In our protocols we have two beta blockers to choose from depending on the patient’s problem. The two are Metoprolol and Labetalol and they are actually quite different in their actions and therefore, their use.

Metoprolol is a selective beta 1 blocker which will specifically block the effects of epinephrine and norepinephrine on the heart. For our purposes this will blunt their chronotropic and inotropic effects thereby reducing CO and blood pressure. Additionally Metoprolol also has been shown to reduce the incidence of post MI arrhythmias.

Labetalol on the other hand is a non-specific beta blocker and also has alpha 1 blocking effects. This alpha blocking effect would make it specifically useful for lowering a high DIASTOLIC pressure as that number is driven primarily by peripheral vascular resistance.

Our protocols allow for Metoprolol is cases of ACS/MI and allow for either one in cases of hypertensive crisis and CVA with associated hypertension. We also can use nitroglycerin in the latter two but NTG has more of an effect on the veins (preload) than the arteries (afterload). I imagine that the choice would be based on whether its the systolic or diastolic that is really high.

Dopamine and other useful Paramedic Drips

My quick and easy way….

400mg in a 250ml bag yields:

• 1600µg per ml
• 26.6µg per gtt (60 gtt set)

So if you need to calculate a drip for a 70kg patient you could do this:

70kg x 5µg (example dose) = 350µg/min . 350/26.6 = 13.15 gtts/min

Works for me…. but some prefer the regular dopamine clock so i have included that below

The clock method

Drug Preparation Rate

Amiodarone (3mg/cc) 150mg in 50cc NS

• 0.5mg/min=10gtts/min

Dopamine (800µg/cc) 200mg in 250cc NS

• 200mcg/min=15gtts/min
• 400mcg/min=30gtts/min
• 600mcg/min=45gtts/min
• 800mcg/min=60gtts/min

Dopamine (1600µg/cc) 400mg in 250cc NS

• 400mcg/min=15gtts/min
• 800mcg/min=30gtts/min
• 1200mcg/min=45gtts/min
• 1600mcg/min=60gtts/min

Epinephrine (4mcg/cc) 1mg in 250cc NS

• 2mcg/min=30gtts/min

Lidocaine (4mg/cc) 1G in 250cc NS

• 1mg/min=15gtts/min
• 2mg/min=30gtts/min
• 3mg/min=45gtts/min
• 4mg/min=60gtts/min

Procainamide (20mg/cc) 1G in a 50cc NS

• 20mg/min=60gtts/min
• 30mg/min=90gtts/min

Procainamide (4mg/cc) 1G in 250cc NS

• 1mg/min=15gtts/min
• 2mg/min=30gtts/min
• 3mg/min=45gtts/min
• 4mg/min=60gtts/min

Vasopressin, also known as ADH or anti-diuretic hormone stimulates the AVP1A receptors (AVPR1A) which are present in the brain, kidneys, liver and vessels. It causes kidney water retention, peripheral vasoconstriction in higher doses, the release of several clotting factors and gluconeogenesis. Also, per this study it stimulates glycogen breakdown in the liver, similar to the effects of glucagon.

Gluconeogenesis is the second way the body maintains blood sugar levels. (The first is glycogenolysis, the body’s conversion of glycogen stores into glucose) In gluconeogenesis, the body generates glucose from non-carbohydrates such as lactate (lactic acid, milk acid), glycerol (glycerin) and glycogenic amino acids.

I’m not sure how water retention and glucose generation are related but I’m still thinking There are quite a few other seemingly unrelated actions that vasopressin causes on other receptor sites so I’m not sure the actions have to be related.

Many times throughout the Paramedic Program I have come across a drug that has an unexpected use listed in the profile. Not very often are we given a comprehensive explanation as to why this drug works for this other use and it is left to us to try and figure this out. One example that I have seen recently is the use of Glucagon for beta blocker overdose. Glucagon is a hormone used in diabetic emergencies; its use for beta blocker overdose is actually pretty simple once it is explained.

This pharmacology booklet was handed out the other night, it is very useful and comprehensive. This was originally prepared for the St Vincent’s class and any references to protocols refer to NYC REMAC (as of 2006).

Sample page:

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También encontré un gran recurso si usted está buscando para comprar en línea de equipos médicos. Ellos llevan las máquinas de EKG, máquinas de ultrasonido, así como desfibriladores

1-5 mcg – Renal Vasoconstriction

5-15 mcg – Peripheral Vasoconstriction

15-20 mcg – Mesenteric Vasoconstriction

Mix: 200mg or 400mg into 250cc of NS

When using a 60gtts drip set each gtt = 13.3mcg/ml for the 200/250 concentration or 26.6mcg/ml for the 400/250 concentration.

Contraindicated in Hypovolemia and exsanguination

Indicated: Cardiogenic Shock, shock secondary to bradycardia, septic shock