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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 sick-
sinus 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 0.03-
0.04 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 30-

40G/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)