Emergency Medications Flashcards
Correct as per BNF May 2023.
What is the action of adrenaline?
Agonises alpha and beta blockers to:
- increase heart rate and contractility (beta1 effects)
- peripheral vasodilation (beta2 effect)
- vasoconstriction (alpha1 effect)
What are the indications of adrenaline as an emergency medication?
- cardiopulmonary resuscitation
- acute anaphylaxis
What is the dose and route of adrenaline in CPR, for an adult patient?
Dose: 1mg of 1:10,000 adrenaline every 3-5 minutes
Route: Slow IV infusion
What is the dose and route of adrenaline in CPR, for an paediatric patient?
Dose: 10mcg/kg (max 1mg) of 1:10,000 adrenaline every 3-5 minutes
Route: Slow IV infusion
What is the dose and route of adrenaline in acute anaphylaxis, for a patient aged <5years?
Dose: 150mcg of 1:1000 adrenaline, repeating dose after 5 minutes if no response. If life-threatening features persist, further doses can be given every 5 minutes until specialist care available.
Route: IM injection to anterolateral aspect of middle third of the thigh.
What is the dose and route of adrenaline in acute anaphylaxis, for a patient aged 6-11years?
Dose: 300mcg of 1:1000 adrenaline, repeating dose after 5 minutes if no response. If life-threatening features persist, further doses can be given every 5 minutes until specialist care available.
Route: IM injection to anterolateral aspect of middle third of the thigh.
What is the dose and route of adrenaline in acute anaphylaxis, for an adult patient (aged >12years)?
Dose: 500mcg of 1:1000 adrenaline, repeating dose after 5 minutes if no response. If life-threatening features persist, further doses can be given every 5 minutes until specialist care available.
Route: IM injection to anterolateral aspect of middle third of the thigh.
What is the mechanism of action of hydrocortisone?
Has an equal glucocorticoid and mineralocorticoid activity.
What are the indications for hydrocortisone as an emergency medication?
- thyrotoxic crisis
- anaphylaxis (adjunct to adrenaline)
- adrenal crisis
- severe acute asthma
- life-threatening acute asthma
What is the dose and route of hydrocortisone in thyrotoxic crisis?
Dose: 100mg every 6 hours, to be administered as sodium succinate.
Route: IV injection
What is the dose and route of hydrocortisone in anaphylaxis?
Dose: 100-300mg, to be administered as sodium succinate.
Route: IV injection
What is the dose and route of hydrocortisone in adrenal crisis?
Dose: 100mg, then 200mg every 24 hours diluted in 5% glucose (by continuous intravenous infusion)
Route: IV/IM loading dose
What is the dose and route of hydrocortisone in severe acute asthma?
Dose: 100mg every 6 hours until conversation to oral prednisolone is possible, given as sodium succinate.
Route: IV injection
What are the indications of chlorphenamine as an emergency medication?
- anaphylactic reactions
What is the dose and route of chlorphenamine in anaphylactic reaction, for adults (age >12years)?
Dose: 10mg, repeated if necessary; max 4 doses per day
Route: IM or IV
What is the indication of atropine as an emergency medication?
Bradycardia following myocardial infarction
What is the dose and route of atropine in bradycardia following MI?
Dose: 500mcg every 3-5 minutes, to a max of 3mg per course.
Route: IV injection
What is the indication of aspirin as an emergency medication?
- unstable angina
- NSTEMI
- STEMI
What is the dose and route of aspirin as an emergency medication?
Dose: 300mg
Route: Chewed or dispersed in water (PO)
What is the indication of clopidogrel as an emergency medication?
Prevention of atherothrombotic events in PCI (adjunct with aspirin) in patients not already on clopidogrel.
What is the dose and route of clopidogrel in PCI?
Dose: 300mg (loading dose)
Route: PO
What is the indication of calcium gluconate as an emergency medication?
- severe acute hypocalcaemia
- severe acute hyperkalaemia
What is the dose and route of calcium gluconate in severe acute hypocalcaemia?
Dose: 10-20ml of calcium gluconate (10%), with plasma-calcium and ECG monitoring.
Route: Slow IV injection
What is the dose and route of calcium gluconate in severe acute hyperkalaemia?
Dose: 30ml of calcium gluconate (10%) administered as a single dose; repeat if no improvement in ECG within 5-10 minutes.
Route: Slow IV injection
What is the indication of insulin/dextrose infusion as an emergency medication?
Acute severe hyperkalaemia
What is the dose and route of insulin/dextrose infusion in severe hyperkalaemia?
Dose: 10 units of fast acting insulin (e.g. Novorapid) with 50ml glucose (50%)
Route: IV
Give the indication of fast acting carbohydrates as an emergency medication.
Blood glucose concentration <4mmol/L, who is conscious and able to swallow, with or without symptoms.
Give the indication of glucagon as an emergency medication.
Blood glucose concentration <4mmol/L, where the patient has reduced level of consciousness and no IV access.
Give the indication of glucose as an emergency medication.
Blood glucose concentration <4mmol/L, where the patient has reduced level of consciousness and has IV access.
or
No response within 10 minutes of IM glucagon.
What is the dose and route of glucagon in hypoglycaemia?
Dose: 1mg (if no response within 10 minutes IV glucose must be given)
Route: IM injection
What is the dose and route of glucose in hypoglycaemia?
Dose: 200ml glucose (10%) over 15 minutes
Route: IV
What are the indications of diazepam as an emergency medication?
- acute alcohol withdrawal
- status epilepticus
- febrile convulsions
What is the dose and route of diazepam in acute alcohol withdrawal?
Dose: 10mg
Route: IM or slow IV injection
What is the dose and route of diazepam in status epilepticus for adults?
Dose: 10mg, then 10mg after 10 minutes if required
Route: IV / PR
What is the indication of lorazepam as an emergency medication?
- status epilepticus
- febrile convulsions
What is the dose and route of lorazepam in status epilepticus for adults?
Dose: 4mg, then 4mg after 10 minutes if required
Route: IV
What is the indication of nebulised salbutamol as an emergency medication?
- moderate acute asthma
- severe acute asthma
- life-threatening acute asthma
- acute severe hyperkalaemia
What is the dose and route of nebulised salbutamol in acute asthma?
Dose: 5mg, repeat every 20-30 minutes or when required.
Route: Oxygen-driven nebuliser
What is the indication of prednisolone as an emergency medication?
- acute asthma
- giant cell arteritis
What is the dose and route of prednisolone in giant cell arteritis?
Dose: 40-60mg daily until remission of disease activity (higher dose used if visual symptoms occur).
Route: PO
What is the dose and route of prednisolone in acute asthma for adults?
Dose: 50mg daily for at least 5 days
Route: PO
What is the indication of morphine as an emergency medication?
- myocardial infarction
What is the dose and route of morphine in myocardial infarction?
Dose: 5-10mg, followed by 5-10mg if required (half if elderly)
Route: Slow IV injection
What is the indication of naloxone as an emergency medication?
Acute opioid overdose
What is the dose and route of naloxone in acute opioid overdose?
Dose: 400mcg > 800mcg > 800mcg >2mg at 1 minute intervals
Route: IV injection
