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

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Dobutamine 250 mg / 50 mls D5S start at 10 ml/hour titrate according to response [Dose range 2 . [Furosemide 40 mg in 40 mls D5W. followed by infusion [undiluted] 10 ml/hr titrate to response [Dose range 2 . IV Dext 5% KVO (keep vein open) Proximal IV access.80 mg slow IV over 2 mins. running NS drip with 3-way attached to infusion line. Emergency Department Hosp Pulau Pinang Page 2 .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. if no response.CM.10 mg bolus over 5 mins. initiate infusion Furosemide 1 mg / min. IV Dext 5% KVO (keep vein open) MAGNESIUM SULPHATE Eclampsia seizures and Torsade de Pointes Proximal IV access. CM 50 mls Dext 50% IV bolus given on 3way with running IV drip. given at 60 ml/hour infusion] IV Isoket infusion (undiluted) at 2 ml/hr IV Labetalol 5 . Hypertensive Emergencies Hypertensive Emergencies / Dissecting Aneurysms for BP / Rate control Proximal IV access.20 ml/hour] IV Furosemide 60 .20 ml/hour] IV Lignocaine 1 . resus-ready. CM Proximal IV access.20 ml/hour] Dopamine 200 mg / 50 mls D5S start at 10 mls / hour titrate according to response [Dose range 2 . 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. running NS drip.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. repeat Gluc 15 min Proximal IV access.1% ampule Acute Heart Failure.CM. CM. running NS drip with 3-way attached to infusion line.CM.1.CM. VSM. IV Dext 5% KVO (keep vein open) ISOKET 0.

repeat as needed [usually after 30 mins] Dose 1 mcg/kg/min. resus-ready. given 2 . IV Noradrenaline 4 mg diluted in 50 ml D5S.10 ml/hr]. Always given via running drip. CM Proximal IV access. Nebulizer therapy continuing. aim to reduce work of breathing High conc Oxygen. watch for fine movements from head to toes Diluted to 20 ml NS. induction agent given and cricoid pressure applied Proximal IV access. Use 25 bolus. running NS drip. running NS drip. IV benzodiazepines given Proximal IV access. Start at 20 ml/hr. 10 mls slow bolus over 5 minutes Dose 1 . Start 1000 mg (4 vials) diluted in 500 mls NS. max dose 4 mg / kg. CM. IV Dext 5% KVO (keep vein open). CM. Use 10 mg dilute to 50 mls NS. resus-ready.30 mins. CM. running NS drip with 3-way attached to infusion line. Ac Heart Failure Proximal IV access. Dose 2 mg / kg IV bolus slow. CM Proximal IV access.5 ml Paralysis post intubation VENTOLIN 5 mg in 5 ml IV solution Severe Acute Asthma Emergency Department Hosp Pulau Pinang Page 3 . running NS drip with 3-way attached to infusion line.02 mcg/kg/min [start at 2 ml/hour. until induction achieved. running NS drip with 3-way attached to infusion line. dose at 0. Intubated. 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. titrate upwards [Dose range 2 . 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. Start at 1 ml/hr.5 mg/kg IV bolus. Dose 0. resus-ready Proximal IV access.5 mg/kg. Proximal IV access. running NS drip. CM.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.4 mls every 30 seconds. resus-ready. NITRO-GLYCERIN BP control in Hypertensive Emergencies. given over 20 . CM. Titrate upwards.4% 10 ml amp Status Epilepticus Induction agent for severe acute asthma. watch for unresponsiveness and apnoea. titrate upwards till response] IV 15 mg/kg loading dose. maintenance of sedation established.1.

Keep vein open . charting 30 . airway management ready. minimum amount just to keep vein open Note: these are adult doses for the average sized adult.Cardiac Monitoring . The doses are presented in a way that allows for rapid initiation and titration based on initial response.Vital Signs Monitoring .60 mins Resus-ready . if this is not possible. continuous SpO2 monitoring. team available bedside KVO . 7.continuous cardiac ECG monitoring. automated BP monitoring at 5 . All infusion drugs must be given via a 3 way stop-cock with a carrier infusion running. 6. automated BP monitoring at 2 minute interval. 3. 2. 4.Resuscitation Trolley bed-side.10 minute interval. continuous SpO2 monitoring. 5. it is even more important to ensure that the carrier infusion is running.IV infusion of Dext 5% at rate of less than 10 drops / min. CM . which will ensure that the drug will reach the systemic circulation in good time.EMERGENCY PARENTERAL DRUGS LIST 2009 (ADULTS DOSE ONLY) Table of Abbreviations and Definitions 1.continuous vital signs monitoring. Emergency Department Hosp Pulau Pinang Page 4 . Infusions should always be placed in IV access that are located proximally and centrally. defibrillator available VSM .

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