I.

Equipment’s in an Emergency Cart

EQUIPMENTS PURPOSE
Top of Emergency Trolley
Oxygen supply It supplies oxygen to the body and removes
carbon dioxide by propelling air into and out
of the lungs in a controlled manner, keeping
the levels of the two gases in the blood
within narrow limits.

Defibrillator with monitor Combined defibrillator/monitors enable the

operator to assess and monitor the ECG
and rapidly deliver a defibrillating
countershock to patients suffering from
ventricular fibrillation during a cardiac
arrest.

Portable suction apparatus A suction machine, also known as an

aspirator, is a type of medical device that is
primarily used for removing obstructions,
like mucus, saliva, blood, or secretions from
a person's airway.

Forceps Forceps are nonlocking grasping tools that

function as an extension of the thumb and
opposing fingers in the assisting hand to
augment the instrument in the operating
hand. Their primary purpose is to grasp,
retract, or stabilize tissue.
Sphygmomanometer To measure blood pressure, your doctor
uses an instrument call a
sphygmomanometer, which is more often
referred to as a blood pressure cuff.

Stethoscope Medical instrument used in listening to

sounds produced within the body, chiefly in
the heart or lungs.

Drawer 1: Medications
• Adenosine
• Aspirin
• Atropine Sulfate
• Amiodarone
• Aminophylline
• Calcium gluconate
• Diphenhydramine
• Diltiazem
• Digoxin
• Dopamine
• Epinephrine
• Magnesium sulphate
• Methylprednisolone
• Metoprolol
• Naloxone
• Lidocaine
• Procainamide
• Sodium bicarbonate
• Verapamil
Drawer 2: Breathing and Airway
Oropharyngeal Airways An oropharyngeal airway (oral airway,
OPA) is an airway adjunct used to maintain
or open the airway by stopping the tongue
from covering the epiglottis.

Nasopharyngeal Airways A nasopharyngeal airway device (NPA) is a

hollow plastic or soft rubber tubes that a
healthcare provider can utilize to assist with
patient oxygenation and ventilation in
patients who are difficult to oxygenate or
ventilate via bag mask ventilation

Endotracheal tubes The

main indication to use an endotracheal
tube is to secure a definitive airway.

Tracheostomy tubes A tracheostomy tube is a curved tube that

is inserted into a tracheostomy stoma (the
hole made in the neck and windpipe.

Face mask Face masks (or other face coverings that

cover your mouth and nose) are one of the
most effective measures that help reduce
spreading of the virus.
Pocket mask Pocket masks are used in the resuscitation
of patients who have stopped breathing or
who are breathing insufficiently and are
designed to prevent the spread of potential
pathogens during mouth-to-mouth
resuscitation.

Suction tube The tubes illustrated are designed

for removing small amounts of secretions
from the nose, throat or ears.

Tracheostomy mask Tracheostomy mask allows for the delivery

of oxygen therapy to patients who have had
a tracheostomy

Nasal cannula The nasal cannula allows breathing

through the mouth or nose, is available for
all age groups, and is adequate for short- or
long-term use.
Laryngoscope Laryngoscopy can be used to treat some
problems in the vocal cords or throat. For
example, long, thin instruments can be
passed down the laryngoscope to remove
small growths (tumors or polyps) on the
vocal cords

Tongue blades It is intended for use during the course of a

medical examination to depress the tongue
in order to allow the clinician an easier
examination of the mouth and throat.

Suction catheter A suction catheter can help prevent

aspiration in a patient undergoing dental
treatment, especially if the patient is in an
altered state of consciousness.

Drawer 3: Circulation: IV supplies

Needle different sizes
A hypodermic (hypo – under, dermic – the
skin) needle is a hollow needle commonly
used with a syringe to inject substances
into the body or extract fluids from it. They
may also be used to take liquid samples
from the body, for example taking blood
from a vein in venipuncture
Syringe different sizes A syringe is the tube with a plunger that
usually connects to a needle. It is used to
inject or take out fluid.

Butterflies Butterfly needles are often used on people

who might be difficult to perform
venipuncture.

