EmergencyDRUGS

Epinephrine

• Indication

▫ VF, pulseless VT, PEA, or asystole

1 mg I.V push every 3-5 min

Intermediate dosing: 2-5 mg IV push over 3-5 min

Escalating dosing: 1mg, 3mg, 5 mg IV push 3 min apart

High dosing: ,1 mg/kg IV push every 3 – 5 min

Symptomatic Bradycardia: continous infusion at 2-10 mcg/min

Nsg. consideration

• Each dose is followed by 20 mL iv fluid flush.

• Can be given via ET tube 2-2.5 x the IV dose, followed with 10 mL Flush PNSS

• IC when no other route is available

• It increases systemic vascular resistance, BP, Cardiac elec. Activity, strenth of contraction, automaticity, and myocardial O2 requirement

Lidocaine

Indication

• VF or Pulseless VT: Initially 1-1.5 mg/kg IV push: every 3-5 mins, max of 3mg/kg

• Stable VT or Stable wide-complex tachycardia: repeat doses are half the original dose.

• If lidocaine succesfully converts the VF/VT: begin continous infusion at 2-4 mg/min

Nsg consideration

• Toxicity( Slurred speech, altertered LOC, Muscle twitching, and seizures), stop the drug/reduce dose

• Via ET: 2-2.5 times the iv dose, flush with 10 ml PNSS

• Don’t give if PVC occurs with bradycardia or escape rhythm.

• No longer recommended for VT/VF prophylaxis in acute MI

Atropine

• Symptomatic Bradycardia

▫ .5-1 mg iv push q 3-5 min, not to exceed .04 mg/kg

• Asystole/PEA

▫ 1 mg iv push q 3-5 min, not to exceed a total dose of .04mg/kg

Nsg consideration

• Don’t give less than .5 mg dose – may further slow heart rate

• Via ET: dilute 1-2 mg in 10 mL sterile water of PNSS, flush with 10 mL PNSS

Adenosine

• PSVT or wide-complex tachycardia:

▫ Initially 6 mg rapid iv push; if no response in 1-2 min, give 12 mg iv push; may be followed by a third 12 mg dose given in 1-2 min.

Nsg consideration

• Given rapidly over 1-3 sec ( half life is 5 sec)

• Follow dose with a 20 ml PNSS flush

• If methylxanthines, dipyridamole and carbamazepine are present higher dose may be needed

• A brief period of Asystole is common after administration

Bretylium

• VF/ of pulseless VT unresponsive to defibrilation, epi and lido

▫ 5mg/kg iv push; is arhythmia persists, increase to 10 mg/kg q 5-10 min, to a max dose of 35 mg/kg

• Stable VT or Stable wide-complex tachycardia:

▫ 5-10 mg/kg over 8-10 min, to max 35 mg/kg over 24 hrs, if loading dose converts arhythmia start infusion of 2 mg/min.

Dobutamine

• Heart Failure

▫ 2-20 mcg/kg/min

Nsg considerations

• May cause tachycardia and other arhythmias, BP fluctuations, nausea and hypokalemia

• Monitor heart closely; increases in heart heartrate more than 10% may induce or exacernateMyocardial Ischemia

Dopamine

• Hypotension c symptomatic bradycardia, heart failure or after spontaneous return of circulation

▫ Initially, 1-5 mcg/kg/min; max is 20 mcg/kg/min

Enhances renal blood flow – 1-2 mcg/kg/min

Nsg consideration

• May induce tachycardia, - dose reduction/withdrawal

• Extravasation may cause severe tissue sloughing and necrosis

• Norepinephrine should be added is more than max dose is needed to maintain BP

• Use slowest infusion first• Can exacerbate pulmonary congestion and

compromise cardiac output• Eliminate hypovolemia as a cause of hypotension

before treating

Magnesium

• VF/VT with hypomagnesemia

▫ 1-2 grams diluted in 10 mL D5W given IV push over 1-2 min

• Torsades de pointes: 5-10 grams iv

• Acute MI with hypomagnesemia

▫ Intermitent of continous infusions

Nsg consideration

• Flushing, sweating, mild bradycardia, and hypotension may develop from rapid administration in non arrest situations

Procainamide

• PVCs or recurrent VT with pulse

▫ Initially, 20 mg/min until

Hypotension occurs

QRS complex

PR interval

QT interval is widened by 50 %

Total of 17mg/kg of the drug was administered

▫ Maintenance infusion 1-4 mg/min

Nsg consideration

• Monitor BP closely during administration; may cause precipitous hypotension, infuse cautiously in patients with acute MI

• Contraindicated in patients with preexisting long QT intervals and torsades de pointes

• Torsades de pointes, or simply torsades is a French term that literally means "twisting of the points". It was first described by Dessertenne in 1966[1] and refers to a specific, rare variety of ventricular tachycardia that exhibits distinct characteristics on the electrocardiogram (ECG).

• CharacteristicsRotation of the heart's electrical axis by at least 180ºProlonged QT interval (LQTS)Preceded by long and short RR-intervalsTriggered by an early premature ventricular contraction (R-on-T PVC)

ToxicologyPoisoning

Occurrence of Poisoning

• Unintentional

• Intentional

Most common poisons

• Unintentional

• Intentional

Antidotes Used In Toxicology

Antidote Toxin Special Info

Botulinum Antitoxin Botulism Given for confirmed cases. Several types available. Must obtain from CDC

Deferoxamine Iron Based on levels and symptomatology

Digibind/Digoxin Fab Fragments

Digoxin Used for severe toxicity

Flumazenil Benzodiazepines Use with caution, many contraindications

Antidotes Used In Toxicology

Antidote Toxin Special Info

Glucagon Beta Blockers Used with significant symptoms

NAC/Mucomyst/N-Acetylcysteine

Acetaminophen Given diluted orally. IV route not FDA approved

Naloxone Nalmefene

Opiates, Clonidine Short- acting. Longer-acting.

Octreotide Sulfonylureas Inhibits growth hormone and insulin secretion

Antidotes Used In Toxicology

Antidote Toxin Special Info

Physostigmine Anti-cholinergics Used only in rare and severe poisonings

Protamine Sulfate Heparin In severe overdose and marked lab indications

Pyridoxine Isoniazid Dose often dependent on amount INH ingested

Vitamin K 1 Anticoagulants/Rat Poisons/Warfarin

Given

EmergencyDRUGS