Emergencies drug doses

Question 1

Anaphylaxis

Answer 1

100% Oxygen
Adrenaline IM 0.5mg
Chlorphenamine IV 10mg
Hydrocortisone IV 200mg
NaCl 0.9% up to 2L per hour (titrate against BP)

Question 2

Asthma attack

Answer 2

100% Oxygen + secure airway
Salbutamol nebs 5mg (4hrly back to back)
\+/- ipratropium 0.5mg/6hr
IV hydrocortisone 100mg
PO Prednisolone 40-50mg 5-7days

Other:
IV MgSO4 1.2-2g over 20mins
IV Salbutamol
IV aminophylline (watch out for arrhythmias)

Question 3

Acute COPD exacerbation

Answer 3

Salbutamol nebs 5mg/4hr + Ipratropium 0.5mg/6hr
Oxygen therapy (if sats <92%/PaO2<7kPa) -> 24-28% if known retainer, 28-40% if not
IV hydrocortisone 200mg + PO pred 30mg 7-14days

Other
IV Abx if infective -> eg amox/clari/doxy
Physio for sputum clearance
IV aminophylline and ITU care etc

Question 4

Acute heart failure

Answer 4

Sit pt upright 
100% O2 if sats low
Diamorphine 1.25-5mg IV slowly 
Furosemide 40-80mg IV slowly
GTN spray 2 puffs SL or 2 x 0.3mg tablets SL (if SBP>100)

Consider:
Nitrate infusion if SBP >100 eg isosorbide nitrate 2-10mg/h IV

Question 5

Suspected meningococcal meningitis

Answer 5

1.2g IM benzylpenicillin

Question 6

Meningitis

Answer 6

2g/12hr IV ceftriaxone/cefotaxime
If meningisim -> 10mg/6hr dexamethasone

prophylaxis for contacts: 500mg ciprofloxacin PO 1 dose (different for kids)

Question 7

NSTEMI

Answer 7

O2
5-10mg diamorphine 
10mg metaclopromide
GTN PRN
300mg aspirin (75mg f/u)
\+/- 180mg ticagrelor (90mg/12hr f/u)

Consider

• Beta blocker eg metoprolol if HTN/tachy/LV function >40%
• 2.5mg SC OD fondaparinux or LMWH (1mg/kg/12hr SC)
• IV nitrate if pain continues

Question 8

STEMI

Answer 8

O2
5-10mg diamorphine 
10mg metaclopromide
GTN (if HTN)
300mg aspirin (75mg f/u)
180mg ticagrelor (90mg/12hr f/u) (prasugrel if PCI indicated)

PCI in <120mins
if not possible -> fibrinolysis with alteplase or tenecteplase within 30mins then send to PCI hospital

Question 9

Pul oedema

Answer 9

O2
1.25-5mg morphine
2 puffs GTN or 2x0.3mg SL tablets
40-80mg frusemide IV

If SBP>100 then consider IV nitrate infusion

Question 10

Bradycardia

Answer 10

Reverse causes and correct electrolyte abnormalities/acid-base etc
500mcg Atropine (can repeat every 3-5mins up to 3mg)

If no work:

• Transcut pacing
• Isoprenaline 5mcg/min IV
• Adrenaline 2-10mcg/min IV
• Glucagon if beta-blocker induced
• Call cardio/anaesthetics + prep for transvenous pacing

Question 11

SVT

Answer 11

Haem unstable -> DC cardioversion, no work then Amiodarone 300mg IV then 900mg/24hr

Haem stable:

1. vagal manoeuvres 2/3 times
2. 6mg Adenosine IV bolus
3. 12mg Adenosine
4. 12mg Adenosine
5. 5mg Verapamil IV

Question 12

Broad complex tachycardia

Answer 12

First: O2 etc and correct abnormalities

Unstable:
1) DC cardioversion
2) Correct K -> up to 60mmol KCl at 30mmol/hr
Mg -> 4ml of 50% over 30min
3) 300mg amiodarone via CL over 10-20min

Stable:

1) Correct abnormalities as above
2) 300mg amiodarone via CL over 20-60min
3) DC cardioversion