Emergency Drugs.pptx

D
Dr. Rakeshkumar S. Gujar. MS(Ay.), (Ph.D)(Ay.). Assistant Professor à BLDEA'S AVS AYURVEDA MAHAVIDYALAYA, VIJAYAPURA
Emergency Drugs
Dr. Rakeshkumar S. Gujar. MS(Ay.), (PhD)(Ay.), MSc-CND.
Assistant Prof., Dept. of PG Studies in Shalyatantra,
BLDEA’S AVS Ayurveda Mahavidyalaya Hospital & Research Centre, Vijayapura.
Adenosine (3 mg/ml)
Acute treatment of
supraventricular
tachycardia
 1st 0.1 mg/kg/dose
 2nd 0.2 mg/kg/dose
 3rd 0.3 mg/kg/dose
Rapid IV push over 1-2
seconds
Flush line immediately
with 5-20 ml NS
Infuse as close to IV site
as possible
IO administration also
successful
Drug (concentration)
and Indication
Dose
Administration /
Remarks
Drug (concentration)
and Indication
Dose
Administration /
Remarks
Atropine (0.1 mg/ml)
Bradycardia
0.02 mg/kg/dose IV
May repeat x 1 dose in
3 minutes
Drug (concentration)
and Indication
Dose
Administration /
Remarks
Calcium gluconate (100
mg/ml)= 9.4 mg
elemental calcium /ml
Cardia arrest
Hypocalcemia
100 mg/kg/dose IV
Not for IM or SQ use
May repeat x 1 dose,
then dose per ionized
calcium results
Administer by slow IV
push for cardiac arrest,
infuse over 30-60
minutes for other
indications. Stop
infusion if HR is greater
than 100 bpm.
Do not give intra-
arterially.
Drug (concentration)
and Indication
Dose
Administration /
Remarks
Dextrose 10% (0.1 Gm/ml)
Hypoglycemia
Hyperkalemia in combination with
insulin
0.2 Gm/kg/dose IV as D10W Then
continuous infusion of D10W at a
GIR of 4-8 mg/kg/min. Titrate to
attain normoglycemia.
2 ml/kg of Dextrose 10%
Hyperkalemia: Continuous infusion
of 0.5 g/kg/hr dextrose and 0.1-0.2
units/kg/hr regular insulin. Dextrose
and insulin dosages are adjusted
based on serum glucose and
potassium concentrations. Abrupt
discontinuation of dextrose infusion
is not recommended due to the risk
of rebound hypoglycemia. Glucose
concentrations less than D15 should
be administered via a central vein to
minimize risk of phlebitis and
thrombosis.
Drug (concentration)
and Indication
Dose
Administration /
Remarks
Dopamine
To give 10 mcg/kg/min.
@ 1 ml/hr : weight x 30
= mg of dopamine (in
kg) in 50 ml D5W/NS
Hypotension
Begin at 5 mcg/kg/min.
May increase in
increments of 2.5 - 5
mcg/kg/min. as needed
up to 20 mcg/kg/min.
Consider if poor
peripheral perfusion,
evidence of shock, or
thready pulses after
epinephrine and
volume expansion (and
bicarbonate)
Administer into a
central vein when
possible. Phentolamine
used for treatment of IV
infiltrates.
Drug (concentration)
and Indication
Dose
Administration /
Remarks
Epinephrine 1 : 10,000 (0.1 mg/ml)
Resuscitation
Severe bradycardia
Short term use for systemic
hypotension
0.1 - 0.3 ml/kg/dose IV, IO (0.01 – 0.03
mg/kg),
- For continuous infusion - start at 0.05
mcg/kg/min to a maximum of 1
mcg/kg/min.
Rapid IV push followed by 0.5-1 ml NS
flush
May repeat every 3-5 minutes
ALWAYS use the diluted 1:10,000 (0.1
mg/ml) concentration for individual
doses.
Only use the 1:1,000 (1 mg/ml) for
continuous infusion solutions
NEVER inject into an artery
Do not mix with bicarbonate
Effectiveness of drug increases if
acidosis is corrected
May mix dose volume with 3-5 ml NS
Follow ET administration with several
positive pressure ventilations.
Do NOT administer these higher doses
intravenously.
