Common Emergency Drugs

King Saud University College of Nursing

Common Emergency Drugs

By : Hatem Alsrour

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 sicksinus syndrome (sss). Atrial flutter. Atrial fibrillation. Ventricular tachycardia. Hypersensitivity to adenosine

Amiodarone Antidysrhythmic Indicated for Prophylaxis of VF & unstable VT refractory to other therapy Contraindicated Pulmonary congestion Cardiogenic shock hypotension

Amiodarone Dose 300

mg loading dose (cardiac arrest) flush with 10 ml of D5 or saline 150 mg supplemental bolus dose (cardiac arrest) flush with 10 ml of D5 or saline 540 mg maintenance infusion over 18 hr

Aspirin Analgesic, anti-inflammatory, antiplatelet Indications AMI Contraindication : Only systemic sensitivity in the context of MI Dose 160-325 mg .

Atropine Sulfate Anticholinergic Indications Symptomatic bradycardia Asystole Bronchospastic disorders

Atropine Sulfate Contraindication: Tachycardia Obstructive disease of GI tract Unstable cardiovascular status in the context of cardiac ischemia & hemorrhage

Atropine Sulfate Dose Bradydysrhymia’s 0.5-1.0mg 5 min to a max of 0.030.04 mg/kg. Asystole 1.0 mg IV or ETT(dilute to 10 ml)  0.1 mg/mI (Adult) 0.05 mg/mL (Pediatric)

Calcium Chloride Electrolyte Indications Hyperkalemia (except dig toxic) Hypocalcaemia Hypermagnesmia

Calcium Chloride Contraindications VF during cardiac resuscitation Dig toxic Renal or cardiac disease Dose 2-4 mg/kg slow IV 10 min .

Dobutamine (Dobutrex) Sympathomimetic Indications Inotropic support for patients with LV dysfunction Contraindications Severe 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) Sympathomimetic Indications Hemodynamically significant hypotension in the absence of hypovolemia Contraindications Tachydysrhythmias VF

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 Contraindications Anuria Hypovolemia/dehydration Electrolyte depletion

Furosemide (Lasix) Dose 20-40 mg slow IV (1-2min)

Isoproterenol (Isuprel) Sympathomimetic Indications Hemodynamically significant bradycardia refractive to other therapy.

Isoproterenol (Isuprel) Contraindications VF/VT Hypotension Ischemia heart disease Cardiac arrest

Isoproterenol (Isuprel) Dose 1mg in 250 ml (4mcg/ml) infuse at 2-20 mcg/min Infusion mix 200 in 250 (0.8 mg/ml) infuse at 2mg/min. Keep the patient in the supine position

Lidocaine (Xylocaine) Antidysrhythmic . Indications VT/VF Wide complex tachycardia . Significant ventricular ectopy in the setting of MI

Lidocaine (Xylocaine) Contraindications Adams-Stokes Syndrome Dose 1.0-1.5 mg/kg consider repeat in 3 min Total IV dose is 3 mg/kg ETT is 2.5 times IV dose

Norepinephrine (Levophed) Sympathomimetic Indications Cardiogenic shock Neurogenic shock Inotropic support Hemodynamically significant hypotension refractory to other sympaths

Norepinephrine (Levophed) Contraindications Hypotensive pts with hypovolemia Dose Dilute

Propranolol (Inderal) Beta adrenergic blocker Indications Hypertension VF/VT and SVT refractory to other therapy

Propranolol (Inderal) Contraindications Sinus bradycardia 2nd or 3rd degree AV block Asthma Cardiogenic shock Pulmonary edema Uncompensated CHF COPD

Propranolol (Inderal) Dose 1-3 mg IV over 2-5 min Can be repeated after 2 min Total dose not to exceed 0.1mg/kg

Sodium Bicarbonate Buffer, alkalinizing agent, electrolyte Indications Known bicarbonate responsive acidosis Intubated pt with long arrest interval Metabolic acidosis

Sodium Bicarbonate Contraindications Chloride loss from vomiting & GI Met or resp alkalosis Severe pulmonary edema Abdominal pain of unknown origin Hypo; Calcemia, kalemia, natremia

