Emergency Drugs

Question 1

Adrenaline

Answer 1

• 0.5mg (500mcg) (0.5ml 1 in 1000) of IM adrenaline for anaplylaxis

Question 2

Hydrocortisone

Answer 2

• 100-300mg by IV injection to be used with adrenaline in anaphylaxis

Adrenal crisis - 100mg IM or IV for one dose, then 200mg/24hrs IV infusion diluted in 5% dextrose

OR 50mg IM or IV every 6 hrs

Question 3

Chlorphenamine

Answer 3

• 10mg IM injection or IV injection for 1 dose, rpt if necessary, max of 4 doses per day for anaphylaxis

Question 4

Atropine

Answer 4

• 500mcg IV injection every 3-5 minutes, max 3mg per course for bradycardia post MI

Question 5

Aspirin

Answer 5

• 300mg chewable/dispersed in water oral dose for ACS or TIA or ischaemic stroke

Question 6

Clopidogrel

Answer 6

• TIA - 300mg oral for 1 dose, within 24hrs of onset of symptoms then 75mg OD
• PCI - 300mg oral for one dose prior to procedure or alt 600mg for 1 dose

Question 7

Calcium gluconate

Answer 7

• Hyperkalaemia - 30ml of calcium gluconate 10% by slow IV injection

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* Hypocalcaemia - 10-20ml calcium gluconate injection 10% by slow IV injection rpt as required and follow with continious infusion to prevent recurrence at 50ml/hr 100ml 10% diltued in 1L 5% glucose

Question 8

Insulin dextrose infusion

Answer 8

• 10 units insulin (actrapid/novorapid)
• In 25g glucose (50ml 50%, 125ml 20%) over 15 minutes

Question 9

Hypoglycaemia treatments

Answer 9

• 1mg glucagon IM
• 50ml/hr 20% glucose if mild not responding
• 100ml 20% glucose over 15-20 mins if severe

Question 10

Diazepam

Answer 10

• 10-20mg by rectum then 10-20mg rpt if needed after 5-10 mins
• Elderly have 10mg
• Can give 10mg via IV injection then 10mg after 10 minutes if required, always at at rate of 1mL/minute (5mg/min)
• Used in status epilepticus

Question 11

Lorazepam

Answer 11

• 4mg for 1 dose by slow IV injection
• 4mg after 5-10 minutes if required
• Administer into large vein
• Used in status epilepticus

Question 12

Salbutamol nebuliser

Answer 12

• 5mg via nebuliser for moderate, severe or LF asthma
• Rpt every 20-30mins or when required
• Give via oxygen driven neb if available

Question 13

Prednisolone in asthma

Answer 13

• 40-50mg orally OD for at least 5 days

Question 14

Morphine

Answer 14

• MI and pulmonary oedema
• 5-10mg by slow IV injection
• Can rpt dose in MI if required
• 1-2mg/min in MI, 2mg/min in PO
• Elderly use 2.5-5mg dose

Question 15

Naloxone

Answer 15

• IV injection 400mcg
• If no response then 800mcg for up to 2 doses at 1 minute intervals
• If no response then increase to 2mg for 1 dose
• If no response review diagnosis, 4mg may be needed in serious overdoses
• IV injection has better onset of action but IM can be given if IV access is not feasible

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* For infusion - adjust rate according to response (initially set at 60% of initial resus dose per hr, this is the dose which maintained resp effort for at least 15 mins