Post on 24-Nov-2014
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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
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