Enter patient weight to calculate weight-based doses and infusion rates

โš ๏ธ Clinical Disclaimer: Doses are based on standard EM/critical care guidelines. Always verify against your institution's pharmacy protocols. All drips require continuous hemodynamic monitoring.
kg
Norepinephrine (Levophed) Vasopressor
Start
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Usual Range
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Max
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Std Concentration
4mg / 250mL NS
= 16 mcg/mL
Start Rate
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Max Rate
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๐Ÿ’ก First-line for septic shock. Potent ฮฑ1 > ฮฒ1. Titrate to MAP โ‰ฅ65. Add vasopressin if >0.25 mcg/kg/min needed.
Epinephrine Vasopressor + Inotrope
Start
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Usual Range
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Max
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Std Concentration
4mg / 250mL NS
= 16 mcg/mL
Start Rate
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Max Rate
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๐Ÿ’ก First-line for anaphylactic shock, refractory shock, cardiac arrest. Low doses โ†’ ฮฒ predominant (inotropy). High doses โ†’ ฮฑ predominant (vasoconstriction). Monitor for tachyarrhythmia.
Dopamine Vasopressor + Inotrope
Start
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Usual Range
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Max
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Std Concentration
400mg / 250mL NS
= 1600 mcg/mL
Start Rate
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Max Rate
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๐Ÿ’ก Dose-dependent effects: 2โ€“5 mcg/kg/min โ†’ dopaminergic (renal perfusion) | 5โ€“10 โ†’ ฮฒ1 (inotropy, HR) | >10 โ†’ ฮฑ1 (vasoconstriction). Higher arrhythmia risk than norepi โ€” use norepi preferentially in septic shock.
Vasopressin Vasopressor
Standard Dose
0.03โ€“0.04 units/min
Max Dose
0.04 units/min
Not Weight-Based
Fixed dose only
Std Concentration
20 units / 100mL NS
= 0.2 units/mL
Rate (0.03 u/min)
9 mL/hr
Rate (0.04 u/min)
12 mL/hr
๐Ÿ’ก Adjunct vasopressor in septic shock when norepi dose โ‰ฅ0.25 mcg/kg/min. V1 receptor mediated โ€” no tachycardia. Do NOT titrate above 0.04 units/min (mesenteric/digital ischemia risk).
Phenylephrine (Neo-Synephrine) Vasopressor
Start
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Usual Range
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Max
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Std Concentration
100mg / 250mL NS
= 400 mcg/mL
Start Rate
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Max Rate
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๐Ÿ’ก Pure ฮฑ1 agonist โ€” no ฮฒ effect. Preferred in neurogenic shock, SVT with hypotension. Reflex bradycardia may occur. Avoid in cardiogenic shock (increases afterload without inotropy).
Dobutamine Inotrope
Start
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Usual Range
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Max
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Std Concentration
250mg / 250mL NS
= 1000 mcg/mL
Start Rate
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Max Rate
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๐Ÿ’ก First-line inotrope for cardiogenic shock with low CO. ฮฒ1 > ฮฒ2. Increases contractility and HR. May cause hypotension via vasodilation โ€” combine with norepi if hypotensive. Not a vasopressor.
Push-Dose Epinephrine Bolus / Peri-intubation

For peri-intubation hypotension, transient hemodynamic instability while setting up drip. Preparation: dilute 1mg/10mL (0.1mg/mL) โ†’ draw 1mL into 9mL NS syringe โ†’ 10 mcg/mL solution.

Standard bolus doseโ€”
Volume to give (10 mcg/mL solution)โ€”
Repeat intervalEvery 2โ€“5 min PRN
Max per bolus20 mcg (2 mL)

โš ๏ธ Bridge only โ€” start drip immediately. Onset 1 min, duration 5โ€“10 min.

MAP Targets by Condition
Septic shockโ‰ฅ 65 mmHg
Neurogenic shockโ‰ฅ 85โ€“90 mmHg
Cardiogenic shockโ‰ฅ 65 mmHg
Traumatic brain injuryโ‰ฅ 80 mmHg
Post-cardiac arrestโ‰ฅ 65โ€“80 mmHg
Anaphylaxisโ‰ฅ 65 mmHg
๐ŸŽฏ First-Line by Shock Type
๐Ÿ”ด Septic / Distributive
1st: Norepinephrine
2nd: Add Vasopressin 0.03 u/min (if norepi โ‰ฅ0.25)
3rd: Add Epinephrine or Dopamine
๐ŸŸ  Cardiogenic
1st: Dobutamine (if no hypotension)
If hypotensive: Norepinephrine + Dobutamine
Alt: Dopamine (if bradycardic)
๐ŸŸก Neurogenic
1st: Phenylephrine or Norepinephrine
Target MAP โ‰ฅ85โ€“90 mmHg
Avoid agents that increase HR if bradycardic โ†’ use Norepi
๐ŸŸฃ Anaphylactic
1st: IM Epinephrine 0.3mg
If refractory: Epi infusion
Add Norepinephrine for persistent hypotension
โšช Peri-intubation Hypotension
Push-dose Epinephrine 10โ€“20 mcg IV
Bridge while setting up drip
Start definitive vasopressor immediately
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