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EMERGENCY PARENTERAL DRUGS LIST 2009 (ADULTS DOSE ONLY)

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

IV Adenosine 6 mg in 1st syringe, 10


Proximal IV access; running NS drip;
ADENOSINE 6 mg ampule SupraVentricular Tachycardias (SVT) mls NS in 2nd syringe; given fast
CM, resus-ready;
bolus 1st followed by 2nd syringe.

IV Adrenaline 1 mg given bolus


ADRENALINE 1 mg ampule CPR - all pulseless conditions Proximal IV access; running NS drip.
followed by 10 mls NS and elevation.

Proximal IV access; running NS drip; IM Adrenaline 0.5 mg given deep IM in


ADRENALINE 1 mg ampule Anaphylactic Shock
CM, resus-ready; thigh, repeated 5 mins till response

3 mg in 50 mls Proximal IV access; running NS drip Start at Adrenaline infusion at 2 ml/


ADRENALINE Shock states for inotropic support
D5W infusion with 3-way attached to infusion line; CM hour, titrate up to max 10 ml / hour.

CPR after 3 shocks and at least once


AMIODARONE 150 mg ampule Refractory Vent Fibrillation IV Amiodarone 300 mg bolus
IV Adrenaline; on-going CPR

Unstable VT following failure of Proximal IV access; running NS drip; IV Amiodarone 300 mg slowly over 10
AMIODARONE 150 mg ampule
synchronized cardioversion CM, resus-ready; - 20 min

Proximal IV access; running NS drip; IV Amiodarone 300 mg over 20 - 60


AMIODARONE 150 mg ampule Rate control Rapid Atrial Fibrillation
CM, resus-ready; min; continued 900 mg over 24 H

IV Atropine 1 mg bolus repeated


ATROPINE 1 mg ampule CPR - asystole, PEA CPR after Adrenaline initial dose
rapidly up to 3 mg maximum

Proximal IV access; running NS drip; IV atropine 0.5 mg bolus repeated up


ATROPINE 1 mg ampule Symptomatic bradycardia < 50 bpm
CM, resus-ready; to 3 mg maximum; consider pacing

Proximal IV access; running NS drip; IV Atropine 1 - 2 mg every 2 - 5 mins


ATROPINE 1 mg ampule Organophosphate poisoning CM, resus-ready; large amounts of until respiratory secretions dry, and
Atropine needed. HR > 100; start infusion titrate to effect

Proximal IV access; running NS drip; Severe Hyper-K+ with ECG changes:


CALCIUM
10% vial Cardio-protective in severe Hyper-K+ CM, resus-ready; use with other Rx to give 10 mls 10% CaCl2 over 2 - 5 min;
CHLORIDE
reduce K levels If in cardiac arrest, give as rapid bolus

Emergency Department Hosp Pulau Pinang Page 1


EMERGENCY PARENTERAL DRUGS LIST 2009 (ADULTS DOSE ONLY)

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

IV access with 3-way on Dext Saline 50 mls Dext 50% IV bolus given on 3-
DEXTROSE 50% 10 ml vial Hypoglycaemia
running drip; VSM; repeat Gluc 15 min way with running IV drip;

Dobutamine 250 mg / 50 mls D5S


Proximal IV access; running NS drip
DOBUTAMINE 250 mg vial Shock states for inotropic support start at 10 ml/hour titrate according to
with 3-way attached to infusion line; CM
response [Dose range 2 - 20 ml/hour]

Dopamine 200 mg / 50 mls D5S start


Proximal IV access; running NS drip
DOPAMINE 200 mg vial Shock states for inotropic support at 10 mls / hour titrate according to
with 3-way attached to infusion line; CM
response [Dose range 2 - 20 ml/hour]

IV Furosemide 60 - 80 mg slow IV
over 2 mins; if no response, initiate
Proximal IV access;CM; IV Dext 5%
FUROSEMIDE 20 mg ampule Acute Heart Failure infusion Furosemide 1 mg / min.
KVO (keep vein open)
[Furosemide 40 mg in 40 mls D5W;
given at 60 ml/hour infusion]

Acute Heart Failure, Hypertensive Proximal IV access;CM; IV Dext 5%


ISOKET 0.1% ampule IV Isoket infusion (undiluted) at 2 ml/hr
Emergencies KVO (keep vein open)