Sodium Bicarbonate Dose 1 mEq/kg IV with 0.5 mEq/kg repeat q 10 min

Verapamil (Calan) Calcium channel blocker Indications PSVT A flutter with rapid response A fib with rapid response Vasospastic and unstable angina Chronic stable angina

Verapamil (Calan) Contraindications SSS (without pacemaker) 2nd & 3rd degree AV block Hypotension/Cardiogenic shock Wide complex tachycardia Severe CHF IV beta blockers

Verapamil (Calan) Dose 2.5-5 mg IVP over 1-2 minutes Repeat 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. Indications Hypoglycemia Coma/seizure of unknown etiology

Dextrose 50% Contraindications Intracranial hemorrhage Increased intracranial pressure Dose 12.5-25 G IV slowly

Diazepam (Valium) Benzodiazepine sedative-hypnotic, anticonvulsant Indications Acute anxiety states/alcohol withdrawal Skeletal muscle relaxation Seizure activity Premedication prior to cardioversion

Diazepam (Valium) Contraindications in coma (unless there is seizure activity) CNS depression as a result of head injury respiratory depression Shock

Diazepam Dosage and Administration Seizure activity Adult: 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 cardioversion Adult: 5-15 mg IV, 5-10 min before procedure

Epinephrine (Adrenalin) Sympathomimetic Indications Bronchial asthma Acute allergic reaction Cardiac arrest Symptomatic bradycardia

Epinephrine (Adrenalin) Contraindications Hypovolemia shock- correct volume deficit Use with caution in coronary insufficiency Dose Cardiac arrest 1 mg IVP q 3-5 min 2.5 times the normal dose if via ETT

Glucagon Pancreatic Hormone, insulin antagonist Indications Persistent hypoglycemia despite glucose Contraindications Only hypersensitivity Dose 0.5-1 mg IM with one repeat in 7-10 min

Nitroglycerin (Nitrostat) Vasodilator Indications Ischemia chest pain Pulmonary hypertension CHF Hypertensive emergencies

Nitroglycerin (Nitrostat) Contraindications Hypotension Head injury Cerebral hemorrhage Dose 0.15-0.6 mg SL q 5 minutes . Infusion- 200-400 mcg/ml .

Naloxone (Narcan) Opiod antagonist Indications Narcotic Coma unknown origin

Naloxone (Narcan) Contraindications Use with caution in addicted pts may precipitate violent withdrawal issues. Dose 0.4-2mg IV, IM or ETT (dilute)

Morphine Sulfate Opiod analgesic Indications Chest pain associated with MI Pulmonary edema . Moderate to severe acute or chronic pain

Morphine Sulfate Contraindications Head injury or undiagnosed abdom. Pain Increased ICP Severe resp depression

Magnesium Sulfate Electrolyte, Anticonvulsant Indications Seizures of eclampsia Hypomagnesaemia Refractory VF

Magnesium Sulfate Contraindications Heart block or myocardial damage Dose Eclampsic seizures 1-4G (8-32 mEq) IV max dose of 3040G/day

Vasopressin Naturally occuring hormone (ADH) Indications May be used as an alternate vasopressor in cardiac arrest May be useful in hemodynamic support of dilatory shock

Vasopressin Contraindications Not recommended for responsive pts with CAD Dose 40 U IV push- one dose only ( about 10 min)

Midazolam (Versed) Short-acting benzodiazepine CNS depressant Indications Seizures Contraindications Glaucoma Shock, Coma.

Midazolam (Versed) Dose 1-2.5 mg IV slowly (1-2 min) Total max dose not to exceed 0.1 mg/kg

Digoxin (Lanoxin) Cardiac Glycoside Indications SVT , A fib/flut CHF Cardiogenic shock

Digoxin (Lanoxin) Contraindications VF/FT AV Block Dig toxicity

heparin Anti coagulent Two preparations Unfractionated (UFH) . Low molecular weight .

heparin UFH Indications AMI Begin with fibrin specific lytics (alteplase) Contraindications Active bleeding Recent intracranial, spinal or eye surgery

heparin Contraindications Severe hypertension Bleeding disorders GI bleeding Dose Initial bolus- 60IU/kg (max bolus 4000IU)