Drugs used in emergency casesVenusa Mae G. TinoyKeren O. BanzonAraceli M. HortezanoCarl Q. Parantar

EMERGENCY DRUGS LISTOXYGENDRUGS FOR CARDIAC DISORDERSDRUGS FOR POISONINGDRUGS FOR SHOCKDRUGS FOR HYPERTENSIVE CRISIS AND PULMONARY EDEMA

OXYGENw/o OXYGEN - Brain death within 6 minPulse oximeter measures oxygen saturation WHATS THE IDEAL O2 SAT?

OXYGEN for severe physiologic stressShockTraumatic injuryAcute myocardial infarctionCardiac arrestOXYGEN DEVICE: Breathing spontaneously: non- rebreather mask with O2 reservoir 10-15L/min For those who needs ventillation Bag-valve mask 15L/minOXYGENCAUTION IN COPD PATIENTS May lose their hypoxic respiratory driveOXYGENEmergency but no severe stress (angina, arrhythmia)Nasal cannula 1-6L/minFace tent (high O2 flow) - childrenDRUGS FOR CARDIAC DISORDERSDrugs for cardiac disordersNITROGLYCERIN - vasodilatorANGINA PECTORISMYOCARDIAL INFARCTIONSUBLINGUAL 0.3-0.4 mg to be repeated after 5 min (max: 3 doses)Translingual aerosol spray 0.4mgDrugs for cardiac disordersNITROGLYCERIN vasodilatorShould not be use along with Sildenafil (VIAGRA)Drugs for cardiac disordersMORPHINE SULFATENarcotic analgesic given for chest pain assoc with MIDose: 1-4mg IV over 1-5min to be repeated q 5-30 until chest pain is relievedDrugs for cardiac disorders MORPHINE SULFATE Adverse effects: respiratory depression and hypotension NALOXONE (NARCAN) Reverses the action of morphineDrugs for cardiac disorders ATROPINE SULFATE Inhibits action of VAGUS nerve for treatment of bradycardia, asystole and AV block dose: 0.5-1mg q 3-5 minDrugs for cardiac disordersISOPROTERENOL beta adrenergic drug increase heart rate for HYPOTENSION monitor heart rateDrugs for cardiac disordersEPINEPHRINE Improves perfusion of the heart and brain, bronchodilationDrugs for cardiac disordersEPINEPHRINE E drug for hypotension, pulseless Vtach, V fibrillation, status asthmaticus monitor cardiac and hemodynamicsDrugs for cardiac disordersSODIUM BICARBONATEFor metabolic/respiratory acidotic statedose: 1meq/kg IV, maybe repeated at 0.5meq/Kg every 10 min prnDrugs for cardiac disorders: ANTI-ARRHYTHMICSADENOSINEVERAPAMILDILTIAZEMLIDOCAINEAMNIODARONEPROCAINAMIDEDrugs for NEURO-SURGICAL DISORDERS : Increase ICPMANNITOLOsmotic diuretic for cerebral edema may inc ICP initial dose 0.5-1g/kg IV of 25% solutionNote: highly irritating to the veins forms crystalsDrugs for NEURO-SURGICAL DISORDERS : Increase ICPMETHYLPREDNISOLONEIndication: spinal cord injury/cerebral edemaContraindications:HIV infection pregnancyUncntrolled diabetesPoisoningPoisoning: Ingested Poisons May be corrosive (alkaline and acid agents that cause tissue destruction) Alkaline products: Lye, drain and toilet bowl cleaners, bleach, non-phosphate detergents, button batteries Acid products: toilet bowl and metal cleaners, battery acidPoisoning ManagementControl the airway, ventilation and oxygenation.ECG, VS, and neurologic status monitored for changes. Note for amounttime since ingestionsigns and symptomsage and weighthealth history are determined. Poisoning ManagementInsert Foley catheter - to monitor renal function blood examinations - test for poison concentrationTreat SHOCKPoisoning ManagementIngestion of corrosive poison give water or milk - for dilution not attempted if patient has acute airway obstruction, or if with evidence of gastric or esophageal burn or perforation. Ipecac syrup - induce vomiting in the alert patient Gastric lavage for the obtunded patient aspirate is tested Activated charcoal administration if poison can be absorbed by it Cathartic - when appropriateIngested Poison Warnings!!!Vomiting is NEVER induced after ingestion of caustic substances or petroleum distillates.Contact poison control center - PGH if an unknown toxic agent has been taken if it is necessary to identify an antidote for a known toxic agent.1. NALOXONE anti-dote for opiates overdose2. FLUMAZENIL reverses respiratory depression secondary to benzodiazepines3. ATROPINE - reverses organophosphate poisoningDrugs for SHOCKDOPAMINEDOBUTAMINENOREPINEPRHINEEPINEPHRINEALBUTEROLEpinephrine: -adrenergic effects can increase coronary and cerebral perfusion pressure by vasoconstriction-adrenergic can increase myocardial contractilityGiven 1 mg per IV/IO every 3-5 minutesDrugs for SHOCK: DOPAMINE SympathomimeticFor hypotension (shock) It can increase heart rate when atropine has not been effectiveDose: 1-20mcg/kg/min (in 250ml D5W)Wean patient gradually can result to severe hypotension if abruptly stopped Drugs for SHOCK: DOPAMINE Assess IV site q1 hrExtravasation can lead to tissue necrosisDrugs for SHOCK: DObutamINE sympathomimetic with beta 1 effects (inc. heart rate) no vasoconstriction, only increase cardiac output dose: 250-1000mg in 250ml D5W or NSSDrugs for SHOCK: norEPINEPRHINE AN EXTREMELY POTENT VASOCONSTRICTORGIVEN WHEN DOPAMINE AND DOBUTAMINE HAVE FAILEDDOSE: 4-8mg to 250ml D5W or NSS and infused at 0.5-30mcg/minDrugs for SHOCK: DOPAMINE Assess IV site q1 hrExtravasation can lead to tissue necrosisANAPHYLACTIC SHOCKALBUTEROL Reverses bronchoconstriction administered via nebulizer side effects: tremors, tachycardia, dysrhythmia, hypertensionANAPHYLACTIC SHOCKDIPHENHYDRAMINEAnti-histamineReduce histamine induced tissue swelling and pruritus25-50mg IV or deep IMDRUGS FOR HYPERTENSIVE CRISISDiastolic pressure that exceeds 110-120mmHg and pulmonary edemaDRUGS FOR HYPERTENSIVE CRISIS LABETALOL Beta blocker Lowers heart rate, BP, myocardial contractility, and myocardial O2 consumption Dose: 10mg IV push for 1-2 min (max dose: 150mg) Contraindicated in patients with AsthmaDRUGS FOR HYPERTENSIVE CRISISSODIUM NITROPRUSSIDEReduces arterial BPEffect: immediate vasodilation and BP goes down but immediately goes up once the drug is stoppedDRUGS FOR HYPERTENSIVE CRISISSODIUM NITROPRUSSIDE inactivated by light wrap in aluminum foilBlue or brown discoloration means drug is degraded prolonged use can lead to cyanide poisoningDRUGS FOR HYPERTENSIVE CRISIS FUROSEMIDE loop diuretic For acute pulmonary edema due to left ventricular dysfunction or hypertensive crisis diuresis may start within 20 minsDRUGS FOR HYPERTENSIVE CRISISFUROSEMIDEAdverse effects: hypotension, dehydration and electrolyte imbalances can result to allergic reactionTHE END