⚙ Dilution Protocol: All calculations assume the drug is diluted "made to 50 ml" (or standard volume) using the specified compatible solvent for an electronic syringe pump.
1. Patient Parameters
2. Select Infusion
⚒ Indian Clinical Context & Pitfalls
Critical care dosing in the subcontinent requires strict attention to variable pharmaceutical packaging and supply chain realities:
Noradrenaline Ampoules: Highly variable. Check if the ampoule contains 2 mg in 2 ml or 4 mg in 2 ml. The protocol requires a total of 4 mg (Single) or 8 mg (Double) in the syringe.
Amiodarone Diluent: Must strictly be diluted in 5% Dextrose ONLY. Saline causes immediate precipitation. Additionally, PVC bags absorb the drug; use glass bottles or polyolefin bags if possible.
Vasopressin: Do not titrate like Noradrenaline. It acts on V1 receptors to restore vascular tone and is used at a fixed rate of 0.04 units/min.
Illness Scripts: Vasopressor Selection
Clinical State
First Line
Rationale
Septic Shock
Noradrenaline
Potent alpha-1 agonism restores systemic vascular resistance (SVR) without the extreme tachyarrhythmia risk of Dopamine. Add Vasopressin if > 0.25-0.5 microgram/kg/min required.
Cardiogenic Shock
Noradrenaline + Dobutamine
Noradrenaline maintains MAP for coronary perfusion; Dobutamine provides inotropy. Dopamine is restricted due to higher mortality in cardiogenic shock.
Anaphylactic Shock
Adrenaline
Mixed alpha and beta agonism. Relieves bronchospasm, reduces mast cell degranulation, and supports cardiac output and SVR simultaneously.