Sterile water vials Used for fluid replacement only after

suitable additives are introduced to
approximate isotonicity and to serve as a
vehicle for suitable medications.

IV cannulas The purpose of cannulation is to deliver

fluids, antibiotics and blood products
intravenously (into the vein) to improve the
condition for which a patient is being
treated.
Tourniquet A tightly tied band applied around a limb
(upper or lower) to prevent severe blood
loss from limb trauma during emergency.

Alcohol swabs Alcohol is used to disinfect the skin prior to

injections in order to prevent infections
caused by bacteria on the skin being
injected within tissue.

Cotton balls Cotton balls have multiple uses in the

medical field including cleaning out wounds
with hydrogen peroxide or iodine, applying
antiseptics or topical ointments, cleaning
minor cuts and skin irritations, and stopping
blood after an injection is given or blood
withdrawn.

Blood tubes Blood collection tubes containing heparin,

which stabilizes the red blood cell
membranes, are used for specialized
hematology studies, such as red cell
fragility tests and several specialized
chemistry tests
Tape Medical adhesive tape, or surgical tape, is
used to attach bandages, gauze, and other
dressings to skin around wounds

Drawer 4- IV solution and tubing

Sodium chloride Sodium Chloride IV Infusion is used for
treatment of fluid loss and to restore sodium
chloride balance. It is used in the treatment
of patients who are unable to take fluids
and nutrients by mouth. It is also used for
dilution of other medicines before injection
into the body.

Dextrose Dextrose injection is a sterile solution used

to provide your body with extra water and
carbohydrates (calories from sugar). It is
used when a patient is not able to drink
enough liquids or when additional fluids are
needed. Dextrose is used in many different
medical conditions

Haes-steril Haes Steril 6% Infusion consists of purified

salt solution. It is used for short term fluid
replacement. Thus, it treats hypovolemia
that can result due to any dehydration, or
injury. It helps to restore the salt and
electrolyte levels in the body.
Ringer lactate Ringer's lactate is largely used
in aggressive volume resuscitation from
blood loss or burn injuries; however,
Ringer's lactate is a great fluid for
aggressive fluid replacement in many
clinical situations, including sepsis and
acute pancreatitis.

Blood pump tubing The blood tubing set typically

includes ports for the administration of
fluids (replacement, dialysate) and
anticoagulants, as well as a chamber in the
venous line for capturing any air that may
enter the blood circuit inadvertently.

I.V tubing Primary IV tubing is used to infuse

continuous or intermittent fluids or
medication.

Drawer 5: Cardiac, Chest Procedures

ECG electrodes Electrodes are placed on the chest to
record the heart's electrical signals, which
cause the heart to beat
Sterile gloves Sterile gloves help prevent surgical site
infections and reduce the risk of exposure
to blood and body fluid pathogens for the
health care worker.

Sutures Sutures and fibrin sealant are important

surgical aids for facilitating wound closure
and creating an optimal setting for wound
healing. Most commonly, sutures are used
to close wounds because suture material
provides the mechanical support necessary
to sustain closure.

Sterile towels By definition the surgical towel is a sterile

drape used to cover the body while surgery
is being performed.

Cut down tray Cutdown Tray is an emergency procedure

It is used to get vascular access in trauma
and hypovolemic shock patients when
peripheral cannulation is difficult or
impossible.
Catheter kit Catheterization Kits supply everything to
manage patient catheter insertion. In fact,
catheterization becomes incredibly
convenient, especially when using an
insertion tray that includes a lubricant,
swabs, gloves, a syringe, an under pad,
collection devices and more.

Chest tubes A chest tube is a plastic tube that is used to

drain fluid or air from the chest. Air or fluid
that collects in the space between the lungs
and chest wall can cause the lung to
collapse.

Scalpels with blades A scalpel is a bladed surgical instrument

used to make cuts into the body. This is a
very sharp instrument and comes in various
sizes for different types of cuts and
surgeries. Most blades are made of either
carbon or stainless (medical grade) steel.

