Avoid Isoproterenol as this can cause peripheral vasodilation and thus hypotension avoid dobutamine alone for this same reason. Catecholamines – first line are Epinephrine or Dopamine, due to both inotropic effect and vasoconstriction. Acts to increase contractility, does not raise HR. CaCl has 3-5x more calcium than Ca gluconate, but is sclerosing to veins and hence must be given through central lines. IV calcium – can give CaCl (if have central line) or Ca Gluconate (if peripheral line). Even though this is considered a 1st-line “antidote” there is actually limited data to support this. This increases contractility and possibly heart rate.
If positive response, can start an infusion at 2-5 mg/hour.Īctivates adenylate cyclase to raise cAMP levels, which increases intracellular Ca releat. Glucagon – 5 mg bolus over 1 minute, can repeat 10-15 minutes later. Side effects: Anticholinergic effects = 1) CNS effects, 2) GI – decreased saliva, nausea, vomiting, ileus, 3) GU – urinary retention, 4) CV – tachycardia (obviously) and arrhythmias, 5) Eyes – blurry visionĢ. Also does not work in transplanted hearts (as they lack vagal innervation). Atropine – 0.5 mg pushes at a time, q3-5 minutes, maximum of 3 g.Īcts at the AV node – will not work for block at or below the bundle of His. Medical Therapy for Beta-Blocker Toxicity:ġ.
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