Emergency Drugs
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Drug dose Indication Contraindication
Acetylcysteine
=Parvolex®
150/kg(max.16500) in 200mL/15'; then 50/kg(max.5500) in 500mL/4h; then 100/kg(max.11000) in 1L/16h +: Paracetamol OD (-): asthma
Adenosine
=Adenocor®
[3/2s, then] 6/2s after 1-2', then 12/2s after 1-2' +: SVT [incl WPW]; diff betw broad/narrow complex SVT -:2-3°HB; SSS [unless PPM]; asthma; (-): AF with accessory pathway; heart transplant (v. sensitive!)
Adrenaline
(Epinephrine)
0.5IM=0.5mLIM of 1:1,000 solution;
or (if doubtful circulation, with extreme caution): 1:10,000 SLOW IV
+: anaphylactic shock -:
Aminophylline 10ml Amp (25mg/ml)=250 eg in 250ml N/Sal=1mg/mL: [if not prevly tx with Aminophylline: loading: 0.25-0.5(5/kg~350/70kg) over 20+min ~ 350ml/70kg (of 500 in 500ml N/Sal=1/ml); then] 0.5/kg/h(~35/70kg/h) as per plasma concentration +: acute severe asthma -: hypokalaemia(!)
Amiodarone 300/20min in 250ml 5%Dex then 900/24h into 500mg 5%Dex + -
Atropine 3iv +: vagal suppression -:
Calcium gluconate 10-30mL10%IV +:severe hyperkalaemia -:
Chlorphenamine
=Piriton®
10qds{SC|IM|IV:1'}; 4POqds[-q4h] +:anaphylactic shock (-):prostatic hypertrophy, glaucoma, hepatic disease, CKD, epilepsy [; safe in porphyria]
Digoxin 500PObd[-tds]×24h; or 0.75-1IVI/2h, then PO +: supraventr arrhythmia (esp. AF); heart failure -: intermittent CHB, 2°AV Block, SVT with accessory pathway (WPW,..), VT/VF; (-): hypertrophic CMP
Diltiazem 0.25/kg~18.5/70kg ≤max 25 IV over 2min +: acute AF with SBP>95: unlicensed (trial) -
Dobutamine 0.0025-0.01/kg/min ~ 10-42/h/70kg=2-8mL/h/70kg with 250/20mL into 50mL N/Sal=5/mL + -
Doxapram 1.5-4/min=90-240/h [100/5mL amp; or 1000 in 500mL 5%Dex=45-120mL/hr] +: acute respir fail -
Flumazenil
=Anexate®
0.2/15s, then 0.1q60s, usu 0.3-0.6; max.1[-2 in ICU] +:BDA reversal -:Status epil
Glucagon
GlucaGen® HypoKit
1{SC|IM|IV} [if no response within 10': IV Dextrose] +: insulin-induced hypoglycaemia; beta-blocker poisoning -: phaeochromocytoma
GTN 1/mLIVI (Nitrocene(R), Nitronal(R)) @ 0.6-12/hr +: angina, LVF -:
Haloperidol
=Haldol®
1.5-3[-5] po bd-tds, or: [eld:1-]2-10[-18] im/iv tds-qds +: acute psychomotor agitiation --: coma, CNS depression, phaeo; (-): hep, ren, cv, PD, epil, depr, MG
Hydrocortisone
=Solu-Cortef®..
100qds[-tds]IVI +: acute adrenocortical insuff; thyrotoxic crisis; etc etc -: systemic infections (unless antimicrobial therapy given)
Insulin (soluble) 5-10u with 50mL50%Glucose IVI/5-15' +: severe hyperkalaemia -:
Lidocaine 50-100IV/2', then 4/'×30', then 2/'×2h, then 1/' +: ventricular arrhythmias (esp. post MI) -: SA/AV block (any °); porphyria; (-): CCF, post cardiac surgery, elderly, hepatic impairm, CKD, pregn
Lorazepam
=Ativan®
status epil: 4lrgIv×1[-2 after 10']; panic: 0.025-0.03iv/kg[usu.1.5-2.5iv]q6h +: status epil; -: resp depr/fail/weakness(MG,...); severe hepatic impairment;
Magnesium sulfate 1200-2000iv/20' +: acute severe asthma
(unlicensed)
-:
Metaraminol
[special order]
0.5-5iv, then 15-100ivi, adjusted a/t response +: acute hypotension -: hypertension, pregnancy
Metoprolol -5mg over 2.5-5min +- repeat after 5min, total dose 10-15mg +: AF with SBP>95 -
Midazolam
=Hypnovel®
conscious sedation: [eld:0.5-1-]2-2.5SlowIv(2/min), icrd in steps of [eld:0.5-]1; usu. total dose 3.5-5, max. [eld. 3.5-]7 +: status epil (unlicensed) -: resp depr/fail/weakness;
Naloxone 0.4-2q2-3' (max.10) [Minijet=400/mL&times1[-2]mL] +: opioid OD (-):opioid dependence, cardiac irritability
Noradrenaline acid tartrate 4(=2 of NA base) in 50mL=0.08/mL starting 0.16-0.33mL/min=10-20mL/h centralIVI +: -:
Phenytoin
=Epanutin®
loading 18mg/kg~1260g/70kg at max 50mg/min ~ 1200mg over 24min: 1200mg into 500mL N/Sal over 24min IVI (via filter); then ~100tds/qds as per plasma conc +: status epilepticus -: sinusbrady, SABlock, 2/3deg heart block, Stokes-Adams syndr, porphyria; (-): hypotension, HF; SE: CNS depr, respir arrest; ECG monitoring
Propranolol
=Inderal®
1IV/1', repeat at 2' intervals, max 10[-5 in anaesthesia] +: arrhythmias, thyrotoxic crisis -: ashtma, uncontrolled HF, marked brady, hypotension, SSS, 2-3°AV block, shock, metabolic acidosis, severe PVD, phaeochromocytoma (unless with alpha-blockers: Phenoxybenzamine/Phentolamine)
Salbutamol [3-]5[-20]mcg/min IVI=[180-]300[-1200]mcg/h=[18-]30[-120]mL/h of 5mg in 500mL N/Sal or 5%Dex=10mcg/mL +: asthma/reversible airways obstruction -: hypokalaemia(!); DKA
Terlipressin
=Glypressin®
2IVqds[-q4h] +:bleeding from oesophageal varices -:(extreme caution:)CAD, vascular disease; chronic nephritis
Thiamine
=Pabrinex®
High-Potency injection [1-]2-3pairs IVI/30' tds[1 pair IM bd] +:coma/delirium from alcohol, from opioids, barbiturates, collapse/psychosis following narcosis; i.e. risk of Wernicke's encephalopathy SE: anaphylaxis
Verapamil
=Cordilox®
=Secoron®
5-10mg IV over [eld:3-]2min, further 5mg after 5-10min if required +: SVT -: hypotension, bradycardia, 2-3°AV block, SSS, shock, SA block; Hx of HF (even if treated!); AF/AFlutter with accessory pathway; porphyria; (-): beta-blocker treatment(!)