Medical Emergencies Pharmacology Review Session

Question 1

Epinephrine

Answer 1

Sympathominemetic

Alpha 1, Beta 1, Beta 2

Asthma, reversible bronchospasm, anaphylaxis and wheezing

0. 3 - 0.5 mg IM 1:1,000
1. 1 - 0.5 mg 1:10,000 IV

Insusion 1mg of 1:1000 epi in 250 ml NS - COH 4 mcg/ml

Dirty Epi
1 mg of 1:10,000 epi in 1000 ml NS - COH 1 mcg/ml - 1-2 mcg/min

Push dose 1ml of 1:10,000 in a 10 ml syringe, now you have 0.01 mg/ml = 10 mcg/ml

Question 2

Albuterol

Answer 2

Sympathomimetic

Selective beta 2 agonist

asthma, copd in bronchospasm in anaphylaxis. Can be used in hyperkalemia

2.4 mg in 2.5 ns over 15-20 mins

Question 3

Ipratroprium Bromide

Answer 3

Atrovent

Anticholinergic

Dose 0.5 mg in 2.5 ml NS mixed with Albuterol - over 15-20 mins

Question 4

Solumedrol

Answer 4

Steroid

Anti-inflammatory, suppress the immune response in allergies

Severe anaphylaxis, asthma, cops, suspected or known adrenal insufficiency

1-2 mg/kg IV max 125 mg

Question 5

Diazepam - Valium

Answer 5

Anticonvulsant and sedative

Increases GABA in the brain, decreases motor activity in the brain. Also causes amnesia

Seziures
before cardioversion
RSI
skeletal muscle relaxant

No analgesic relief

SEIZURES 5-10 mg IV in 10-15

ANXIETY: 2-5 mg

CARDIOVERSION: 5-15 mg

Question 6

Lorazepam - Ativan

Answer 6

The prefered medication for seizures

Binds to GABA receptors and increases GABA

Causes amnesia

Major motor seizures
Status epilepticus
premedication before cardioversion
acute anxiety states

DOSE 2-4 mg SLOW IV
Muse be diluted with equal amount of saline before IV/IO

Question 7

Midazolam - Versed

Answer 7

Short acting

CNS depressant and sighnificant amnesia

No analgesic properties

DOSE: 2-6 mg SLOW IV or IM

Question 8

Flumazenil - Romazicon

Answer 8

Benzodiazepine receptor antagonist used in benzo overdose

Question 9

Dextrose

Answer 9

50%, 25%, 10%

Indicated for hypoglycemia

NEVER MORE THAN 10% IN NEONATES, THEY WILL DIE

Question 10

Narcan

Answer 10

Dose 0.4-2mg IV/IO/IM/IN

Question 11

thiamine

Answer 11

treats thiamine deficiency before dextrose administration

yo start at 50, this shit causes cardiac arrest…

50-100 mg iv

Question 12

Ondasteron - Zofran

Answer 12

Nausea

Can cause long QT syndrome, never give to someone with long QT

Question 13

Diphenhydramine - Benadryl

Answer 13

Blocks histime 1 receptor in allergic reactions

Do not give in pregnancy or milking mother

Dose 25-50 mg iv/io/im

Question 14

DuoDote - Atropine and pralidozime auto injector

Answer 14

1-2 g mix in 100 ml NS given over 15-30 mins

Question 15

Atropine orgaophosphate poisioning

Answer 15

2-6 mg im/iv/io every 5 minutes

Question 16

Haldol

Answer 16

antipsychotic

3-5 mg IM

Onset 20-30 min peaks at 50-60

Question 17

Ketamine - Ketalar

Answer 17

NMDA receptor antagonist

Blacks glutamine (CNS neurotransmitter in the brain)

Sedation and Pain management

RSI

Behavioral
-4 mg/Kg IM only. 400 mg singe dose max. onset 3-4 minutes

Analgesia

• 0.3-0.5 mg/Kg IV repeat in 10 mins
• 1 mg/kg IM or IN, repeat in 20 minutes

Electrical therapy

• 0.1-0.5 mg/kg IV
• 1 mg/Kg IM, repeat in 5 minutes

Question 18

Glucagon

Answer 18

Turn glycogen stores in the liver into glucose

hypoglycemia 0.5 - 1mg I’m, iv, io, in

BB or CCB overdose 1-5 mg im/iv/im

Question 19

Calcium Chloride

Answer 19

Elevates serum calcium levels

Positive inotropy

Positive promotropy

Stabilizes cellular membranes in hyperkalemia

Calcium is the Mag antagonist

MAH toxicity
BURP
BP decrease
Urine output decrease
RR decrease
Petellar reflex absent 

Avoid if pt is on dig

DO NOT MIX WITH SODIUM BICARBONATE

Dosing

Hyperkalemia, hypermag, hypocalcemia 0.5-1g IV/IO over 2-5 minutes, repeat as necessary

Question 20

Sodium Bicarb

Answer 20

Elevates blood pH

Acidosis

Indication for Toxicology
-methanol, ethylenol glycol, cardiac toxicology in tricylic antidepressant, sasicylate OD, Sodium channel blocker OD

Question 21

Hydroxocabalmin Cyanokit

Answer 21

cyanide toxicity

5g over 15mins

COH = 25 mg/ml

second dose in severe cases