Emergency Drugs Year 3 Flashcards
STEMI (with post-MI bradycardia)
Morphine IV 5-10mg at 1-2mg/min (slow infusion).
- Repeat if required. Half dose in elderly/frail patients.
Aspirin 300mg orally
- then 75mg for life
Clopidogrel 300mg orally
- then 75mg for up to 12 months (or for 4 weeks after TIAs or minor ischaemic strokes)
(Atropine IV 500 micrograms every 3-5 mins up to max of 3mg AKA 6 times)
Other relevant info that is not on emergency drugs list:
GTN spray sublingually
Metoclopromide IV
Oxygen if appropriate
Insulin if hyperglycaemia (over 11mmol/L)
Primary Percutaneous Coronary Intervention (PCI) if within 12 hours of Sx onset, or within 2 hours of time when fibrinolysis could have been given, is preferred strategy for most patients.
or Coronary Artery Bypass Graft (CABG) are often appropriate alongside drug treatment for ACS
NSTEMI and unstable angina are treated with:
Aspirin 300mg orally
Glyceryl trinitrate (GTN) spray sublingually
Clopidogrel (NSTEMI)
Anaphylaxis
Adrenaline 500 micrograms IM, repeat after 5 mins (normal concentration is 1mg/ml, 1 in 1000)
Hydrocortisone 100-300mg IV
Clorphenamine 10mg IM or IV, up to 4 x a day
Adrenal crisis
Hydrocortisone 100mg IV
Acute severe hyperkalaemia (6.5mmol/L or more, or in presence of ECG changes)
10% Calcium gluconate 30ml IV (slow infusion of single dose), repeat if no ECG improvement within 10 mins
Salbutamol 10-20mg nebulised
Soluble Insulin 5-10 units IV in
50ml of 50% glucose IV given over 15 mins
Opioid overdose
Low dose OD (e.g palliative care or post op: when there is a risk of withdrawal and a therapeutic effect is still required - accidentally gave too much of a morphine dose they were going to have anyway):
IV Naloxone 100-200 micrograms initially, then 100 micrograms for up to 2 doses 1 min apart, then can titrate up to 2mg. If still no response give a further 2mg dose (so that’s a total of 4mg for seriously poisoned patients).
High dose:
Naloxone 400 micrograms IV initially, then 800 micrograms for up to 2 doses 1 min apart, then increase to 2mg for one dose if still no response. (4mg dose may be required in seriously poisoned patients)
Hypoglycaemia
STOP IV INSULIN if applicable. RESTART when >4.0mmol/L
A) If conscious and able to swallow:
15-20g of fast acting carbs orally (glucogel if uncooperative)
Recheck CBG every 10-15 mins & repeat tx if <4mmol/L (max 3 times, if unresolved try B or C)
Slower release carbs orally once above 4mmol/L
Recheck CBG 30-60 mins later, then regularly for next 48 hours.
B) If unable to swallow/unconscious + without IV access:
Glucagon 1mg IM
Recheck CBG at 20 mins (Do not repeat this tx. If unresolved try C)
C) If unable to swallow/unconscious + WITH IV access:
100ml of 20% glucose IV over 10-15 mins
Recheck CBG after 10 mins. If still <4, repeat tx or start IV 20% glucose at 50ml/hour
Acute asthma attack
Nebulised salbutamol 5mg through an oxygen driven nebuliser, repeat every 20-30 mins if necessary.
Hydrocortisone 100mg IV every 6 hours until they can take 40-50mg Prednisolone orally daily for at least 5 days.
Other info that isn’t necessarily on emergency drug list:
Oh - Oxygen
Shit - Salbutamol 5mg nebulised
I - Ipratropium bromide inhaled
Hate - Hydrocortisone 100mg IV or Prednisolone 40-50mg orally for 5 days
My - Magnesium sulphate IV
Asthma - Aminophylline IV or theophylline orally
Acute alcohol withdrawal
Diazepam 10mg IM or IV (IV into a large vein at no more than 5mg/min)
Repeat after at least 4 hours if required
If delirium tremens present (CHAP: Confusion, Hallucinations (visual/auditory), Agitation, Paranoia), oral lorazepam is first line
Status epilepticus
Lorazepam 4mg IV, repeat once after 5-10mins if required (slow infusion into large vein)
Diazepam 10mg IV then repeat once after 10mins if required (slow infusion at 1ml/min)
or Diazepam 10-20mg rectally then repeat after 5-10 mins if required
