common emergency drugs
Post on 12-Nov-2014
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Common Emergency Drugs
By : Hatem Alsrour
King Saud UniversityCollege of Nursing
Adenosine
Anti-dysrhythmic
Indication.; SVT
Dose: 6mg rapid IVP followed by 20ml saline flush.
May repeat in 1-2 min if no response. 12 mg IVP, then
again in 1-2 min.
Adenosine
Contraindications
Second- or third-degree AV block, or sick-sinus syndrome (sss). Atrial flutter. Atrial fibrillation. Ventricular tachycardia. Hypersensitivity to adenosine
Amiodarone
AntidysrhythmicIndicated forProphylaxis of VF & unstable VT
refractory to other therapyContraindicatedPulmonary congestionCardiogenic shockhypotension
Amiodarone
Dose300 mg loading dose (cardiac arrest)
flush with 10 ml of D5 or saline150 mg supplemental bolus dose (cardiac
arrest) flush with 10 ml of D5 or saline540 mg maintenance infusion over 18 hr
Aspirin
Analgesic, anti-inflammatory, antiplatelet
IndicationsAMI
Contraindication :Only systemic sensitivity in the context of
MI
Dose160-325 mg .
Atropine Sulfate
Anticholinergic
IndicationsSymptomatic bradycardiaAsystoleBronchospastic disorders
Atropine Sulfate
Contraindication:TachycardiaObstructive disease of GI tractUnstable cardiovascular status in the
context of cardiac ischemia & hemorrhage
Atropine Sulfate
DoseBradydysrhymia’s
0.5-1.0mg 5 min to a max of 0.03-0.04 mg/kg.
Asystole1.0 mg IV or ETT(dilute to 10 ml)
0.1 mg/mI (Adult) 0.05 mg/mL (Pediatric)
Calcium Chloride
ElectrolyteIndicationsHyperkalemia (except dig toxic)HypocalcaemiaHypermagnesmia
Calcium Chloride
ContraindicationsVF during cardiac resuscitationDig toxicRenal or cardiac disease
Dose2-4 mg/kg slow IV 10 min .
Dobutamine (Dobutrex)
SympathomimeticIndicationsInotropic support for patients with LV
dysfunctionContraindicationsSevere hypotension.
Dobutamine (Dobutrex)
Dosage and Administration
Adult:
The drug is infused at 2-20 mcg/kg/min (instead of 2.5-20).
Pediatric:
2-20 mcg/kg/min (titrated to desired effect
Dopamine (Intropin)
SympathomimeticIndicationsHemodynamically significant
hypotension in the absence of hypovolemia
ContraindicationsTachydysrhythmiasVF
Dopamine (Intropin)
Dose“renal”dose 1-5mcg/kg/min“cardiac” dose 5-15 mcg/kg/min“vasopressor” dose 15mcg/kg/min
Furosemide (Lasix)
Loop Diuretic
Indications Associated with CHF, hepatic or renal
disease
ContraindicationsAnuriaHypovolemia/dehydrationElectrolyte depletion
Furosemide (Lasix)
Dose20-40 mg slow IV (1-2min)
Isoproterenol (Isuprel)
Sympathomimetic
IndicationsHemodynamically significant
bradycardia refractive to other therapy.
Isoproterenol (Isuprel)
ContraindicationsVF/VTHypotension Ischemia heart disease Cardiac arrest
Isoproterenol (Isuprel)
Dose1mg in 250 ml (4mcg/ml) infuse at 2-20
mcg/minInfusion mix 200 in 250 (0.8 mg/ml)
infuse at 2mg/min. Keep the patient in the supine position
Lidocaine (Xylocaine)
Antidysrhythmic .
IndicationsVT/VFWide complex tachycardia .Significant ventricular ectopy in the
setting of MI
Lidocaine (Xylocaine)
ContraindicationsAdams-Stokes Syndrome
Dose1.0-1.5 mg/kg consider repeat in 3 minTotal IV dose is 3 mg/kgETT is 2.5 times IV dose
Norepinephrine (Levophed)
Sympathomimetic
IndicationsCardiogenic shockNeurogenic shockInotropic supportHemodynamically significant
hypotension refractory to other sympaths
Norepinephrine (Levophed)
ContraindicationsHypotensive pts with hypovolemia
DoseDilute
Propranolol (Inderal)
Beta adrenergic blocker
IndicationsHypertensionVF/VT and SVT refractory to other
therapy
Propranolol (Inderal)
ContraindicationsSinus bradycardia2nd or 3rd degree AV blockAsthmaCardiogenic shockPulmonary edemaUncompensated CHFCOPD
Propranolol (Inderal)
Dose1-3 mg IV over 2-5 minCan be repeated after 2 minTotal dose not to exceed 0.1mg/kg
Sodium Bicarbonate
Buffer, alkalinizing agent, electrolyte IndicationsKnown bicarbonate responsive acidosisIntubated pt with long arrest intervalMetabolic acidosis
Sodium Bicarbonate
ContraindicationsChloride loss from vomiting & GIMet or resp alkalosisSevere pulmonary edemaAbdominal pain of unknown originHypo;
Calcemia, kalemia, natremia
Sodium Bicarbonate
Dose1 mEq/kg IV with 0.5 mEq/kg repeat q
10 min
Verapamil (Calan)
Calcium channel blocker
IndicationsPSVTA flutter with rapid responseA fib with rapid responseVasospastic and unstable anginaChronic stable angina
Verapamil (Calan)
ContraindicationsSSS (without pacemaker)2nd & 3rd degree AV blockHypotension/Cardiogenic shockWide complex tachycardiaSevere CHFIV beta blockers
Verapamil (Calan)
Dose2.5-5 mg IVP over 1-2 minutesRepeat 5-10 mg 15-30 mins after initial
dose Max dose 30mg
Dextrose 50%
Dextrose is the 6 carbon sugar that is the principal carbohydrate used by the body.
