EMERGENCY PARENTERAL DRUGS LIST 2009 (ADULTS DOSE ONLY)

Drug Name Preparation Available Clinical Indication Clinical Preparation Dose and Mode of Delivery IV Adenosine 6 mg in 1st syringe, 10 mls NS in 2nd syringe; given fast bolus 1st followed by 2nd syringe. IV Adrenaline 1 mg given bolus followed by 10 mls NS and elevation. IM Adrenaline 0.5 mg given deep IM in thigh, repeated 5 mins till response Start at Adrenaline infusion at 2 ml/ hour, titrate up to max 10 ml / hour. IV Amiodarone 300 mg bolus IV Amiodarone 300 mg slowly over 10 - 20 min IV Amiodarone 300 mg over 20 - 60 min; continued 900 mg over 24 H IV Atropine 1 mg bolus repeated rapidly up to 3 mg maximum IV atropine 0.5 mg bolus repeated up to 3 mg maximum; consider pacing IV Atropine 1 - 2 mg every 2 - 5 mins until respiratory secretions dry, and HR > 100; start infusion titrate to effect Severe Hyper-K+ with ECG changes: give 10 mls 10% CaCl2 over 2 - 5 min; If in cardiac arrest, give as rapid bolus

ADENOSINE

6 mg ampule

SupraVentricular Tachycardias (SVT)

Proximal IV access; running NS drip; CM, resus-ready; Proximal IV access; running NS drip. Proximal IV access; running NS drip; CM, resus-ready; Proximal IV access; running NS drip with 3-way attached to infusion line; CM CPR after 3 shocks and at least once IV Adrenaline; on-going CPR Proximal IV access; running NS drip; CM, resus-ready; Proximal IV access; running NS drip; CM, resus-ready; CPR after Adrenaline initial dose Proximal IV access; running NS drip; CM, resus-ready; Proximal IV access; running NS drip; CM, resus-ready; large amounts of Atropine needed. Proximal IV access; running NS drip; CM, resus-ready; use with other Rx to reduce K levels

ADRENALINE ADRENALINE ADRENALINE AMIODARONE AMIODARONE AMIODARONE ATROPINE ATROPINE

1 mg ampule 1 mg ampule 3 mg in 50 mls D5W infusion 150 mg ampule 150 mg ampule 150 mg ampule 1 mg ampule 1 mg ampule

CPR - all pulseless conditions Anaphylactic Shock Shock states for inotropic support Refractory Vent Fibrillation Unstable VT following failure of synchronized cardioversion Rate control Rapid Atrial Fibrillation CPR - asystole, PEA Symptomatic bradycardia < 50 bpm

ATROPINE

1 mg ampule

Organophosphate poisoning

CALCIUM CHLORIDE

10% vial

Cardio-protective in severe Hyper-K+

Emergency Department Hosp Pulau Pinang

Page

EMERGENCY PARENTERAL DRUGS LIST 2009 (ADULTS DOSE ONLY)

Drug Name Preparation Available Clinical Indication Clinical Preparation Dose and Mode of Delivery

DEXTROSE 50%

10 ml vial

Hypoglycaemia

IV access with 3-way on Dext Saline running drip; VSM; repeat Gluc 15 min Proximal IV access; running NS drip with 3-way attached to infusion line; CM Proximal IV access; running NS drip with 3-way attached to infusion line; CM

50 mls Dext 50% IV bolus given on 3way with running IV drip; Dobutamine 250 mg / 50 mls D5S start at 10 ml/hour titrate according to response [Dose range 2 - 20 ml/hour] Dopamine 200 mg / 50 mls D5S start at 10 mls / hour titrate according to response [Dose range 2 - 20 ml/hour] IV Furosemide 60 - 80 mg slow IV over 2 mins; if no response, initiate infusion Furosemide 1 mg / min. [Furosemide 40 mg in 40 mls D5W; given at 60 ml/hour infusion] IV Isoket infusion (undiluted) at 2 ml/hr IV Labetalol 5 - 10 mg bolus over 5 mins; followed by infusion [undiluted] 10 ml/hr titrate to response [Dose range 2 - 20 ml/hour] IV Lignocaine 1 - 1.5 mg/kg slow IV bolus IV MgSO4 10 ml undiluted bolus over 5 minutes; followed by maintenance infusion at 2 ml/hr

DOBUTAMINE

250 mg vial

Shock states for inotropic support

DOPAMINE

200 mg vial

Shock states for inotropic support

FUROSEMIDE

20 mg ampule

Acute Heart Failure

Proximal IV access;CM; IV Dext 5% KVO (keep vein open)

ISOKET

0.1% ampule

Acute Heart Failure, Hypertensive Emergencies Hypertensive Emergencies / Dissecting Aneurysms for BP / Rate control

