Emergency drugs Flashcards
Hydrocortisone
100-300mg IV in allergy
Initially 100 mg for 1 dose, then (by continuous intravenous infusion) 200 mg/24 hours, dilute in Glucose 5% in adrenal crisis
100 mg every 6 hours until conversion to oral prednisolone is possible, dose given, preferably, as sodium succinate asthma
Epinephrine/adrenaline dose
500 micrograms, using adrenaline 1 in 1000 (1 mg/mL) injection, repeat dose after 5 minutes if no response; if life-threatening features persist, further doses can be given every 5 minutes until specialist critical care available, to be injected preferably into the anterolateral aspect of the middle third of the thigh. High flow O2 also
Cardiopulmonary rhesus- IV 1 mg every 3–5 minutes as required of 100 micrograms/mL solution
Chlorphenamine
10 mg for 1 dose, to be repeated if necessary; maximum 4 doses per day. For anaphylaxis, IV or IM
Atropine post MI bradycardia
500 micrograms every 3–5 minutes; maximum 3 mg per course. IV
Aspirin
Secondary CVS prevention 75 mg once daily oral tablet
300mg one dose ACS (oral chewed or dispersed in water)
Clopidogrel
Secondary prevention of transient ischaemic attack/stroke [in patients without atrial fibrillation], 75mg OD oral
Pre PCI (adjunct with aspirin) Loading dose 300 mg for 1 dose, to be taken prior to the procedure, oral
TIA/stroke Initially 300 mg for 1 dose, to be started within 24 hours of onset of symptoms, then 75 mg once daily. oral tablet
ACS without ST elevation - Initially 300 mg for 1 dose, then 75 mg once daily for up to 12 months. oral
ACS with ST elevation, 75 mg once daily for at least 4 weeks. oral
Calcium gluconate
Severe acute hypocalcaemia or hypocalcaemic tetany, slo IV injection, Initially 10–20 mL, calcium gluconate injection 10%. Repeated as required
Acute severe hyperkalaemia [plasma-potassium concentration 6.5 mmol/litre or greater, or in the presence of ECG changes], slow IV injection, 30 mL, calcium gluconate 10% (providing approximately 6.8 mmol of calcium) should be administered as a single dose, repeat dose if no improvement in ECG within 5 to 10 minutes.
Insulin/dextrose infusion
Insulin-dextrose protocol. Our local protocol required IV administration of 10 U regular insulin with 25 g of glucose as 50 mL of 50% dextrose.
For hyperkalaemia - Administer as follows: Transfer 100 units in 1ml insulin from insulin syringe into 10 ml syringe and make up to 10 ml using sodium chloride 0.9%. Add 0.5 ml of the diluted insulin solution to a 500 ml bag of glucose 10%. Label as per Trust policy. Set pump to run at 360 ml/ hour for 10 minutes only.
Hypoglycaemia
15–20 g glucose
Adults with symptoms of hypoglycaemia who have a blood-glucose concentration greater than 4 mmol/litre, should be treated with a small carbohydrate snack such as a slice of bread or a normal meal, if due.
Any patient with a blood-glucose concentration less than 4 mmol/litre, with or without symptoms, and who is conscious and able to swallow, should be treated with a fast-acting carbohydrate by mouth. Fast-acting carbohydrates include Lift® glucose liquid (previously Glucojuice®), glucose tablets, glucose 40% gels (e.g. Glucogel®, Dextrogel®, or Rapilose®), pure fruit juice, and sugar (sucrose) dissolved in an appropriate volume of water.
If necessary, repeat treatment after 15 minutes, up to a maximum of 3 treatments in total. Once blood-glucose concentration is above 4 mmol/litre and the patient has recovered, a snack providing a long-acting carbohydrate should be given to prevent blood glucose from falling again - do not omit insulin if due
Hypoglycaemia which does not respond (blood-glucose concentration remains below 4 mmol/litre after 30–45 minutes or after 3 treatment cycles), should be treated with intramuscular glucagon 1mg or glucose 10% intravenous infusion if not effective after 10 mins
or glucose 20% intravenous infusion
By intravenous injection into large vein
ADULT 75–100 mL infused over 15 minutes
Diazepam
Convulsive (including febrile) seizures lasting longer than 5 minutes
Either diazepam rectal solution (2 mg/mL, 4 mg/mL). ADULT 10–20 mg, repeated once after 5–10 minutes if necessary.