Dressings A dressing is a sterile pad or compress

applied to a wound to promote healing and
protect the wound from further harm. A
dressing is designed to be in direct contact
with the wound, as distinguished from a
bandage, which is most often used to hold
a dressing in place.
II. Medications in an Emergency Cart

MEDICATIONS USES
Adenosine Used to bring your heart back into a
normal rhythm. This medicine is not
useful for all types of irregular
heartbeats. It may be used to test the
heart for coronary artery disease.

Aspirin Aspirin is a common drug for relieving

minor aches, pains, and fevers.
People also use it as an anti-
inflammatory or a blood thinner.

Atropine Sulfate Atropine sulfate eye drops is used

to dilate the pupil before eye exams. It
is also used to treat an eye condition
called amblyopia (lazy eyes) and other
eye conditions (eg, cycloplegia).

Amiodarone Amiodarone is used to treat life-

threatening heart rhythm problems
called ventricular arrhythmias. This
medicine is used in patients who have
already been treated with other
medicines that did not work well.

Aminophylline Aminophylline injection is used

together with other medicines to treat
the acute symptoms of asthma,
bronchitis, emphysema, and other
lung diseases in a hospital setting.
Calcium gluconate It may be used to treat conditions
caused by low calcium levels such as
bone loss (osteoporosis), weak bones
(osteomalacia/rickets), decreased
activity of the parathyroid gland
(hypoparathyroidism), and a certain
muscle disease (latent tetany).

Diphenhydramine Diphenhydramine is an antihistamine

medicine that relieves the symptoms
of allergies. It's known as a drowsy
(sedating) antihistamine and is more
likely to make you feel sleepy than
other antihistamines.

Diltiazem Diltiazem is a medicine used to treat

high blood pressure. If you have high
blood pressure, taking diltiazem helps
to prevent future heart disease, heart
attacks and strokes.

Digoxin A medicine used to treat irregular

heartbeats.
Dopamine Dopamine is a prescription medicine
used to treat the symptoms of low
blood pressure, low cardiac output
and improves blood flow to the
kidneys.

Epinephrine Epinephrine is in a class of

medications called alpha- and beta-
adrenergic agonists. It works
by relaxing the muscles in the airways
and tightening the blood vessels.

Magnesium sulphate Mineral supplement used to prevent

and treat low amounts of magnesium
in the blood.

Methylprednisolone It is used to treat a number of different

conditions, such as inflammation
(swelling), severe allergies, adrenal
problems, arthritis, asthma, blood or
bone marrow problems, eye or vision
problems, lupus, skin conditions,
kidney problems, ulcerative colitis,
and flare-ups of multiple sclerosis.
Metoprolol Metoprolol is used alone or in
combination with other medications to
treat high blood pressure.

Naloxone Naloxone is a medication approved by

the Food and Drug Administration
(FDA) designed to rapidly reverse
opioid overdose.

It causes loss of feeling in the skin and

Lidocaine surrounding tissues. It is used to
prevent and to treat pain from some
procedures. This medicine is also
used to treat minor burns, scrapes and
insect bites.
Procainamide Procainamide is a medication used to
manage and treat ventricular
arrhythmias, supraventricular
arrhythmias, atrial flutter, atrial
fibrillation, AV nodal re-entrant
tachycardia, and Wolf-Parkinson-
White syndrome.

Sodium bicarbonate Sodium bicarbonate, also known as

baking soda, is used to relieve
heartburn, sour stomach, or acid
indigestion by neutralizing excess
stomach acid. When used for this
purpose, it is said to belong to the
group of medicines called antacids. It
may be used to treat the symptoms of
stomach or duodenal ulcers.

