed based on a dosage of 1 mEq/kg.

By performing these calculations accurately, healthcare providers can ensure the appropriate dosing and administration of medications during critical situations such as cardiac arrest, optimizing the chances of a positive patient outcome.