EMERGENCY DRUG

CNE 201119 FEB 2011

ADRENALINE (EPINEPHRINE) 1mg/ml

1st drug use in cardiac arrest Indications: - VF - Pulseless VT- PEA- Asystole- Asthma / relieve of bronchial spasm- Anaphylactic shock

Cont…

• Routes of administration- IV push (dilute with 10 mls of normal saline =

1:10,000); may repeat at 3-5 min interval- ETT (2-2.5×IV dose)- Can be given via IV (3mg in 50mls of normal

saline – hospital protocol) and run it acording to doctor’s order. Ensure that large viens are used.

- Subcutaneous 0.1-0.5mg/1-0.25mg IV- Nebulizer

Cont…

• Side effect:- Tachycardia- PVCs- Palpitation- Headache- Acute MI- Cerebral hemorrhage / stroke- Use with caution in pregnant lady

ATROPINE (1mg/ml)

• Indication:- Asystole- Haemodynamically unstable bradycardia- Acute cholinergic / organophosphate

poisoning (i.e insectiside)

Cont…

• Routes of administration:- 1mg IV push- Repeat every 3-5min (if asystole persist) to a

maximum dose of 0.04mg/kg or 2.4-3mg- ETT rapid push – 2.3mg diluted in 10mls

normal saline- IV infusion depends on hospital protocol

Cont…• Side effect:- Tachycardia- Palpitation- Paradoxical bradycardia (if<0.5mg)- Hypertension/hypotension- Use caution in MI case- Dry mouth- Blurred vision/pupils dilate- Headache/dizziness- Constipation or paralytic ileus

LIGNOCAINE

• Indication:- Multifocal PVCs (haemodynamically

compromising)- Pulseless VT or VT with pulse- VT- Local anesthesia

Cont…

• Routes of administration:- IV push (1-1.5mg/kg)- ETT (2-2.5×IV dose) – 2-4mgkg- IV infusion 1mg in 50cc of D5% of normal

saline

Cont…

• Side effect:- Seizure- Respiratory depression/arrest- Nausea and Vomitting- Widening of QRS complexes- Bradycardia

DOPAMINE 200mg/5ml

• Indication:- Cardiogenic shock- Septicaemia shock- Neurogenic shock- Anaphylactic shock- Hypovolemia shock only after fluid

resusitation has failed the BP

Cont…

• IV Dopamine is giving through IV infusion (200mg/400mg in 50cc normal saline or D5% - depends on hospital protocol)

• 3×body weight

Cont…

• Dilates renal and mesenteric vessels (1- 2ug/kg/min) →enhaning renal blood flow

• Increase myocardial contractility (2-10ug/kg/min)→increasing CO

• Cause peripheral vasoconstriction (>10ug/kg/min)→elevating blood pressure

Cont…

• Monitor BP and cardiac rhythm• Monitor drip site Observe for onset of extravasation → tissue necrosis

Low dose• Hypotension• Tachycardia

Medium dose• Tachycardia• Angina• Ventricular arrhythmias

High dose• Same as medium dose•Decrease renal function• Hypertension

DOBUTAMINE 250mg/20ml

• It increase cardiac contractility and cardiac output thus help increase BP

• Indication:- Cardiogenic shock- Low cardiac output states- Sepsis- Open heart surgery

Cont…

• IV Dobutamine is giving through IV infusion (250mg/500mg in 50cc normal saline or 3× body weight)

• Maximum dosage is 20ug/kg/min• Administer through centre venous catheter if

possible; if administered peripherally, use large vein

Cont…

• Side effect:- Tachycardia- Ventricular ectopic- Hypertension or hypotension- Nausea, vomiting- Headache- Palpitations- Chest pain

NORADRENALINE (Levophed)4mg/4ml

• Indication:- Severe hypotension

Cont…

• IV Noradrenaline is giving through IV infusion (4mg in 50cc normal saline)

• Maximum dosage is 20ug/min• Use large Vein if giving peripherally

Cont…

• Side effect:- Bradycardia- Ventricular dysrythmias- Hypertension- Chest pain- Low urine output - Peripheral cold to touch

ADENOSINE(6mg/2ml)

• A short acting agent that depresses sinus node and AV node function

• Half Life: 5 seconds• Indication- To treat supraventricular tachycardia (STV)

Cont…

• Dosage and how to give- Initial bolus of 6mg given rapidly over 1-3sec

followed by normal saline bolus of 20cc by attach the both syringe to the IV port closest to patient, then elevate the extremity

- Repeat dose of 12mg in 1-2 min if needed- A 3rd dose of 12mg may be needed in 1-2 mins

