Drugs & Doses: Emergencies

Question 1

Acute angle closure glaucoma

Answer 1

1. Timolol 0.5% drop (B-blocker) – one drop.
   then 1 minute later
2. Pilocarpine 2% - one drop
   Repeat above 3 times at ~5 minute intervals
3. PLUS Acetazolamide oral 500mg (reduces IOP)

Question 2

Bacterial keratitis

Answer 2

Cipro 0.3% 1-2 drops Q15min for 6hrs, then Q1H for 48hrs, then Q4H until healed

Question 3

HSV keratitis

Answer 3

Acyclovir 3% ointment 5x/day for 2/52 or 3 days post healing, whichever is earlier

Question 4

HSV ophthalmicus

Answer 4

PO valacyclovir 1g TDS for 7/7

Question 5

Addison crisis

Answer 5

Hydrocort 100mg IV , then 50-100mg Q4-6H until stable

Question 6

Anaphylaxis

Answer 6

1. Adrenaline 10mcg/kg IM lateral thigh, adults 0.5mg (0.5ml of 1:1000 adrenaline)
2. Promethazine (Phenergan®) 25-50mg IM/IV (NOT oral ever)

Question 7

Seizure

Answer 7

Midazolam 5-10mg (paeds 0.2mg/kg) IV / IM (repeat once after 15mins if still seizing)
Paeds 0.3mg/kg buccal/IN/IM, 0.1mg/kg IV

Question 8

Sedation – for drug overdose or delirium

Answer 8

1. Diazepam oral 20mg if pt will take it,
2. Diazepam 2.5-5mg IV, repeat 3 to 4 mins as needed to max of 20 -30mg
3. Midazolam 2.5-5mg IV/IM, repeat every 3-4 mins as needed to max 20mg

Question 9

Hypoglycaemia

Answer 9

1. Rule of 15 - 15g quick acting carb, recheck in 15mins, repeat if not improving
2. Glucagon 1mg IM
3. 50ml 50% dextrose/glucose IV

Question 10

Asthma severe attack

Answer 10

1. Salbutamol 5mg (2.5mg in <6yo) nebulised - may give continuously
2. Ipratropium 500mcg (250mcg in <6yo) nebulised (every 20 mins for 1st hour, rpt every 4-6 hrs as needed)
3. Prednisone 1mg/kg (max 50mg) PO

Question 11

Croup

Answer 11

1. Mild to mod - 1mg/kg pred + repeat following evening
2. Severe
   Adrenaline 5ml of 1:1000 (5mg) via nebuliser, rpt after 30 mins if needed, PLUS
   Prednisolone 2mg/kg (max 50mg), single dose OR dexamethasone 0.6mg/kg (max 12mg)

Question 12

Tachyarrhythmias

Answer 12

SVT
• Valsalva → if fails
• 6mg IV adenosine (rapidly) → if ineffective, 2nd bolus of 12mg IV → if still ineffective further 18mg bolus → if fails cardiologist

Atrial flutter/AF
• Stable = Metoprolol 5mg IV over 5mins, may repeat
• Unstable = synchronised shock 70J

VT
• Conscious = amiodarone 300mg IV over 20mins, then 900mg IV infusion over 24hrs
• Unstable = sedate with Midazolam 2mg IM/IV, then synchronised shock 150J
• Unconscious = shock

Question 13

Bradyarrhythmias

Answer 13

Atropine 600mcg IV (may repeat, max 3mg) +/- external pacing

Question 14

ACS

Answer 14

1. 300mg oral aspirin
2. GTN spray/tab 0.4mg 1-2 (may repeat every 5mins to 3 doses)
3. IV line / cannulate
4. Transfer immediately to hospital via ambulance
5. Morphine for pain IV 5mg , rpt after 5-10 mins, titrate to pain
6. Close monitoring of vital signs- BP, Pulse rate, SaO2
7. Oxygen ONLY IF sats are low

Question 15

APO

Answer 15

GTN spray/tab 1-2 (may repeat every 5mins)

Question 16

Opioid overdose

Answer 16

Naloxone 400mcg IM/SC (may repeat every 5 mins) OR 40-100mcg IV every 2 mins OR 1.8mg/0.1ml IN Max 10mg

Question 17

Serotonin syndrome

Answer 17

Mild-mod - benzo

If no improvement - cyproheptadine 12mg PO single dose

Question 18

Acute dystonic reaction

Answer 18

Benzatropine 1-2mg IV/IM followed with PO if required

Question 19

Meningitis

Answer 19

Ceftriaxone 2g (paeds 50mg/kg) IM/IV OR Cefotaxime 2g (paeds 50mg/kg)

Question 20

Paeds Analgesia

Answer 20

1. Paracetamol 15mg/kg 4 hrly to max of 4 doses daily

2. Ibuprofen 10mg/kg 6 hrly to max 3 doses daily

Question 21

STINGS

• Box Jelly
• Irukandji
• Blue Bottle
• Redback Spider
• Funnel Web

Answer 21

Box jelly - vinegar + antivenom
Irukandji - resus
Blue bottle - NO vinegar, hot water instead
Redback spider - analgesia, antivenom rarely used
Funnel web - as per snake bite

Question 22

Syringe driver

Answer 22

Morphine, metoclopramide, haloperidol, clonazepam, hyoscine butyl bromide