IV Labetalol 5 - 10 mg bolus over 5


Hypertensive Emergencies /
Proximal IV access;CM; IV Dext 5% mins; followed by infusion [undiluted]
LABETALOL 25 mg / 5 ml Dissecting Aneurysms for BP / Rate
KVO (keep vein open) 10 ml/hr titrate to response [Dose
control
range 2 - 20 ml/hour]

Lignocaine for
IV use only - Proximal IV access;CM; IV Dext 5% IV Lignocaine 1 - 1.5 mg/kg slow IV
LIGNOCAINE Ventricular arrhythmias
100 mg/5 ml KVO (keep vein open) bolus
plastic amp

IV MgSO4 10 ml undiluted bolus over


MAGNESIUM 5 ml amp with Eclampsia seizures and Torsade de Proximal IV access; running NS drip;
5 minutes; followed by maintenance
SULPHATE 10 mmol Mg Pointes CM, resus-ready;
infusion at 2 ml/hr

Emergency Department Hosp Pulau Pinang Page 2


EMERGENCY PARENTERAL DRUGS LIST 2009 (ADULTS DOSE ONLY)

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

IV GTN 20 mg in 20 mls undiluted.


10 mg in 10 ml BP control in Hypertensive Proximal IV access; CM; IV Dext 5%
NITRO-GLYCERIN Start at 1 ml/hr; titrate upwards [Dose
amp Emergencies; Ac Heart Failure KVO (keep vein open); resus-ready
range 2 - 10 ml/hr].

IV Noradrenaline 4 mg diluted in 50 ml
Proximal IV access; running NS drip
NORADRENALINE 4 mg / 4 ml amp Shock states for inotropic support D5S; dose at 0.02 mcg/kg/min [start at
with 3-way attached to infusion line; CM
2 ml/hour, titrate upwards till response]

Proximal IV access; running NS drip IV 15 mg/kg loading dose. Start 1000


PHENYTOIN 250 mg in 5 ml
Status Epilepticus with 3-way attached to infusion line; mg (4 vials) diluted in 500 mls NS;
SODIUM vial
CM; IV benzodiazepines given given over 20 - 30 mins.

10 mg/ml 1% Induction agent for severe acute Proximal IV access; running NS drip; Dose 2 mg / kg IV bolus slow; watch
PROPOFOL
ampule asthma, status epilepticus CM, resus-ready; for unresponsiveness and apnoea.

SODIUM Proximal IV access; running NS drip Always given via running drip; 10 mls
8.4% 10 ml amp Severe Hyper-K+ (if acidotic)
BICARBONATE with 3-way attached to infusion line; CM slow bolus over 5 minutes

Proximal IV access; running NS drip;


SUCCINYL Dose 1 - 1.5 mg/kg IV bolus; watch for
100 mg amp Rapid Sequence Induction CM, resus-ready; induction agent given
CHOLINE fine movements from head to toes
and cricoid pressure applied

Diluted to 20 ml NS; given 2 - 4 mls


THIOPENTAL Rapid Sequence Induction especially Proximal IV access; running NS drip;
500 mg vial every 30 seconds; until induction
SODIUM for Status Epilepticus CM, resus-ready;
achieved; max dose 4 mg / kg.

Intubated, maintenance of sedation


Dose 0.5 mg/kg. Use 25 bolus; repeat
TRACIUM 25 mg in 2.5 ml Paralysis post intubation established, aim to reduce work of
as needed [usually after 30 mins]
breathing

Dose 1 mcg/kg/min. Use 10 mg dilute


5 mg in 5 ml IV High conc Oxygen, Nebulizer therapy
VENTOLIN Severe Acute Asthma to 50 mls NS. Start at 20 ml/hr. Titrate
solution continuing; monitor SpO2 and K levels
upwards.

Emergency Department Hosp Pulau Pinang Page 3


EMERGENCY PARENTERAL DRUGS LIST 2009 (ADULTS DOSE ONLY)

Table of Abbreviations and Definitions

1. CM - Cardiac Monitoring - continuous cardiac ECG monitoring, automated BP monitoring at 2 minute interval, continuous SpO2
monitoring, defibrillator available

2. VSM - Vital Signs Monitoring - continuous vital signs monitoring, automated BP monitoring at 5 - 10 minute interval, continuous
SpO2 monitoring, charting 30 - 60 mins

3. Resus-ready - Resuscitation Trolley bed-side, airway management ready, team available bedside

4. KVO - Keep vein open - IV infusion of Dext 5% at rate of less than 10 drops / min; minimum amount just to keep vein open

5. 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.

6. 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.

7. 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.

Emergency Department Hosp Pulau Pinang Page 4