Verapamil Verapamil is used alone or together

with other medicines to treat heart
rhythm problems, severe chest pain
(angina), or high blood pressure
(hypertension)
DRUG NAME ACTION INDICATIONS CONTRAINDICA SIDE NURSING
TIONS EFFECTS/ADVERSE CONSIDERATION
EFFECTS S
Atropine Sulfate • Blocks • Symptomatic • Avoid in • Dry mouth, • Monitor
parasymp sinus hypotherm thirst, apical pulse
athetic bradycardia ( ic dysphagia, prior to
stimulatio 1st line drug bradycardi nausea, administrati
Classification: n of SA of choice as! vomiting, const on.
Parasympathetic node according to • Not useful ipation, • Cardiac
blocking agent • Increases ACLS) in Mobitz paralytic ileus monitor
(blocks muscarinic automatici • Asystole (2n Type II or • Tachycardia should be
receptor sites) ty of SA d line drug of 3rd degree • Dry mucous used on
node choice after AV blocks membranes, patients
Dosage: (positive epinephrine (wide flushing of skin receiving
• IV bolus: chronotro according to QRS's) (red, dry) atropine IV
(for bradycar pic) ACLS) • Hypersens • Urinary boluses.
dias or heart • Decrease • 1st degree or itivity to retention • Doses of
blocks) 0.5 s AV 2nd degree belladonn • Mydriasis, 0.5 mg or
mg IV push, conductio (Mobitz type a alkaloids blurred vision, less may
repeated n time I) AV blocks– • Angle photophobia result in
every 3-5 only if closure • Headache, paradoxical
minutes until symptomatic glaucoma dizziness, slowing of
maximum • Organophos • Obstructiv ataxia, heart rate.
dose of 3 phate e irritability, • Eye
mg. poisoning (an uropathies drowsiness, preparation
• IV bolus: tidote) (prostatic confusion, s generally
(for asystole • Ophthalmic hypertroph disorientation used only
) 1 mg IV or agent to y) • Drying and for
IO every 3-5 produce • Paralytic thickening of procedures
minutes for mydriasis ileus bronchial and have
maximum of and paralysis • GI bowel secretions only
3 doses (3 of ciliary obstructio localized
mg). muscle n effects on
(responsible optic
• IV bolus: (for for • Use muscles.
organophos accommodati cautiously Chronic
phate on) in patients use of eye
poisoning) 2 • Intestinal with preparation
– 4 mg or hypertonicity asthma or s may
higher (may & COPD result in
need to be hypermotility • Use systemic
repeated • Preoperative cautiously anticholiner
periodically) agent to in patients gic
decrease with symptoms
body myocardial which may
secretions ischemia be
and intestinal or hazardous
motility infarction. in infants
during • Safety and
surgery during children.
pregnancy • Atropine
or lactation can be
not administere
establishe d via
d endotrache
(Category al tube in
C). dose of 2-3
mg diluted
in 10 ml
H2O, but
intraosseou
s route is
preferred
over
endotrache
al tube if IV
access
cannot be
achieved.
• Older
adults and
debilitated
patients
may be
more
vulnerable
to CNS
disturbance
s from
atropine.
• Monitor
temperatur
e in infants
and
children for
"atropine
fever".
• Measures
to relieve
dry mouth:
adequate
fluid
hydration,
oral
hygiene
(don't use
alcohol-
based
mouthwash
es), ice
chips,
sugarless
gum, or
hard
 candies to
suck on.
• Avoid
driving or
operating
heavy
machinery
while under
the
influence of
atropine.
• Reduce
lighting to
decrease
photophobi
a.
• Monitor GI
motility
(BMs and
flatus) and
urine output
while
patient is
receiving
atropine.
• Atropine is
a common
pre-
operative
agent, and
can be
given IM,
SC, PO, or
IV.
DRUG NAME ACTION INDICATIONS CONTRAINDICATI SIDE NURSING
ONS EFFECTS/ADVER CONSIDERATIONS
SE EFFECTS
Amiodarone • Blocks • Pulseless • Cardiogenic • Muscle • Monitor blood
potassiu ventricular shock weakness, pressure and
Classification: m fibrillation • Severe fatigue, apical pulse prior
Potassium channels or sinus tremor, to administration.
