3rd semester- Med. Emergencies Flashcards
Diazepam (Valium)
Classification: Benzodiazepine, long-acting; sedative-hypnotic; anticonvulsant; schedule IV drug Mechanism of Action: Potentiates effects of inhibitory neurotransmitters. Raises the seizure threshold. Induces amnesia and sedation.
Indications: Seizure activity, sedation for medical procedures, chemical restraint, may be helpful in acute symptomatic cocaine overdose.
Contraindications: Hypersensitivity, narrow-angle glaucoma, myasthenia gravis, respiratory depression, coma, head injury
Precautions: Dizziness, drowsiness, confusion, headache, respiratory depression, hypotension, nausea, vomiting, ataxia.
Dosage/Route:
Adult: Seizure activity: 5 mg IV over 5 minutes or 10 mg IM
Anxiety: 2 to 10 mg IM/IV.
Premedication for cardioversion: 5 to 15 mg IV over 5 to 10 minutes prior to
cardioversion.
Pediatric: Seizure activity: 0.05 to 0.1 mg/kg slow IV or 0.1 to 2 mg/kg IM; 0.5mg/kg Rectal
Diphenhydramine (Benadryl)
Classification: Antihistamine (H1 blocker)
Mechanism of Action: Blocks H histamine receptors in the respiratory tract, blood vessels, and GI smooth muscle; decreases motion sickness. Reverses extrapyramidal reactions.
Indications: Symptomatic relief of allergies, allergic reactions, and anaphylaxis. Motion sickness and relief of acute dystonic reactions.
Contraindications: Hypersensitivity to antihistamines
Precautions: Hallucinations, confusion, and paradoxical CNS excitation can occur in children. Adverse Reactions: Drowsiness, sedation, seizures, dizziness, headache, blurred vision, wheezing, thickening of bronchial secretions, palpitations, hypotension, dysrhythmias, dry mouth, diarrhea, nausea, vomiting.
Dosage/Route:
Adults: 25 to 50 mg IM, IV, PO
Pediatrics: 1 to 2 mg/kg IV, IO slowly, or IM. If PO: 5 mg/kg per 24 hours
D50W (Dextrose)
Classification: Carbohydrate, antihypoglycemic
Mechanism of Action: Rapidly increases serum glucose levels
Indications: Hypoglycemia, altered level of consciousness, coma of unknown origin, seizure of unknown origin, status epilepticus
Contraindications: Intracranial hemorrhage, Hyperglycemia
Precautions: Extravasation leads to tissue necrosis. Cerebral hemorrhage; hyperglycemia Dosage:
Adult: 25 g slow IV push 50% dextrose (D50).
Pediatric: 1 year and older; 0.5 to 1 g/kg of 25% dextrose (D25)
Glucagon
Classification: Hyperglycemic agent, pancreatic hormone, insulin antagonist
Mechanism of Action: Increases blood glucose level by stimulating glycogenolysis. Unknown mechanism of stabilizing cardiac rhythm in beta-blocker overdose.
Indications: Altered LOC with hypoglycemia. Beta-blocker and calcium channel blocker overdose. Contraindications: Hyperglycemia, hypersensitivity.
Adverse Reactions: Dizziness, headache, hypertension, tachycardia, nausea, vomiting, rebound hypoglycemia
Dosage/Route:
Adult: Hypoglycemia: 1 mg IM; may repeat in 7 to 10 minutes
Calcium channel blocker or beta-blocker overdose: 3 to 10 mg IV slowly over 3 to 5 minutes
Pediatric Hypoglycemia: 1 mg IM if 20 kg or greater (or 5 years or more); 0.5 mg IM if less than 20 kg or younger than 5 years
Calcium channel blocker or beta-blocker toxicity: 0.05 to 0.15 mg/kg IV/IO over 3 to 5 minutes
Ketamine (Ketalar)
Classification: Sedative, analgesic dissociative anesthetic
Mechanism of Action: Blocks pain receptors and minimizes spinal cord activity, affecting the association pathways of the brain between the thalamus and limbic system.