Proximal IV access;CM; IV Dext 5% KVO (keep vein open) Proximal IV access;CM; IV Dext 5% KVO (keep vein open)

LABETALOL

25 mg / 5 ml

LIGNOCAINE

Lignocaine for IV use only 100 mg/5 ml plastic amp 5 ml amp with 10 mmol Mg

Ventricular arrhythmias

Proximal IV access;CM; IV Dext 5% KVO (keep vein open)

MAGNESIUM SULPHATE

Eclampsia seizures and Torsade de Pointes

Proximal IV access; running NS drip; CM, resus-ready;

Emergency Department Hosp Pulau Pinang

Page

EMERGENCY PARENTERAL DRUGS LIST 2009 (ADULTS DOSE ONLY)

Drug Name Preparation Available 10 mg in 10 ml amp Clinical Indication Clinical Preparation Dose and Mode of Delivery IV GTN 20 mg in 20 mls undiluted. Start at 1 ml/hr; titrate upwards [Dose range 2 - 10 ml/hr]. IV Noradrenaline 4 mg diluted in 50 ml D5S; dose at 0.02 mcg/kg/min [start at 2 ml/hour, titrate upwards till response] IV 15 mg/kg loading dose. Start 1000 mg (4 vials) diluted in 500 mls NS; given over 20 - 30 mins. Dose 2 mg / kg IV bolus slow; watch for unresponsiveness and apnoea. Always given via running drip; 10 mls slow bolus over 5 minutes Dose 1 - 1.5 mg/kg IV bolus; watch for ne movements from head to toes Diluted to 20 ml NS; given 2 - 4 mls every 30 seconds; until induction achieved; max dose 4 mg / kg. Dose 0.5 mg/kg. Use 25 bolus; repeat as needed [usually after 30 mins] Dose 1 mcg/kg/min. Use 10 mg dilute to 50 mls NS. Start at 20 ml/hr. Titrate upwards.

NITRO-GLYCERIN

BP control in Hypertensive Emergencies; Ac Heart Failure

Proximal IV access; CM; IV Dext 5% KVO (keep vein open); resus-ready Proximal IV access; running NS drip with 3-way attached to infusion line; CM Proximal IV access; running NS drip with 3-way attached to infusion line; CM; IV benzodiazepines given Proximal IV access; running NS drip; CM, resus-ready; Proximal IV access; running NS drip with 3-way attached to infusion line; CM Proximal IV access; running NS drip; CM, resus-ready; induction agent given and cricoid pressure applied Proximal IV access; running NS drip; CM, resus-ready; Intubated, maintenance of sedation established, aim to reduce work of breathing High conc Oxygen, Nebulizer therapy continuing; monitor SpO2 and K levels

NORADRENALINE

4 mg / 4 ml amp

Shock states for inotropic support

PHENYTOIN SODIUM PROPOFOL SODIUM BICARBONATE SUCCINYL CHOLINE THIOPENTAL SODIUM

250 mg in 5 ml vial 10 mg/ml 1% ampule 8.4% 10 ml amp

Status Epilepticus Induction agent for severe acute asthma, status epilepticus Severe Hyper-K+ (if acidotic)

100 mg amp

Rapid Sequence Induction

500 mg vial

Rapid Sequence Induction especially for Status Epilepticus

TRACIUM

25 mg in 2.5 ml

Paralysis post intubation

VENTOLIN

5 mg in 5 ml IV solution

Severe Acute Asthma

Emergency Department Hosp Pulau Pinang

Page

EMERGENCY PARENTERAL DRUGS LIST 2009 (ADULTS DOSE ONLY)

Table of Abbreviations and Denitions

1. CM - Cardiac Monitoring - continuous cardiac ECG monitoring, automated BP monitoring at 2 minute interval, continuous SpO2 monitoring, debrillator available VSM - Vital Signs Monitoring - continuous vital signs monitoring, automated BP monitoring at 5 - 10 minute interval, continuous SpO2 monitoring, charting 30 - 60 mins Resus-ready - Resuscitation Trolley bed-side, airway management ready, team available bedside KVO - Keep vein open - IV infusion of Dext 5% at rate of less than 10 drops / min; minimum amount just to keep vein open Note: these are adult doses for the average sized adult. The doses are presented in a way that allows for rapid initiation and titration based on initial response. All infusion drugs must be given via a 3 way stop-cock with a carrier infusion running; which will ensure that the drug will reach the systemic circulation in good time. Infusions should always be placed in IV access that are located proximally and centrally; if this is not possible, it is even more important to ensure that the carrier infusion is running.

2.

3. 4. 5.

6.

7.

Emergency Department Hosp Pulau Pinang

Page