channel blocker in phase ventricular bradycardia peripheral • Cardiac monitor
(Antidysrhythmic 3 of the tachycardia • Hypersensiti neuropathie should be used
Drug Class III) action (ACLS 1st vity to s, tingling on patients
potential line choice benzyl sensations receiving
Dosage: • Delays for IV alcohol • Blue-gray amiodarone
• PO: 800- repolariza antidysrhyt • Use discoloratio therapy.
1600 mg tion of hmic agent) cautiously in n of the • Baseline chest x-
daily fast • Unstable hepatic or skin (3-5%) ray and
(loading); action ventricular thyroid • Prolonged pulmonary
100 – 400 potential; tachycardia disease. QT interval function test is
mg daily prolong • Has been • Safety and PR recommended
(maintena action indicated in during interval before
nce) potential the past for pregnancy, • Hypotensio beginning PO th
• IV • Prolongs supraventri lactation or n, sinus erapy.
bolus: 30 QT cular with children arrest, heart • Baseline
0 mg IV or interval tachycardia not failure, AV assessments
IO in 20- • Decrease s–but has established blocks, should be
30 ml s heart been (Category dysrhythmia checked of liver
D5W; rate moved D). s function and
2nd dose (negative down due • Anorexia, thyroid function.
of 150 mg chronotro to risks of nausea, • Initial therapy
may be pic) toxicity vomiting, should be
given in 3- • Decrease • Atrial constipation implemented
5 minutes s fibrillation , under hospital
contractili (oral doses) hepatotoxici precautions with
ty ty access to
(negative • Photosensit advanced life
inotropic) ivity, support.
corneal
 microdeposi • Monitor serum
ts, optic level frequently.
neuropathy, • Encourage
blindness patient to wear
• Fatal sunglasses for
gasping photosensitivity.
syndrome (I • Encourage
V) with patient to wear
children protective
clothing and
sunscreen when
outdoors.
• Caution
patient/family
about using OTC
herbal products
(e.g., St. John's
wart, echinacea).
• Patient should
obtain
ophthalmic exam
regularly.
DRUG NAME ACTION INDICATIONS CONTRAINDICATIO SIDE NURSING
NS EFFECTS/ADVERSE CONSIDERATIO
EFFECTS NS
Diltiazem • Slows SA • Dysrhythmi • Hypersensitiv • Headache • Check
node as–slows ity to • Fatigue blood
Classification: automatici ventricular diltiazem • Dizziness pressure,
Calcium (Ca++) ty rate in atrial • Sick sinus • Nervousness heart rate,
channel blocker (negative fibrillation syndrome • Bradycardia, AV and
chronotro and atrial • 2nd or 3rd blocks, heart cardiac
Dosage: pic) flutter degree AV failure, flushing, monitor
PO: (angina 30 • Delays AV • Dysrhythmi blocks hypotension, prior to
mg q.i.d.) node as–after • Hypotension syncope, peripher administer
(hypertension conductio adenosine, (systolic BP < al edema ing
60 – 120 mg n 2nd line 90 mm Hg) • Nausea, diltiazem.
sustain- • Reduces drug for • Heart failure vomiting, constipa • Assess
released b.i.d.) myocardia refractory • Safety not tion, diarrhea, baseline
l SVT established impaired taste renal
Intravenous: (at contractilit (narrow for children, (BUN, Cr)
rial fibrillation y QRS pregnancy, or and liver
0.25 mg/kg or (negative tachycardia lactation function
15 – 20 mg inotropic) s) (AST,
slow IV bolus • Dilates • Variant ALT) lab
over 2 minutes) coronary angina tests.
arteries (reduces • Monitor for
IV Drip: 5 – 15 during coronary signs of
mg/hr titrated to variant vasospasm heart
appropriate angina s) failure
heart rate • Dilates • Hypertensio (e.g.,
peripheral n (relaxes pulmonary
arteries smooth edema,
reducing muscles in weakness,
afterload arterial dyspnea).
walls) • Provide
analgesic
for
headache.
• Use
caution
during
position
changes
to prevent
orthostatic
hypotensi
on.
DRUG ACTION INDICATIONS CONTRAINDICATIO SIDE NURSING
NAME NS EFFECTS/ADVERSE CONSIDERATIONS
EFFECTS
Digoxin • Increases • Heart failure • Digitalis • Nausea • Monitor blood