Indications Excited delirium, pain management, procedural sedation.
Contraindications: Hypersensitivity, conditions where hypertension would be hazardous to the patient’s care.
Precautions: Ketamine increases the effects of opiates, barbiturates, and nondepolarizing neuromuscular blockers
Adverse Reactions: Hypertension, dysrhythmia, bronchodilation, respiratory depression Dosage/Route:
Adult / Pediatric: 1 to 2 mg/kg IV push over 1 to 2 minutes.
Methylprednisolone (Solu-Medrol)
Classification: Corticosteroid
Mechanism of Action: Synthetic glucocorticoid that suppresses acute and chronic inflammation. Indications: Anaphylaxis, bronchodilator for unresponsive asthma.
Contraindications: Premature infants, systemic fungal infections, use with caution in patients with GI bleeding.
Adverse Reactions: Depression, euphoria, headache, restlessness, seizure, increased ICP, hypertension, heart failure, nausea, vomiting, fluid retention, hypernatremia, hyperkalemia.
Precautions: Hypoglycemic responses to insulin and hypoglycemic agents may be blunted. Dosage/Route:
Adult/Pediatric: Asthma 125-250 mg IV
Midazolam (Versed)
Classification: Benzodiazepine, short/intermediate acting; schedule IV drug.
Mechanism of Action: Reversibly interacts with GABA receptors in the CNS causing sedative, anxiolytic, amnesic, and hypnotic effects
Indications: Seizures, sedation for medical procedures (eg, intubation, ventilated patients, cardioversion), chemical restraint
Contraindications: Acute narrow-angle glaucoma, shock, coma, alcohol intoxication, overdose, depressed vital signs. Concomitant use with barbiturates, alcohol, narcotics, or other CNS depressants. Adverse Reactions: Headache, somnolence, respiratory depression, respiratory arrest, apnea, hypotension, cardiac arrest, nausea, vomiting
Dosage/Route:
Adult: Seizures: 0.2 mg/kg IM or IN, maximum dose is 10 mg; 0.1 mg/kg IV, max dose is 4 mg Procedural sedation: 0.5 to 2.5 mg IV. May be repeated to total max: 0.1 mg/kg Chemical restraint: 5 mg IV or IN; 5 mg IM
Pedi: Seizures: 0.1 to 0.3 mg/kg IV/IM (maximum single dose: 10 mg)
Procedural sedation: 0.05 to 0.5 mg/kg IV
Chemical restraint: 0.05 to 0.1 mg/kg IV; 0.1 to 0.15 mg/kg IM
Promethazine (Phenergan)
Classification: Phenothiazine, antiemetic, antihistamine
Mechanism of Action: H1 receptor antagonist; blocks action of histamine; possesses sedative, anti motion, antiemetic, and anticholinergic activity.
Indication: Nausea/vomiting, motion sickness
Contraindications: Coma, CNS depression from alcohol, barbiturates, or narcotics, Reye syndrome, lower respiratory symptoms
Adverse Reactions: Headache, dizziness, drowsiness, confusion, restlessness, wheezing, chest tightness, thickening of bronchial secretions, palpitations, bradycardia, reflex tachycardia, QT prolongation, postural hypotension, diarrhea, nausea, vomiting
Dosage:
Adults: 12.5 to 25 mg IV, deep IM, PO
Pediatric: 0.25 to 0.5 mg/kg deep IM
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Rocuronium
Classification: Nondepolarizing neuromuscular blocker
Mechanism of Action: Antagonizes acetylcholine at the motor end plate producing skeletal muscle paralysis
Indications: RSI
Contraindications: Known sensitivity to bromides; use with caution in heart and liver disease Precautions: . Intubation and ventilatory support must be readily available. Monitor the patient carefully. Rocuronium has no effect on consciousness or pain.
