emergency drugs - oscestop

Question 1

cardiac arrest

Answer 1

DC shock 150J biphasic
adrenaline 1mg IV
amiodarone 300mg IV (if shockable rhythm)

Question 2

anaphylaxis

Answer 2

adrenaline 0.5mg IM

chlorphenamine 10 mg IV or IM, repeated as necessary (maximum 4 doses per day)

Question 3

seizure

Answer 3

lorazepam 4mg IV
if no IV access, diazepam 10mg PR

Question 4

hypoglycaemia

Answer 4

10% glucose 200ml IV or 20% glucose 100ml IV (repeat as needed)
if no IV access, glucagon 1mg IM

Question 5

hyperkalaemia

Answer 5

calcium gluconate: 30ml 10% IV over 15 minutes
THEN actrapid insulin 10 units in 125ml 20% dextrose IV over 30 minutes
+ salbutamol 10mg neb

Question 6

bradycardia

Answer 6

atropine 500mcg IV (repeat every 3-5 minutes to maximum of 3mg if needed)

Question 7

SVT

Answer 7

adenosine 6mg IV, can be followed by 12mg then 18mg if unsuccessful
(must be given as a bolus and flushed quickly via a large vein)

Question 8

pulsed VT (without life threatening features)

Answer 8

amiodarone 300mg IV over 10-60 minutes followed by 900mg over 24 hours through a large vein (900mg should be via central venous line)

Question 9

rapid tranquillisation of agitated patient at risk of self harm to self or others

Answer 9

lorazepam 1-2mg PO/IM or olanzapine 5-10mg PO/IM

Question 10

diabetic ketoacidosis

Answer 10

if patient is on long-acting insulin, then keep administering as normal

• actrapid 50 units to 50ml 0.9% - infuse continuously at 0.1 units per kg per hour (continue until plasma ketones reduce to <0.3mmol/L and venous pH >7.3 and blood glucose)
• glucose 10% at 125mL/hour to run along side saline when BM hits <14mmol/L to avoid hypoglycaemia
• potassium chloride - give 40mmol if K+ within range of 3.5 to 5.5
• fluid deficits (100ml per kg), reassess after 12 hours

Question 11

hyperosmolar hyperglycaemic state

Answer 11

• immediate vigorous rehydration - 0.9% saline - 1L over 1 hour
• FRIII at 0.05 units/kg/hour
• potassium chloride as required (40mmol if K+ within range of 3.5-5.5 and specialist advice if lower than this range)

Question 12

acute asthma attack

Answer 12

• oxygen therapy
• nebulised salbutamol 5mg every 20-30 minutes or as needed
• prednisolone 40-45mg PO

Question 13

fluid resuscitation

Answer 13

500 ml bolus of a crystalloid solution (e.g NaCl 0.9%/ Hartmann’s solution) over less than 15 minutes

Question 14

post MI

Answer 14

aspirin 300mg PO chewed (loading dose)
clopidogrel 300mg PO
long term - 75mg aspirin for life and 75mg clopidogrel / second antiplatelet

Question 15

adrenal insufficiency

Answer 15

• IV hydrocortisone, initially 100 mg, then 200 mg every 24 hours, diluted in glucose 5%

(if patient has been on >7.5mg long term steroid treatment daily)

Question 16

chest pain

Answer 16

morphine 5-10mg IV
antiemetic (12.5mg IV prochlorperazine)

Question 17

opioid overdose

Answer 17

• naloxone , 0.8mg IV every 2-3 minutes if respiratory rate is <12/min, up to a total dose of 3.2mg (4 times) or until the respiratory rate is >15/min
• if there is a response to bolus naloxone, start IV infusion of 2mg naloxone to 500 ml glucose 5% or normal saline - titrate against respiratory level and conscious level

plasma half life of naloxone = 1 hour