Pediatric Shock Part 9 Medications

Medications

·         Inotropic agents

·         Vasopressors

·         Vasodilators

·         Inodilators

Epinephrine

·         Acts directly on adrenergic receptors

·         Low dose cause increased myocardial contractility, heart rate, pulse pressure, and SBP

·         Higher doses produce increased SBP and DBP pressures and a narrowing of the pulse pressure.

Epinephrine Indications

·         Inadequate cardiac output

·         Hypotension

·         Symptomatic bradycardia

·         Pulseless arrest

·         Septic shock

Dosages

0.1-1mcg/kg/min infusion

Wide variety of response so the nurse should titrate it according to the patient’s response.

Mix 0.6 x body weight (kg) equals mg to add to sufficient fluid to create a total volume of 100ml.

1ml/hr delivers 0.1mcg/kg/min

Precautions

·         Preferably use a central line

·         Can cause local ischemia if infiltration occurs

·         Inactivated by alkaline solutions

·         May cause peripheral ischemia and necrosis if administered in peripheral line

·         May aggravate myocardial ischemia and increase myocardial oxygen demand

Norepinephrine

·         At clinical doses vasoconstrictive properties predominate

·         When used in combination with Dopamine or Dobutamine, it has been shown to increase splanic and renal artery perfusion

Norepinephrine indications

·         Hypotension, especially due to vasodilation

·         Inadequate cardiac output

·         Spinal shock

·         Alpha adrenergic overdoses: Tricyclic overdose and neuroleptic agents

Dosages

·         0.1-2mcg/kg/min infusion

·         Wide variety of response so the nurse should titrate it according to the patient’s response.

·         Mix 0.6 x body weight (kg) equals mg to add to sufficient fluid to create a total volume of 100ml.

·         1ml/hr delivers 0.1mcg/kg/min

Precautions

·         Hypertension

·         Organ ischemia

·         Distal extremity ischemia

·         Infuse via a secure central line

·         Extravasation can result in local tissue necrosis

Dopamine

·         Lower dose lead to increased renal and splanchnic, coronary, and cerebral blood flow

·         Higher dose lead to peripheral vasoconstriction and heart rate.

·         Wide variety in patient responses

Indications

·         Inadequate cardiac output

·         Hypotension

·         Need to increase renal and splanchnic blood flow

Precautions

·         May produce tachycardia which may aggravate myocardial ischemia

·         Deliver through a secure large bore peripheral cath

·         Higher does should be delivered via a central line

·         Avoid mixing with alkaline solutions

Dobutamine

·         Increases cardiac contractility

·         Increases heart rate

·         Produces mild vasodilation of the peripheral vascular bed

Indications

·         Myocardial dysfunction

·         Inadequate cardiac output, especially in patients with increased pulmonary vascular resistance

Dosages

·         2-20mcg/kg/min infusion

·         Preparation:  6 x body wt (kg) equals amount in mg to be added to sufficient diluent to create a total volume of 100ml

·         1ml/hr delivers 1mcg/kg/min

Precautions

·         Tachycardia

·         Tachydysrrhythmias

·         Hypertension

·         N&V

·         Local tissue necrosis due to extravasation

Sodium Nipride

·         Vasodilator that reduces vascular tone

·         It improves myocardial function by reducing peripheral vascular resistance

Indications

·         Hypertensive emergencies

·         Inadequate cardiac output due to high peripheral vascular resistance

·         Cadiogenic shock

Precautions

·         Monitor BP closely

·         Hypotension is the most common side effect

·         Monitor thiocyanide levels if used for more than 2-3 days

Milrinone

An inodilator that increases myocardial contractility and produces peripheral and vascular bed vasodilation

Indications

·         Inadequate cardiac output due to increased peripheral vasoconstriction

·         Cardiogenic shock

·         Septic shock

Dosages

·         Loading dose of 50-75mcg/kg over 10-60 minutes

·         Continuous infusion of 0.5-0.75mcg/kg/min IV/IO

Precautions

·         Monitor for hypotension during loading dose

·         Long half-life

·         Thrombocytopenia may occur

Inamrinone

·         Loading dose of 0.75 to 1mg/kg over 5 minutes. May repeat x 2 for total loading dose of 3mg

·         Continuous infusion of 5-10mcg/kg/min


Source:

Pediatric Advanced Life Support Provider Manual by Leon, M.D. Chameides, Ricardo A., M.D. Samson, Stephen M., M.D. Schexnayder and Mary Fran, RN Hazinski (Oct 12, 2011)