Drugs

Question 1

Dose of adrenaline

Answer 1

1mg (10mL 1:10,000) IV
If Shockable - give after 3 shocks
If non shockable - give ASAP

Repeats every 3-5 mins (1 cycle give, 1 cycle don’t give)

Question 2

Dose of amiodarone

Answer 2

300mg bolus IV diluted in 5% dextrose to a volume of 20mL
After 3 attempts of defibrillation

2nd dose is 150mg after 5 attempts of defibrillation

Question 3

Dose of calcium and when to use?

Answer 3

PEA due to hyperkalaemia, hypocalcaemia or OD of Ca channel blockers.

10mL 10% calcium chloride (6.8mmol Ca)
or 30mL 10% calcium gluconate IV (each 10 mL has 2.2mmol Ca)

Question 4

Dose of sodium bicarbonate and when to use?

Answer 4

Shockable and non-shockable rhythms for hyperkalaemia and tricyclic OD (use acid base analysis to guide therapy)

50mmol (50mL of 8.4% solution) IV

Routine use NOT recommended

Question 5

Dose of tenecteplase? When?

Answer 5

500-600mcg / kg bolus IV

?PE (remember CPR for at least 60-90 mins)

Question 6

Dose of Alteplase and when to use?

Answer 6

50mg IV bolus if ?PE

Consider 2nd dose of 50mg IV bolus when prolonged CPR attempt (e.g. 30 min after 1st dose)

Question 7

Dose of adenosine and when to use?

Answer 7

Paroxysmal SVT (Narrow QRS, regular and failed vagal manoeuvres)

6mg IV bolus
If unsuccessful after 1-2 mins, give 12mg IV bolus
If unsuccessful after 1-2 mins, give 12 or 18mg IV

Question 8

What to give when irregular narrow QRS?

Answer 8

Rate control B- blockers
Consider digoxin or amiodarone if evidence of HF
Anticoagulate if > 48h

Atenolol 5mg IV over 5 mins repeated if needed after 10 mins
Metoprolol 2.5mg IV at 5 min intervals, total of 15mg
Propranolol 100mcg/kg IV slowly 3 equal doses at 2-3 mins intervals
Esmolol 500mcg/kg IV over 1 min followed by 50-200mcg/kg min

Question 9

After giving 3 doses of adenosine, what to give if ineffective?

Answer 9

Verapamil 2.5-5mg IV over 2 min

(in the absence of therapeutic response or induced adverse event, give repeated doses of 5-10mg every 15-30 mins to a max of 20mg)

Question 10

What to give on Broad QRS regular tachycardia?

Answer 10

If VT - Amiodarone 300mg IV over 10-60 min

If previous certain SVT with bundle branch block/ aberrant conduction treat as regular narrow tachycardia (maneuvres and adenosine)

Question 11

What to give on broad QRS irregular tachycardia?

Answer 11

If AF with bundle branch block treat as regular narrow QRS tachy (vagal manoeuvres and adenosine)

If polymorphic VT (e.g. Torsades) give Mg 2g over 10 min

Question 12

What to give in tachyarrhythmia when drugs fail? Or if features of life threat?

Answer 12

Syncronised DC shock up to 3 attempts + sedation/analgesia

Question 13

Dose of GTN (glyceryl trinitrate) and when to use?

Answer 13

Angina, unstable angina, MI, acute left ventricular HF

1-2 doses of sublingual 300mcg tablet or 400mcg spray

GTN infusion - 10-200mcg min

Isosorbide dinitrate IV 2-10mg / h

Question 14

What to give in anaphylaxis?

Answer 14

Adrenaline 0.5,mg or 500mcg IM (1:1000)
Repeated every 5 mins

50mcg IV bolus dose titrate to effect whilst awaiting infusion

Question 15

What to give in life-threatening bradycardia?

Answer 15

500mcg (or 0.5mg) atropine IV (not ALS, but every 3-5 mins)
Max 3mg

Question 16

Options for drug pacing in bradycardia not responding to atropine?

Answer 16

Isoprenaline 5mcg min IV
Adrenaline 2-10mcg min IV