Hypotension | Metaraminol | 0.5–1 mg | Intravenous | Dilute 1 mL of metaraminol 10 mg/1 mL solution to 20 mL with normal saline (1 mL=0.5 mg). Administer 1–2 mL intravenously. Repeat as necessary. |
Phenylephrine | 100–500 μg | Slow intravenous | Phenylephrine 1 mg/10 mL solution (1 mL=100 μg). Administer 1–5 mL. Phenylephrine 10 mg/1 mL solution: dilute 1–10 mL with normal saline. Discard 9 mL and dilute remainder to 10 mL with normal saline (1 mL=100 μg). Administer 1–5 mL. Repeat as necessary. |
Anaphylaxis | High-flow oxygen and anaesthetic support | |
Crystalloid | 500–1000 mL | Intravenous | Fluid challenge. Repeat as necessary. |
Epinephrine | 50–100 μg | Intravenous | Dilute 1 mL of epinephrine 1:1000 to 10 mL with normal saline (1 mL=100 μg). Administer 0.5–1 mL intravenously. Repeat as necessary. |
500 μg | Intramuscular | 0.5 mL of epinephrine 1:1000. |
Hydrocortisone | 200 mg | Intramuscular or slow intravenous | Stat dose. |
Chlorphenamine | 10 mg | Intramuscular or slow intravenous | Stat dose. |
Bleeding | Protamine | 25–50 mg | Intravenous | 1 mg neutralises 80–100 units of unfractionated heparin when given within 15 min (if longer than 15 min since heparin, less protamine required). Rate not to exceed 5 mg/min. Maximum dose 50 mg. |
Packed red cells, platelets and fresh frozen plasma | Intravenous | Consider activating local major haemorrhage protocol. |
No-reflow | Nitrates | 100 μg–1 mg | Intracoronary | Dilute 1 mL of isosorbide dinitrate 10 mg/10 mL solution to 10 mL with normal saline (1 mL=100 μg). Administer 1–10 mL. Repeat as necessary. |
Adenosine | 100 μg | Intracoronary | Draw 1 mL from a 2 mL phial (6 mg/2 mL solution) in a 10 mL Luer-Lok syringe. Dilute to 9 mL total with normal saline and mix. Discard 6 mL and dilute remainder to 10 mL with normal saline (1 mL=100 μg). Deliver 1 mL aliquots via microcatheter or aspiration device. Up to 4 mg over 1 min. |
Verapamil | 100–200 μg | Intracoronary | Draw 1 mL from a 2 mL phial (5 mg/2 mL solution) in a 10 mL Luer-Lok syringe. Dilute to 10 mL total with normal saline and mix. Discard 6 mL and dilute remainder to 10 mL with normal saline (1 mL=100 μg). Deliver 1–2 mL aliquots via microcatheter or aspiration device. Up to 1 mg. |
Sodium nitroprusside | 100–200 μg | Intracoronary | Add 50 mg powder and solvent for solution for infusion phial to 500 mL of 5% glucose (1 mL=100 μg). Deliver 1–2 mL aliquots via microcatheter or aspiration device. Up to 1 mg. |
Thrombus | Abciximab | Dose based on weight | Intracoronary, intravenous | Reconstitute as per manufacturer’s instructions. Give loading followed by maintenance dose according to weight-based dosage table. |
Tirofiban | Dose based on weight | Intracoronary, intravenous | High bolus dose regimen—bolus 25 μg/kg over 2–3 min, and then 0.15 μg/kg/min for 12 hours.54
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Alteplase | 200–300 μg | Intracoronary | Reconstitute Actilyse 10 mg or 20 mg powder and solvent for solution for injection—1 mg in 1 mL. Draw up 1 mL and make up to 10 mL with normal saline (1 mL=100 μg). Dose 2–3 mL (200–300 μg). |