IndicationsHypoglycemiaComa/seizure of unknown etiology
Dextrose 50%
ContraindicationsIntracranial hemorrhageIncreased intracranial pressure
Dose12.5-25 G IV slowly
Diazepam (Valium)
Benzodiazepine sedative-hypnotic, anticonvulsant
IndicationsAcute anxiety states/alcohol withdrawalSkeletal muscle relaxationSeizure activityPremedication prior to cardioversion
Diazepam (Valium)
Contraindicationsin coma (unless there is seizure activity)CNS depression as a result of head injuryrespiratory depressionShock
Diazepam
Dosage and AdministrationSeizure activityAdult: 5-10 mg IV q 10-15 min (maximum dose 30 mg)Pediatric: 0.2-0.3 mg/kg/dose IV(< = 1 mg/min) q 2-5 min (maximum total dose 10 mg)Amnesia for cardioversionAdult: 5-15 mg IV, 5-10 min before procedure
Epinephrine (Adrenalin)
Sympathomimetic
IndicationsBronchial asthmaAcute allergic reactionCardiac arrestSymptomatic bradycardia
Epinephrine (Adrenalin)ContraindicationsHypovolemia shock- correct volume deficitUse with caution in coronary insufficiency
DoseCardiac arrest
1 mg IVP q 3-5 min2.5 times the normal dose if via ETT
Glucagon
Pancreatic Hormone, insulin antagonist
IndicationsPersistent hypoglycemia despite glucose
ContraindicationsOnly hypersensitivity
Dose0.5-1 mg IM with one repeat in 7-10 min
Nitroglycerin (Nitrostat)
Vasodilator
IndicationsIschemia chest painPulmonary hypertensionCHFHypertensive emergencies
Nitroglycerin (Nitrostat)
ContraindicationsHypotensionHead injuryCerebral hemorrhage
Dose0.15-0.6 mg SL q 5 minutes .Infusion- 200-400 mcg/ml .
Naloxone (Narcan)
Opiod antagonist
IndicationsNarcotic Coma unknown origin
Naloxone (Narcan)
ContraindicationsUse with caution in addicted pts may
precipitate violent withdrawal issues.
Dose0.4-2mg IV, IM or ETT (dilute)
Morphine Sulfate
Opiod analgesic
IndicationsChest pain associated with MIPulmonary edema .Moderate to severe acute or chronic pain
Morphine Sulfate
ContraindicationsHead injury or undiagnosed abdom. PainIncreased ICPSevere resp depression
Magnesium Sulfate
Electrolyte, Anticonvulsant
IndicationsSeizures of eclampsiaHypomagnesaemiaRefractory VF
Magnesium Sulfate
ContraindicationsHeart block or myocardial damage
DoseEclampsic seizures
1-4G (8-32 mEq) IV max dose of 30-40G/day
Vasopressin
Naturally occuring hormone (ADH)
IndicationsMay be used as an alternate vasopressor
in cardiac arrestMay be useful in hemodynamic support
of dilatory shock
Vasopressin
ContraindicationsNot recommended for responsive pts
with CAD
Dose40 U IV push- one dose only ( about 10
min)
Midazolam (Versed)
Short-acting benzodiazepine CNS depressant IndicationsSeizures
ContraindicationsGlaucoma Shock, Coma.
Midazolam (Versed)
Dose1-2.5 mg IV slowly (1-2 min)Total max dose not to exceed 0.1 mg/kg
Digoxin (Lanoxin)
Cardiac Glycoside
IndicationsSVT , A fib/flutCHFCardiogenic shock
Digoxin (Lanoxin)
ContraindicationsVF/FTAV BlockDig toxicity
heparin
Anti coagulent
Two preparationsUnfractionated (UFH) .Low molecular weight .
heparin
UFHIndicationsAMIBegin with fibrin specific lytics (alteplase)
ContraindicationsActive bleedingRecent intracranial, spinal or eye surgery
heparin
ContraindicationsSevere hypertensionBleeding disordersGI bleeding
DoseInitial bolus- 60IU/kg (max bolus
4000IU)
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