Drug (concentration)
and Indication
Dose
Administration /
Remarks
Fentanyl (50 mcg/ml)
Analgesia
Sedation
Anesthesia
1 mcg/kg
Consider 10 mcg/ml for
doses less than 5 mcg
Drug (concentration)
and Indication
Dose
Administration /
Remarks
Hydralazine (20 mg/
ml)
Hypertension by
vasodilation
0.1-0.5 mg/kg
Doses greater than 2
mg; consider 0.4 mg/ml
Drug (concentration)
and Indication
Dose
Administration /
Remarks
Lorazepam (2 mg/ml)
Sedation
Seizures
0.05-01 mg/kg
Slow IV push
Seizures, may repeat q
10-15 minutes
Drug (concentration)
and Indication
Dose
Administration /
Remarks
Morphine (1 mg/ml)
Pain
Sedation
0.05-0.1 mg/kg
Slow IV push over 5-10
minutes, IM, SQ
Drug (concentration)
and Indication
Dose
Administration /
Remarks
Naloxone (1 mg/ml)
Narcotic antagonist
0.1 ml/kg rapid IV push,
IM
May repeat in 3 - 5
minutes if no response
during resuscitation.
Duration of reversal is
brief; may need
repeated doses.
Drug (concentration)
and Indication
Dose
Administration /
Remarks
Phenobarbital (65
mg/ml)
Anticonvulsant
15 - 20 mg/kg
-For refractory seizures-
Additional 5 mg/kg
doses, up to a total of
40 mg/kg can be given.
IV push over 10-15
minutes, no faster than
1 mg/min.
Drug can be
administered by slow IV
push, IM, PR, or PO.
Diluted IV product can
be used orally.
Drug (concentration)
and Indication
Dose
Administration /
Remarks
Sodium Bicarbonate
4.2% (0.5 mEq/ml)
Metabolic acidosis
1 - 2 mEq/kg
Slow IV push over 30
minutes.
Use only 0.5 mEq/ml
solution for infants
Infuse 1 mEq/kg over ≥
1 minute
CAUSTIC; don’t infuse
faster than 2
ml/kg/minute.
NOT routinely given for
resuscitation.
Can also be given by
continuous infusion, IO,
or PO
Drug (concentration)
and Indication
Dose
Administration /
Remarks
Vecuronium ( 1mg/ml)
Paralysis
Rapid Sequence
Intubation*
0.1 mg/kg
IV push over less than 1
minute
Drug (concentration)
and Indication
Dose
Administration /
Remarks
Volume Expanders
RBCs, NS
Hypotension
Hypovolemia
With evidence of acute
blood loss or a decrease
in effective volume
RBCs: 15 ml/kg IV
NS: 10 ml/kg IV
RBCs: Infuse over 4
hours
NS: Infuse over at least
10 minutes, but
preferably over 30-60
minutes.
Consider if poor
response to
resuscitative efforts or
weak pulses with a
good heart rate
References
Emergency drug doses
Jeffrey L. Segar, MD and Sarah B. Tierney, PharmD
Thank you all for your Patient
hearing…
1 sur 18

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Emergency Drugs.pptx

  • 1. Emergency Drugs Dr. Rakeshkumar S. Gujar. MS(Ay.), (PhD)(Ay.), MSc-CND. Assistant Prof., Dept. of PG Studies in Shalyatantra, BLDEA’S AVS Ayurveda Mahavidyalaya Hospital & Research Centre, Vijayapura.
  • 2. Adenosine (3 mg/ml) Acute treatment of supraventricular tachycardia  1st 0.1 mg/kg/dose  2nd 0.2 mg/kg/dose  3rd 0.3 mg/kg/dose Rapid IV push over 1-2 seconds Flush line immediately with 5-20 ml NS Infuse as close to IV site as possible IO administration also successful Drug (concentration) and Indication Dose Administration / Remarks
  • 3. Drug (concentration) and Indication Dose Administration / Remarks Atropine (0.1 mg/ml) Bradycardia 0.02 mg/kg/dose IV May repeat x 1 dose in 3 minutes
  • 4. Drug (concentration) and Indication Dose Administration / Remarks Calcium gluconate (100 mg/ml)= 9.4 mg elemental calcium /ml Cardia arrest Hypocalcemia 100 mg/kg/dose IV Not for IM or SQ use May repeat x 1 dose, then dose per ionized calcium results Administer by slow IV push for cardiac arrest, infuse over 30-60 minutes for other indications. Stop infusion if HR is greater than 100 bpm. Do not give intra- arterially.
  • 5. Drug (concentration) and Indication Dose Administration / Remarks Dextrose 10% (0.1 Gm/ml) Hypoglycemia Hyperkalemia in combination with insulin 0.2 Gm/kg/dose IV as D10W Then continuous infusion of D10W at a GIR of 4-8 mg/kg/min. Titrate to attain normoglycemia. 2 ml/kg of Dextrose 10% Hyperkalemia: Continuous infusion of 0.5 g/kg/hr dextrose and 0.1-0.2 units/kg/hr regular insulin. Dextrose and insulin dosages are adjusted based on serum glucose and potassium concentrations. Abrupt discontinuation of dextrose infusion is not recommended due to the risk of rebound hypoglycemia. Glucose concentrations less than D15 should be administered via a central vein to minimize risk of phlebitis and thrombosis.
