Emergency medicines

EMERGENCY MEDICINES

Dr.Sadia ShabbirHouse surgeon surgical 1

ADRENALINE

• The substance is adrenaline tartarate which is manufactured under the trademark of adrenaline.

DOSE: • 0.2-0.5ml S/C or I/M• 0.25ml dil in saline slow I/V• 0.5ml intracardiac

INDICATIONS:• Allergic reactions • Acute attack of bronchial asthma• Cardiac arrest• Homeostasis• Along with local anesthetic• To have bloodless field

ADVERSE REACTIONS• Palpitations , tremors, pallor,headache• If injected rapidly or I/V causes marked increase

in BP• Ventricular arrhythmias• Acute pulmonary edema• Anginal pain

NOR ADRENALINE

It is available as 0.2% sol in 2ml ampules.

DOSE: • 2ml of noradrenalin+1000ml of 5% dextrose and

administer at the rate of 0.5ml/minute• 2ml of noradrenalin+N/S+vit C

INDICATIONS:

• Treatment of hypotension of circulatory failure

SIDE EFFECTS:• Palpitations,tremors,pallor,headache• Ventricular arrythmias• Acute pulmonary edema• Anginal pain• Extravasation in S/C tissues causes necrosis of skin

DOPAMINE

DOSE:• It is available in 5ml ampoules each containing

40mg/ml solution

INDICATIONS:• Hypotension to increase peripheral circulation • Open heart surgery• Renal failures• Cardiac failure

ADVERSE EFFECTS

• It should be administered via central vein, extravasation may cause local ischemia

• We should stop or decrease the dosage if the urine output is diminishing, tachycardia,or arrythmias.

PROPRANOLOL

• It is available in 1mg/ml ampoule

INDICATIONS:• Thyrotoxic crises• Pheochromocytoma• Cardiac arrythmias• Acute MI

ADVERSE EFFECTS• Congestive heart failure,bradycardia,aggravation

of A-V conduction defect• Bronchospasm• Hypoglycemia• Nausea and vomiting• Uterine hypomotility and prolonged labour• Thrombocytopenia and leucopenia

ATROPINE SULPHATE

• It is available in two strengths• 0.65mg/ml ampoule • 6mg/ml ampoule

INDICATIONS:• Pre anesthetic medication 30min before surgery to

prevent vasovagal shock and also 2 dryout the secretions• Before pleural and ascitic tap• In the treatment of colics and

dysmenorrhea,bradyarrythmias and parkinsonism• Organophosphorus poisoning

ADVERSE EFFECTS• Dry mouth• Dysphagia• Retention of urine• Blurring of vision,precipitate to glaucoma• Skin rash and local dermatitis

NEOSTIGMINE

• It is available in 0.5mg/ml solution in ampoule DOSE:• 0.5-2mg I/M or I/V

INDICATIONS:• Myasthenia gravis• Acute congestive glaucoma• Treatment of NM paralysis due to snake bite

ADVERSE EFFECTS

• Salivation,sweating and lacrimation• Nausea vomiting,diarrhea,abd pain• Tremors and fasciculation• HTN

HYDROCORTISONE• It is available in a bulb containing 100mg

hydrocortisone

INDICATIONS:• Life threatening emergencies e.g anapylactic

shock,status asthamaticus,hypoglycemia,thyrotoxic crises,addison’s crises,hypercalcemia

• Intra-articularly in osteoarthritis• Topically in keloids • As retention enema

ADVERSE EFFECTS:• Gastritis,peptic ulcer,perforation and

pancreatitis• HTN• Osteoporosis• Supresses immunity• Delays wound healing

AMINOPHYLLINE

• It is available in 10ml ampoule

DOSE:• 10ml dil in 20ml of 10% dextrose is given I/V or

slowly

INDICATION:• Bronchial asthma• Cardiac asthma• Cheyne stroke respiration

ADVERSE EFFECTS:• Nausea,vomiting• Fits preceded by twitching of mouth or severe

hyperventilation• Collapse and death

MORPHINE

• It is available in 1ml ampoule(15mg/ml)

DOSE: • 5-20mg S/C or I/M

INDICATIONS:• As analgesic• As preanesthetic medication• Acute LVF

ADVERSE EFFECTS• Vomiting • Hypotension • Respiratory depression• Drug dependency• Urinary retention• Miosis• bradycardia

PETHIDINE

• Available in 2ml ampoule(50mg/ml)

INDICATIONS:• Given I/M or I/V• As analgesic• As preanesthetic medication

ADVERSE EFFECTS:• Same as that of morphine

DIAZEPAM

• Available in 2ml ampoule(5mg/ml)

DOSE: 10mg I/V or I/M

INDICATIONS:• Muscle relaxant in tetanus• Pre anesthetic medication• Treatment of convulsions• As tranquillizer

AVIL(CHLORPHENARAMINE MALEATE)• Available in 2ml ampoule(22.75mg/ml)

INDICATIONS:• Allergic reactions• Pruritis• Hypnotics

ADVERSE EFFECTS:• Sedation and fatigue• Dryness of mouth and blurring of vision• Nausea and vomiting• Blood dyscrasias

INSULIN• Available in 40 units/ml and 100 units/ml in 10ml bulb

DOSE: Given S/C

INDICATIONS:• Diabetic ketoacidotic coma• Glucose insuline drip in hyperkalemia• Diabetes

ADVERSE EFFECTS:• Hypoglycemias

SODIUM BICARBONATE• Available in 10ml ampoule

INDICATIONS:• Metabolic acidosis• Lactic acidosis• Respiratory acidosis • Hyperkalemia

ADVERSE EFFECTS:• Metabolic alkalosis• Edema due to Na+ retentions

LASIX(FRUSEMIDE)

DOSE: 20mg I/M or I/V

INDICATIONS:• Pulmonary edema• To induce forced diuresis in barbiturates poisoning• Treatment of mannitol resistant acute oliguria• Advanced RF• Prostatectomy

ADVERSE EFFECTS• Water and elecrolyte disturbance• Orthostatic hypotension• Retention of urine• Hepatic coma• Cardiac arrest • Hearing loss

MANNITOL:• It is a sugar available as 20% sol in 350ml glass bottel

DOSE: 0.5-1g/kg

INDICATIONS:• Induce diuresis in barbiturate poisoning• Acute oliguric RF• After severe traumatic injuries• To reduce intracranial pressure• After CVA,cerebral edema,hepatic encaphlopathy

ADVERSE EFFECTS

• Precipitate CHF• Fluid overload causes the ARF

CONTRAINDICATIONS:• Shock• Cardiac failure • Renal impairment

POTASSIUM CHLORIDE

• Available in 10ml ampoule(150mg/ml)

INDICATION:• Hypokalemia

ADVERSE EFFECTS: • Cardiac arrest if given rapidly

CALCIUM GLUCONATE

• Available in 10ml ampoule(1g)

DOSE:• 2g I/V slowly in tetany• 1g I/V slowly in epididymo-orchitis

INDICATIONS:• Tetany• After 1000ml of blood transfusion• As inotropic drug in cardiac arrest• Hyperkalemia• Hypoparathyroidisim• As a coagulant(factor 5)