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)