or midazolam oromucosal solution. ADULT 10 mg, repeated once after 5–10 minutes if necessary [unlicensed]
Meningococcal disease
Benzylpenicillin sodium injection (600 mg, 1.2 g)
or if history of allergy to penicillin
Cefotaxime injection (500 mg, 1 g, 2 g)
Angina: unstable, NSTEMI
Aspirin dispersible tablets (75 mg, 300 mg)
By mouth (dispersed in water or chewed)
ADULT 300 mg
Plus
either glyceryl trinitrate aerosol spray (400 micrograms/metered dose)
Sublingually
ADULT 1–2 sprays, repeated as required
or glyceryl trinitrate tablets (300 micrograms, 500 micrograms, 600 micrograms)
Sublingually
ADULT 0.3–1 mg, repeated as required
Myocardial infarction: ST-segment elevation
MONA IV
Aspirin dispersible tablets (75 mg, 300 mg)
By mouth (dispersed in water or chewed)
ADULT 300 mg
Glyceryl trinitrate aerosol spray (400 micrograms/metered dose)
Sublingually
ADULT 1–2 sprays, repeated as required
or glyceryl trinitrate tablets (300 micrograms, 500 micrograms, 600 micrograms)
Sublingually
ADULT 0.3–1 mg, repeated as required
Metoclopramide hydrochloride injection (5 mg/mL)
By intravenous injection
ADULT 18–19 YEARS (BODY-WEIGHT UP TO 60 KG): 5 mg
ADULT 18–19 YEARS (BODY-WEIGHT 60 KG AND OVER): 10 mg
ADULT OVER 19 YEARS 10 mg
Diamorphine hydrochloride injection (5 mg powder for reconstitution)
By slow intravenous injection (1–2 mg/minute)
ADULT 5 mg followed by a further 2.5–5 mg if necessary
ELDERLY or FRAIL patients, reduce dose by half
or morphine sulfate injection (10 mg/mL)
By slow intravenous injection (1–2 mg/minute)
ADULT 5–10 mg followed by a further 5–10 mg if necessary
ELDERLY or FRAIL patients, reduce dose by half
Oxygen, if appropriate
Asthma: acute
High-flow oxygen should be given if available (via tight-fitting face mask in children) to achieve and maintain an SpO2 level of 94‑98%.
Either salbutamol aerosol inhaler (100 micrograms/metered inhalation)
By aerosol inhalation via large-volume spacer. 2-10 puffs every 10-20 mins
or salbutamol nebuliser solution (1 mg/mL, 2 mg/mL). ADULT 5 mg every 20–30 minutes or as necessary
either prednisolone tablets (or prednisolone soluble tablets) (5 mg). ADULT 40–50 mg once daily for at least 5 days
or hydrocortisone (preferably as sodium succinate). By intravenous injection. ADULT 100 mg every 6 hours until conversion to oral prednisolone is possible
While awaiting ambulance, repeat nebulised beta2 agonist (as above) and give with
Ipratropium bromide nebuliser solution (250 micrograms/mL). ADULT 500 micrograms every 4–6 hours as necessary
Croup
Dexamethasone oral solution (2 mg/5 mL)
By mouth
CHILD 1 MONTH–2 YEARS 150 micrograms/kg as a single dose
lorazepam
Status epilepticus,
Febrile convulsions,
Convulsions caused by poisoning
Adult
4 mg for 1 dose, then 4 mg after 5–10 minutes if required for 1 dose, to be administered into a large vein.
Salbutamol nebuliser
Moderate, severe, or life-threatening acute asthma
Adult
5 mg, repeat every 20–30 minutes or when required, give via oxygen-driven nebuliser if available.
Prednisolone
Mild to moderate acute asthma,
Severe or life-threatening acute asthma
for prednisolone
Adult
40–50 mg daily for at least 5 days.
Morphine
Acute pain - By mouth, or by subcutaneous injection, or by intramuscular injection
Adult
Initially 10 mg every 4 hours, adjusted according to response, subcutaneous injection not suitable for oedematous patients, dose can be given more frequently during titration, use dose for elderly in frail patients.
By slow intravenous injection
Adult
Initially 5 mg every 4 hours, adjusted according to response, dose can be adjusted more frequently during titration, reduced dose recommended in frail and elderly patients.
MI - By slow intravenous injection
Adult
5–10 mg, followed by 5–10 mg if required, dose to be administered at a rate of 1–2 mg/minute, use dose for elderly in frail patients.
Elderly
2.5–5 mg, followed by 2.5–5 mg if required, dose to be administered at a rate of 1–2 mg/minute.
Naloxone
Acute opioid overdose–high-dose regimen [when rapid titration with naloxone is necessary to reverse potentially life-threatening effects]
Adult
Initially 400 micrograms, then 800 micrograms for up to 2 doses at 1 minute intervals if no response to preceding dose, then increased to 2 mg for 1 dose if still no response (4 mg dose may be required in seriously poisoned patients), then review diagnosis; further doses may be required if respiratory function deteriorates following initial response, intravenous administration has more rapid onset of action, doses may be given by intramuscular route but only if intravenous route is not feasible.
Principles of IV fluid prescribing
Intravenous (IV) fluids should only be prescribed for patients whose needs cannot be met by oral or enteral routes. Where possible oral fluid intake should be maximised and IV fluid only used to supplement the deficit.
Examples of when IV fluids may be required:
A patient is nil by mouth (NBM) for medical/surgical reasons (e.g. bowel obstruction, ileus, pre-operatively)
A patient is vomiting or has severe diarrhoea
A patient is hypovolaemic as a result of blood loss (blood products will likely be required in addition to IV fluid)
IV fluid types
IV fluids can be categorised into 2 major groups:
Crystalloids: solutions of small molecules in water (e.g. sodium chloride, Hartmann’s, dextrose)
Colloids: solutions of larger organic molecules (e.g. albumin, Gelofusine)
Colloids are used less often than crystalloid solutions as they carry a risk of anaphylaxis and research has shown that crystalloids are superior in initial fluid resuscitation.
main fluids used
fluid history
Fluid intake:
Assess if the patient’s fluid intake been adequate.
Symptoms suggestive of dehydration:
Thirst
Dizziness/syncope
Fluid loss:
Vomiting (or NG tube loss)
Diarrhoea (including stoma output)
Polyuria
Fever
Hyperventilation
Increased drain output (e.g. biliary drain, pancreatic drain)
Co-morbidities:
Heart failure
Renal failure
