Emergency drugs finals Flashcards
What drug is indicated for paroxsymal supraventricular tachycardia?
Adenosine
Initial dose of adenosine required for SVT?
Route of administration?
Further dose required ?
6mg is given initially
Route IV (rapid bolus)
Initially 6mg then 12mg and a further 12 mg if there is no improvement between doses.
MOA of adenosine?
Adenosine slows the cardiac conduction via the AV node. by interrupting the AVN it interrupts the accessory pathway in SVT & resets to sinus rhythm.
What should you warn a patient about before giving adenosine?
Warn the patient they may initially feel worse/ feeling of impending doom. It can cause a brief period of asystole or bradycardia.
In which patients should adenosine be avoided?
Avoid in patients with asthma, COPD/ heart failure/ heart block or severe hypotension.
What drug is required in cardiac arrest?
(Shockable rhythm given after what? Non shockable rhythm when is it given?)
What time is allowed between cycles of this drug being given?
Adrenaline 1mg
1: 10,000 –> Give 10 ml
For shockable rhythms (pulseless VT or VF) give after the third shock.
For non shockable rhythms (asystole or PEA).
Time allowed - 3-5 minutes (given after every other cycle).
What drug is indicated in acute anaphylaxis?
What route?
What dose in:
Children 0-5 yrs
Children 6-11 yrs
Children 12-17 yrs and adults
Adrenaline
IM
Children 0-5 yrs –> 150 micrograms
Children 6-11 yrs –> 300 micrograms
Children 12-17 yrs & adults –> 500 micrograms
What additional drug is required in cardiac arrest on the shockable side of the algorithm?
When would this drug be given?
How much? What route?
Can further doses be given?
Amiodarone
Given after the 3rd shock, after adrenaline has been given.
300 mg is given IV.
Yes further doses can be given. An additional 150 mg can be given after the 5th shock.
What drug is indicated to be given immediately in ACS?
What dose?
Aspirin PO 300 mg
What drug is indicated for periarrest due to bradycardia?
what dose and what route?
what is the maximum dose that can be given in how many doses?
Atropine 500 micrograms IV
This can be repeated up to 6 times if there is no improvement to a total dose of:
3mg.
What is the MOA of atropine?
What are key SE’s of atropine?
Atropine = anti muscarinic anticholinergic drug that blocks parasympathetic innervation to the SAN.
Key SE’s –> urinary retention, pupillary dilation, dry eyes, dry oral mucosa, constipation
2nd line drug in peri-arrest bradycardia with no improvement to maximal atropine dose?
2nd line –> transcutaneous external pacing or adrenaline infusion
What drugs are indicated for acute severe pain?
what doses can be given?
Via what route and what speed?
Diamorphine slow IV 1.25-2.5 mg
or Morphine 5mg
Route IV, slow IV = administration of the drug over a period of 4-5 mins with patient in recumbent (lying flat) position
What are the signs & symptoms of opioid overdose?
what drug is indicated for reversal?
What dose?
Pinpoint pupils
unconsciousness
respiratory depression
Naloxone IV 400 micrograms initially
Drug indicated for resistant hypertension or oedema?
Route and dose
Furosemide
IV, 20-50 mg
Drug for the relief of acute angina?
route and dose
Glyceryl trinitrate
Given sublingual
400-800 micrograms
Emergency management of acute asthma in adults?
Which drugs are used
What route are they given/ at what dose?
In what order?
What can be done if there is no improvement with initial management?
(hospital setting)
OSHIT oxygen salbutamol hydrocortisone ipratroprium theophylline (aminophylline).
Oxygen –> maintain 94–98%
Beta 2 Agonist Salbutamol PLUS Ipratroprium via nebuliser (preferably O2 driven)
Salbutamol 5mg
Ipratroprium 0.5 mg
If tolerating prednisilone 40 - 50 mg orally
Not tolerating oral intake –> IV hydrocortisone 100 mg.
If no improvement:
Give repeat salbutamol 5mg + ipratroprium 0.5mg via oxygen driven nebuliser after 15 mins
Consider continuous salbutamol nebuliser 5-10 mg/ hr
consider IV magnesium sulphate 1.2- 2 g over 20 minutes
Hydrocortisone has two indications:
What are these indications?
What doses are required for each indication?
1) acute asthma management 100 mg IV
2) anaphylaxis 200 mg IV
Key drug to manage acute bronchospasm
Route and dose required?
Ipratroprium Nebulised 500 micrograms
Drug used in acute severe asthma management in adults (initial management has failed).
Dose & route
Magnesium sulfate IV 1.2 - 2 g
Oral steroid indicated in severe acute asthma?
Prednisilone PO 40 -50 mg
Key nebuliser in acute asthma
1st line
Salbutamol nebulised 5 mg
Drug indicated for severe nausea and vomiting?
Route and dose?
Metoclompramide 5-10 mg
Slow IV (administration over period 4-5 minutes, patient lying down).
Drug indicated in duodenal ulcers?
Route and dose?
Omeprazole 40 mg IV
Emergency treatment of status epilepticus
Pre hospital stage - drugs and doses, time for repeat
Early status epileptics - drugs and doses, time for repeat
Established status epilepticus - drugs, dose
Refractory status epilepticus
Pre hospital –> Diazepam 10 mg - 20 mg rectal or Midazolam 10 mg buccally. Repeat 15 mins if seizures continue.
Early status –> Lorazepam IV 0.1mg/ kg (usually 4 mg bolus). Repeat after 10- 20 mins
Established status –> Phenytoin infusion 15 - 18 mg/ kg at rate of 50mg/ min OR fosphenytoin at dose of 15-20 mg at rate of 50 mg/ min OR phenobarbital bolus 10- 15 mg at rate of 100 mg/ min
Refractory status –> General anaesthesia:
Propofol
Midazolam
Thiopental sodium
1st line drug in status epilepticus (prehospital)
Name, dose, route
Diazepam PR 10-20 mg
Repeat after 15 mins
(or midazolam 10 mg buccal)
1st line drug early status epilepticus (after diazepam rectal or buccal midazolam).
Name, route, dose
Lorazepam IV 4mg (0.1mg/ kg)
Repeat at 10-20 mins if no improvement
Management of acute severe asthma children 2- 5 yrs
B2 agonist salbutamol plus ipratroprium nebulised
Salbutamol 2.5 mg and ipratroprium 0.25 mg
repeat bronchodilator 20-30 mins
oral prednisilone 20 mg or IV hydrocortison 4mg/ kg if vomiting
Management of acute asthma attack in child > 5 yrs
B2 bronchodilator plus ipratroprium:
Nebuliser salbutamol 5 mg and ipratroprium 0.25 mg every 20 minutes
OR if nebs and ipratrorium not available give B2 agonist via spacer (1 puff given at a time, inhaled by tidal breathing, give next puff after 60 seconds up to max 10 puffs)
Oral prednisilone 30-40 mg
or IV hydrocortisone 100 mg if vomiting
