Emergency drug doses

Question 1

Naloxone for opioid OD

Answer 1

IV (SC or IM if not possible): initially 400 ug, then up to 800 ug for up to 2 doses at 1 min interval if no response, then increase to 2 mg for 1 dose if still no response.

Further doses may be required if resp. function deteriorates.

Question 2

Morphine for acute pain

Answer 2

PO, SC or IM: 10 mg every 4 hrs (5 mg in elderly)

Slow IV injection: 5 mg every 4 hrs

Question 3

Morphine for MI or acute pulmonary oedema

Answer 3

Slow IV injection: 5-10 mg (at 1-2 mg/min, 1/2 dose in elderly)

Question 4

Salbutamol for acute asthma

Answer 4

O2-driven nebuliser: 5 mg every 20-30 mins or as required

Question 5

Ipratropium for acute severe asthma

Answer 5

Nebulised: 500 ug every 4-6 hrs as required

Question 6

Hydrocortisone for acute asthma, adrenocortical insufficiency or anaphylaxis

Answer 6

asthma: IV injection: 100 mg every 6 hrs
adrenal crisis: IV/IM: 100-500 mg 3-4x/day
anaphylaxis: IV injection: 100-300 mg

Question 7

Chlorphenamine for anaphylaxis

Answer 7

IM/IV: 10 mg (max. 4 doses/day)

Question 8

Adrenaline for anaphylaxis

Answer 8

IM: 0.5 mg (repeat as required)

Question 9

Adrenaline for CPR

Answer 9

IV: 1 mg every 3-5 mins as required (1:10,000 solution)

Question 10

Atropine for bradycardia after beta-blocker OD

Answer 10

IV: 3 mg

Question 11

Atropine for bradycardia after MI

Answer 11

IV injection: 500 ug every 3-5 mins (max. 3 mg per course)

Question 12

Aspirin for ACS

Answer 12

PO: 300 mg

Question 13

Clopidogrel for PCI after NSTEMI/STEMI

Answer 13

PO: initially 300 mg, then 75 mg for at least 4 weeks

Question 14

Calcium gluconate for severe hyperkalaemia

Answer 14

slow IV injection: 10-20 mL 10% calcium gluconate

Question 15

Calcium gluconate for severe acute hypocalcaemia

Answer 15

slow IV injection (over 10 min): 10 ml 10% calcium gluconate in 50 ml 5% dextrose

(repeat until asymptomatic max 4x)

Question 16

Insulin/dextrose infusion for severe hyperkalaemia

Answer 16

slow IV injection (over 15 mins): 10 units Actrapid in 50 ml 50% dextrose

Question 17

Diazepam for status epilepticus, febrile convuslions or severe acute anxiety

Answer 17

IV injection (over 2 mins): 10 mg

Repeat after 10 mins if required.

Question 18

Lorazepam for status epilepticus, febrile convulsions or convulsions caused by poisoning

Answer 18

slow IV injection: 4 mg, repeat after 10 mins if required

Question 19

Glucose for hypoglycaemic emergency

Answer 19

10-20 g glucose in many forms (e.g. glucogel, 5x glucose tablets, 100-200 ml cola or other drink, 4-5 sugar lumps or teaspoons)

IM: 1 mg glucagon - if no response within 10 mins, IV glucose given via infusion at 20%