NORTH COAST EMERGENCY MEDICAL SERVICES Policy # 5410

POLICIES AND PROCEDURES

Subject: Medical Direction

Isoproterenol Hydrochloride (Isuprel) Protocol

Associated Policies: 02/06/98

  1. Class:
  1. Synthetic catecholamine. (Pure beta).
  1. Therapeutic Effects:
  1. Potent inotropic and chronotropic properties.
  1. Indications:
  1. Refractory symptomatic bradycardias with hemodynamically significant hypotension.
  2. AV blocks.
  3. Bradycardia in the denervated transplanted heart.
  4. Refractory Torsades de Pointes.
  1. Contraindications:
  1. Absolute: Tachycardias.
  2. Relative: Use caution in patients with suspected acute MI.
  1. Adverse Reactions:
  1. May induce or exacerbate myocardial ischemia.
  2. Ventricular arrhythmia and tachycardias especially when given to patients with digitalis toxicity and hypokalemia.
  3. Hypotension.
  4. Precipitation of angina.
  5. Facial flushing.
  1. Administration and Dosage:
  1. Adult dose range: 2 -10 æg/minute IV.
  1. Mix 1 mg in 250 ml IV solution or 2 mg in 500 ml IV solution, yielding 4æg/ml. Titrate IV drip rate to pulse rate of 60 per minute, beginning with 2-4æg/min. Reassess pulse and increase dose until desired effect is achieved or until maximum dose is reached. Maximum dose 10æg/ min (micro gtt tubing = 150 gtts/ min)
  1. Pediatric dose range: 0.05 - 1.5 æg/kg/minute IV or IO.
  1. Refer to the Pediatric Resuscitation tape for specific ml of medication to add and ml of solution to remove from 100 ml solution to achieve desired weight specific concentration and delivery dose.

OR

  1. To mix infusion, add 0.6mg (3 ml) X the child’s weight in kilograms to sufficient diluent to create a solution totaling 100 ml. Infusion rate of 1 ml per hour will deliver 0.1 æg/kg/min. Titrate to desired effect
  1. Special Information:
  1. Monitor EKG, pulse, and blood pressure closely
  2. Confirm with Base Hospital what pulse rate to maintain
  3. Use of Isuprel is considered a temporizing measure until cardiac pacing is available and after all other treatments have failed.
  4. To reduce the volume of medication needed to prepare the pediatric solution, increase the drug concentration by a factor of 10 and decrease the hourly infusion rate by a factor of 10.