Adverse Reactions: Bronchospasm, wheezing, rhonchi, respiratory depression, apnea, dysrhythmias, tachycardia, transient hypotension and hypertension, nausea, vomiting
Dosage:
Adult/Pediatric: 0.6 to 1.2 mg/kg IV, IO
Sodium Bicarbonate
Classification: Systemic hydrogen ion buffer, alkalizing agent
Mechanism of Action: Buffers metabolic acidosis and lactic acid buildup in the body caused by anaerobic metabolism by reacting with hydrogen ions to form water and carbon dioxide Indications: Metabolic acidosis during cardiac arrest, tricyclic antidepressant, hyperkalemia, crush injuries.
Contraindications: Metabolic and respiratory alkalosis, hypokalemia, electrolyte imbalance due to severe vomiting or diarrhea.
Precautions: Increases the effects of amphetamines. Decreases the effects of benzodiazepines, tricyclic antidepressants. May deactivate sympathomimetics
Adverse Reactions: Hypernatremia, metabolic alkalosis, seizures, fluid retention, hypokalemia, electrolyte imbalance, sodium retention, peripheral edema
Dosage/Route:
Adult: 1 mEq/kg slow IV, IO, may repeat at 0.5 mEq/kg every 10 minutes
Pediatric: 1 mEq/kg slow IV, IO.
Succinylcholine (Anectine)
Classification: Neuromuscular blocker, depolarizing; skeletal muscle relaxant
Mechanism of Action: Ultra-short-acting depolarizing skeletal muscle relaxant that mimics acetylcholine as it binds with the cholinergic receptors on the motor end plate, producing a phase 1 block as manifested by fasciculations
Indications: RSI.
Contraindications: Acute narrow-angle glaucoma, penetrating eye injuries, malignant hyperthermia; acute injury after multisystem trauma, major burns, or extensive muscle injury that may result in hyperkalemia.
Adverse Effects: Apnea, respiratory depression, bradydysrhythmia, tachydysrhythmia, dysrhythmia, cardiac arrest, salivation, prolonged muscle rigidity, rhabdomyolysis, malignant hyperthermia, increased intraocular pressure, hyperkalemia
Precautions: Pregnancy C; patients taking MAO inhibitors; myasthenia gravis. Dosage:
Adult/Pediatric: 1 to 2 mg/kg rapid IV. Repeat once if needed.
Thiamine
Classification: Vitamin
Mechanism of Action: Combines with ATP to form a necessary component for carbohydrate metabolism
Indications: Coma of unknown origin; Wernicke-Korsakoff syndrome; beriberi; delirium tremens Contraindications: Hypersensitivity
Precautions: Give thiamine prior to administration of glucose especially in alcoholic patients Dosage:
Adult: 50 to 100 mg slow IV/IM
Pediatric: 10 to 25 mg slow IV/IM
Vecuronium
Classification: Neuromuscular blocker, nondepolarizing
Mechanism of Action: Neuromuscular agent with intermediate duration of action that competes with acetylcholine for receptors at the motor end plate, resulting in neuromuscular blockade Indications: RSI
Contraindications: Acute narrow-angle glaucoma, penetrating eye injuries, inability to control airway or support ventilations with oxygen and positive pressure, newborns, myasthenia gravis, hepatic or renal failure
Precautions: Intubation and ventilatory support must be readily available. Monitor the patient carefully. Vecuronium has no effect on consciousness or pain
Adverse Effects: Weakness, prolonged neuromuscular block, bronchospasm, apnea, dysrhythmias, bradycardia, tachycardia, PVCs, transient hypotension, cardiac arrest, excessive salivation Dosage:
Adult: 0.1 to 0.2 mg/kg IV push. Maintenance dose within 45 to 60 minutes: 0.8 to 1.2 mg/kg IV push
Pediatric: 0.1 to 0.3 mg/kg IV/IO. Maintenance dose within 20 to 40 minutes: 0.01 to 0.015 mg/kg IV push