  • 6. Drug (concentration) and Indication Dose Administration / Remarks Dopamine To give 10 mcg/kg/min. @ 1 ml/hr : weight x 30 = mg of dopamine (in kg) in 50 ml D5W/NS Hypotension Begin at 5 mcg/kg/min. May increase in increments of 2.5 - 5 mcg/kg/min. as needed up to 20 mcg/kg/min. Consider if poor peripheral perfusion, evidence of shock, or thready pulses after epinephrine and volume expansion (and bicarbonate) Administer into a central vein when possible. Phentolamine used for treatment of IV infiltrates.
  • 7. Drug (concentration) and Indication Dose Administration / Remarks Epinephrine 1 : 10,000 (0.1 mg/ml) Resuscitation Severe bradycardia Short term use for systemic hypotension 0.1 - 0.3 ml/kg/dose IV, IO (0.01 – 0.03 mg/kg), - For continuous infusion - start at 0.05 mcg/kg/min to a maximum of 1 mcg/kg/min. Rapid IV push followed by 0.5-1 ml NS flush May repeat every 3-5 minutes ALWAYS use the diluted 1:10,000 (0.1 mg/ml) concentration for individual doses. Only use the 1:1,000 (1 mg/ml) for continuous infusion solutions NEVER inject into an artery Do not mix with bicarbonate Effectiveness of drug increases if acidosis is corrected May mix dose volume with 3-5 ml NS Follow ET administration with several positive pressure ventilations. Do NOT administer these higher doses intravenously.
  • 8. Drug (concentration) and Indication Dose Administration / Remarks Fentanyl (50 mcg/ml) Analgesia Sedation Anesthesia 1 mcg/kg Consider 10 mcg/ml for doses less than 5 mcg
  • 9. Drug (concentration) and Indication Dose Administration / Remarks Hydralazine (20 mg/ ml) Hypertension by vasodilation 0.1-0.5 mg/kg Doses greater than 2 mg; consider 0.4 mg/ml
  • 10. Drug (concentration) and Indication Dose Administration / Remarks Lorazepam (2 mg/ml) Sedation Seizures 0.05-01 mg/kg Slow IV push Seizures, may repeat q 10-15 minutes
  • 11. Drug (concentration) and Indication Dose Administration / Remarks Morphine (1 mg/ml) Pain Sedation 0.05-0.1 mg/kg Slow IV push over 5-10 minutes, IM, SQ
  • 12. Drug (concentration) and Indication Dose Administration / Remarks Naloxone (1 mg/ml) Narcotic antagonist 0.1 ml/kg rapid IV push, IM May repeat in 3 - 5 minutes if no response during resuscitation. Duration of reversal is brief; may need repeated doses.
  • 13. Drug (concentration) and Indication Dose Administration / Remarks Phenobarbital (65 mg/ml) Anticonvulsant 15 - 20 mg/kg -For refractory seizures- Additional 5 mg/kg doses, up to a total of 40 mg/kg can be given. IV push over 10-15 minutes, no faster than 1 mg/min. Drug can be administered by slow IV push, IM, PR, or PO. Diluted IV product can be used orally.
  • 14. Drug (concentration) and Indication Dose Administration / Remarks Sodium Bicarbonate 4.2% (0.5 mEq/ml) Metabolic acidosis 1 - 2 mEq/kg Slow IV push over 30 minutes. Use only 0.5 mEq/ml solution for infants Infuse 1 mEq/kg over ≥ 1 minute CAUSTIC; don’t infuse faster than 2 ml/kg/minute. NOT routinely given for resuscitation. Can also be given by continuous infusion, IO, or PO
  • 15. Drug (concentration) and Indication Dose Administration / Remarks Vecuronium ( 1mg/ml) Paralysis Rapid Sequence Intubation* 0.1 mg/kg IV push over less than 1 minute
  • 16. Drug (concentration) and Indication Dose Administration / Remarks Volume Expanders RBCs, NS Hypotension Hypovolemia With evidence of acute blood loss or a decrease in effective volume RBCs: 15 ml/kg IV NS: 10 ml/kg IV RBCs: Infuse over 4 hours NS: Infuse over at least 10 minutes, but preferably over 30-60 minutes. Consider if poor response to resuscitative efforts or weak pulses with a good heart rate
  • 17. References Emergency drug doses Jeffrey L. Segar, MD and Sarah B. Tierney, PharmD
  • 18. Thank you all for your Patient hearing…

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