Emergency Drugs Flashcards
What does a 1% solution mean?
1g in 100ml
= 1000mg/100ml
=10mg/ml
=
What does a 10% solution mean?
10g in 100ml
=10,000/100ml
=100mg/ml
What strength adrenaline is used in cardiac arrest?
1 in 10,000
1g in 10,000mls
=1000mg in 10,000mls
= 0.1mg/ml
=100mcg/ml
What does of adrenaline is used in cardiac arrest in children (excluding newborns)?
10mcg/kg
(Also equates to 0.1ml/kg)
1 in 10,000= 1g in 10,000mls
=1000mg/10,000mls
=0.1mg/ml
=100mcg/ml
=10mcg/0.1ml
What dose of adrenaline is used in newborns in cardiac arrest?
20mcg/kg (0.2ml/kg)
Haemodynamic effects of adrenaline are dose dependent; true or false?
True
* Lower doses = more beta-adrenergic effects
* Higher doses = more alpha-adrenergic effects
When is amiodarone indicated in cardiac arrest?
Refractory pulseless VT or VF to be used after 3rd shock. Can be reepated after 5th shock if needed
What does of amiodarone is used in cardiac arrest?
5mg/kg
The delivery rate of amiodarone is important in patients who have a perfusing rhythm such as in VT with a pulse or SVT; at what rate should it be delivered in such circumstances?
Slowly over at least 20 mins preferably with expert cardiology advice to avoid bradycardia & cardiac arrest (as it increases duration of action potention and refractory period in both atrial and ventricular myocardium)
Broadly speaking, what venous access site should be used for adenosine and why?
Access site as central/close to heart as possible due to very short half life.
Note: it is often seen to be ineffective when given via IO route
What dose of adenosine is used in neonates?
Include initial dose, incremental increases and max single dose
Initially 150mcg/kg increased in **steps of 50-100mcg/kg **every 1-2 mins if required. Can be repeated until tachycardia terminated or a maximum single dose of 300mcg/kg.
What dose of adenosine is used in children aged 1 to 11 months old?
Include initial dose, incremental increases and max single dose
Initially 150mcg/kg increased in **steps of 50-100mcg/kg **every 1-2 mins if required. Can be repeated until tachycardia terminated or a maximum single dose of 500mcg/kg.
What dose of adenosine is used in children aged 1 to 11 years?
Include initial dose, incremental increases, max single dose and max tot
Initially 100mcg/kg increased in **steps of 50-100mcg/kg **every 1-2 mins if required. Can be repeated until tachycardia terminated or a maximum single dose of 500mcg/kg. Maximum total dose 12mg (12000mcg)
What dose of adenosine is used in children aged 12 to 17 years?
Include initial dose, incremental increases, max single dose and max tot
Initially 3mg, followed by 6mg after 1-2 mins if required, followed by 12mg after 1-2 mins if required.
What medication makes children less sensitive to adenosine?
Theophylline
State 2 conditions in which adenosine should be used in caution
- Asthma (bronchospasm)
- Heart transplant
Why may atropine be less useful in bradycardia in a child?
Atropine blocks the effects of the vagus nerve at the SA and AV node. Bradycardia in children often hypoxia related, not vagal mediated, hence atropine may not be as beneficial (no evidence that it has any benefit in asphyxia)
What dose of atropine is used in children aged:
* Up to 11yrs
* 12-17 yrs
- Up to 11yrs: 20mcg/kg
- 12-17yrs: 300-600mcg
Note: doses can be repeated but once vagus nerve has been fully blocked there is no further beneficial effect
Discuss why sodium bicarbonate is not routinely used in cardiac arrests
- Best treatment for the metabolic acidosis in cardiac arrest is a combination of effective chest compressions & ventilation
- Administration of sodium bicarbonte generates CO2 which if not rapidly cleared by the lungs rapidly diffuses into cells exacerbating the intracellular acidosis
- It also has negative inotropic effects, increases osmotic load of plasma, shifts oxygen dissociation curve to left, intracellular shift of potassium lowering the VF threshold, decreases plasma calcium
- Hence, not routinely used in cardiac arrests but may be considered in prolonged cardiac arrest, hypoerkalaemia and arrhythmias associated with TCAs
If sodium bicarbonate is used in cardiac arrest, what dose is used and what strength solution is used for children and for newborns and infants?
- 1mmol/kg
- Children: use 8.4% solution which equates to 1ml/kg
- In newborn & infants use 4.2% solution which equates to 2ml/kg
What dose of calcium is given (if it used in cardiac arrest)? Include doses and maximum doses for both 10% calcium chloride and 10% calcium gluconate
Note: not routinely used as previously mentioned
10% calcium chloride: 0.2ml/kg (max 10ml)
10% calcium gluconate: 0.5ml/kg (max 20ml)
What dose of 10% glucose should be given in hypoglycaemia in:
* Newborn
* Child
- Newborn: 250mg/kg of 10% glucose (2.5ml/kg)
- Child: 200mg/kg of 10% glucose (2ml/kg)
What dose of naloxone is used for:
* Children <5yrs
* Children >5yrs
- Children <5yrs: 100mcg/kg (max 2mg)
- Childre >5yrs: 2mg