Cont…

• Side effect:- Transient flushing- Chest pain or tightness- Brief period of asystole or bradycardia- Hypotension- Brochospasm therefore should not be given to

patient known case asthma

AMIODARONE 150mg/3ml

• Indication: - Life – threatening or refractory ventricular

dysrythmias i.e VF or VT- Stable VT- PSVT or AF

Cont…

• Refractory VT/VF- Initial dose of 300mg and can be followed by

150mg• Other arrythmias- Loading dose: 150mg/300mg in 50cc D5%

over 23 hours- Depends on doctor’s order

Cont…

• Side effect- Hypotension- Nausea and vomiting- Headache or dizziness- Observe drip site as it can cause extravasation

NITROGLYCERIN (GTN) 10mg/ml

• Indication:- Unstable angina- AMI- Pulmonary edema with high BP- Hypertensive crisis

Cont…

• Routes of administration:- Sublingual - Transdermal- IV infusion 10-20ug/min titrated to response

Cont…

• A venodilator• Dilates coronary arteries• Relieves coronary spasm• Opens up collateral vessel- Increasing blood flow to myocardium

Cont…

• Headache• Flushing• Tachycardia• Hypotension• Use with caution in hypotension and

tachycardia

VERAPAMIL 5mg/2ml

• Indication:- PSVT- Acute arterial fibrillation or atrial flutter

(WPW has to be excluded)

Cont…

• Routes of administration:- IV slow bolus – 5mg diluted in 5 mls of distilled

water and given at 1mg/min

Cont…

• Action: - Slow conduction and prolongs refractory

period at AV node, thus slowing down heart rate

- Dilates coronary, systemic and peripheral vessels, thus increasing blood flow and lowering blood pressure

Cont…

• Hypotention• Bradycardia• PVCs• Heart blocks• VF in patient with WPW and AF

CALCIUM CHLORIDE

• Indication:- Hypocalcemia- Calcium channel blocker toxicity- Hyperkalemia- Magnesium sulphate overdose

Cont…

• Route of administration:- IV slow bolus→5-10mls IV for hyperkalemia

and calcium channel blocker overdose

Cont…

• Bradycardia (especially if injected rapidly)• Hypotension• Cardiac arrest• Hypercalcemia• Pain and burning sensation at injection site,

phlebitis

SODIUM BICARBONATE

• Indication:- Metabolic acidosis with ph of 7.0 or less- Aspirin overdose

Cont…• Route of administration:- IV injection 1mEq/kg as initial dose ; dose

guided by arterial blood gases- Formula : 1/3 BW/BE• Give half of the amount• 8.4% can be given through CVP line• Dilute to 4.2% with normal saline if given

through peripheral line- Administer through a large peripheral vein or

a centre venous catheter- Must run at single line

EMERGENCY TREATMENT AND TREATMENT SEQUENCE FOR HYPERKALEMIA

• Calcium chloride: 5-10 mls slow IV bolus to antagonize the toxic effect of hyperkalemia at cell membrane→onset is 1-3 mins and lasting for 30-60 mins

• Sodium bicarbonate: analysis of ABG is necessary (depent on doctor’s order)

• D50% + insulin 10 unit to redistribute potassium info intracellular caompartment

Cont…

• Nebulized ventolin to redistribute potassium into intracellular compartment

• Diuresis with frusemide : as ordered by physician to remove potassium from body

• Kalimate 15-30gm PO or PR• Peritoneal or haemodyalisis if severe

MAGNESIUM SULPHATE

• Indication:- Hypomagnesemia- Ventricular tachydysrhythmia, especially

torsades de pointes- Eclampsia of pregnancy- Siezures- Asthma

Cont…

• Routes of administration:- When VF / pulseless VT cardiac arrest is

associated with torsades de pointes, 1-2gm magnesium sulphate diluted in 10 mls D5% IV push 5-20mins

Cont…

• Side effect:- Bradycardia- Hypotension- Diaphoresis- Flushing- Hypermagnesemia resulting in respiratory

muscle weakness and arrest

Digoxin

• Indication:- Supraventricular tachycardias, especially in

patients with heart failure• Routes of administration:- Can be given through IV or PO- In IV form→0.5mg/0.75mg dilute in

50mls/100 mls normal saline run over half hour as ordered by physician

Cont…

• Toxic effect: - Anorexia, nausea, vomiting, or diarrhea- Fatigue, muscle weakness- Visual disturbances- Agitation

Anexate

• Benzodiazepine antagonist→is for reversal of the centrally sedative effect of benzodiazepine anaest and intensive care

• Can be given IV bolus or infusion as ordered by anesthetist or physician

• Can be dilute with D5% or normal saline• Side effect→flushing, nausea, vomiting,

anxiety, palpitation, and fear

Naloxone

• Reversal respiratory depression due to opiods overdose

• Can be administered IV, IM, SC, ETT• Dosage →0.1mg-0.2mg at 2-3 min interval and

can be repeated few time till maximun 1mg• Side effect: Tachycardia, hypertension,

arrythmia, cardiac arrest, nausea, vomiting, sweating

http://tintingpanjai.rumahpanjai.com/heathcarehttp://www.tuchum.co.cc/healthcare