force of (left-sided or hypersensitivi • Vomiting pressure and
Classificatio myocardia right-sided) ty • Anorexia apical pulse
n: l • Atrial • Ventricular • Diarrhea prior to
Cardiac contractio fibrillation or fibrillation • Fatigue administration.
glycoside n (positive Atrial flutter • Ventricular • Visual • Cardiac monitor
inotropic) (to decrease tachycardia disturbances (e should be used
Dosage: • Decrease ventricular • Safety during .g., blurred on patients
PO: (loadin d rate) pregnancy, vision, yellow receiving
g dose) 10- sympathet • Supraventric lactation tinge to vision, digoxin,
15 mcg/kg ic tone ular (Category A). halos around especially
in divided • Increased tachycardia lights) loading doses.
doses over urine • Prolonged PR • Monitor serum
24 – 48 production interval digoxin levels
hours • Decrease • Increased AV closely,
d renin blocks especially if
IV bolus: release receiving
• Confusion
(loading • Slows antibiotic
dose) 10-15 • Drowsiness
conductio therapy.
• Dizziness
mcg/kg (1 n through • Monitor serum
mg) in • Insomnia
the AV electrolytes,
divided • Nightmares
node especially
doses over • Decreases potassium.
24 hours automatici • Check for
ty in the toxicity if visual
Maintenanc SA node or GI
e Dose (IV (negative disturbances
or PO): 0.1 chronotrop occur.
– 0.375 ic) • If DIGOXIN
mg/day TOXICITY
occurs with
DYSRHYTHMI
AS, 1)
 Discontinue any
digitalis
medications
and any
potassium
depleting
diuretics. 2)
Check serum
potassium
level. 3) Pheny
toin or lidocaine
can be used as
antidysrhythmic
medications [Do
Not Use
Quinidine or
Amiodarone.].
4) Atropine can
be used for
bradycardias or
AV blocks. 5)
Fab antibody
agents can be
administered
carefully
intravenously.
• Avoid electrical
cardioversion if
patient is
receiving
digoxin unless
condition is life-
threatening. Th
en use lower
doses (10-20
joules).
• Emphasize to
patient the
importance of
taking digoxin
as prescribed at
regular intervals
and not missing
doses.
• Do not breast
feed while
taking digoxin.
DRUG ACTION INDICATIONS CONTRAINDICATI SIDE NURSING
NAME ONS EFFECTS/ADV CONSIDERATIONS
ERSE
EFFECTS
Dopamine • Low dose (<3 • Shock: Moder • Tachy- • Hypotens • Monitor blood
mcg/kg/min): ate doses dysrhythmi ion pressure, pulse, and
activates dop enhance as • Hyperten peripheral pulses
Classificati aminergic contractility • Ventricular sion every 15 minutes.
on: receptors in increasing fibrillation • Tachycar • Monitor hourly urine
Beta- kidneys cardiac output; • Pheochrom dia output.
adrenergic producing High doses ocytoma • Anginal • Cardiac monitor
& alpha- renal artery produce • Safety pain should be used on
adrenergic dilation. vasoconstrictio during • Ectopic patients receiving
agonist • Mod dose (3 – n to enhance pregnancy, beats dopamine infusion.
10 blood lactation or • Vasocon • Notify physician
Catechola mcg/kg/min): pressure. with striction immediately if 1)
min primarily • Heart children not • Nausea oliguria develops; 2)
activates β1 a Failure: At established. • Vomiting tachy-dysrhythmias
Dosage: drenergic moderate develop; 3) diastolic
• Headach
IV receptors in doses, pressure rises
e
Infusion: heart dopamine reducing pulse
Begin at 2 • Tissue
increasing enhances pressure; 4)
– 5 necrosis
heart rate contractility. H hypotension
mcg/kg/mi and
(positive igher doses continues to exist at
n and sloughin
chronotropic exacerbate maximum dose of
titrate to g if
agent), heart failure by 20 mcg/kg/min; 5)
blood extravas
contractility increasing signs of peripheral
pressure ation
(positive afterload and ischemia (purple
according occurs
inotropic producing extremities, cold
to desired agent) additional extremities,
response • High dose (10 workload on diminished
to a – 20 the heart. peripheral pulses)
maximum mcg/kg/min): • Bradycardia: • Weigh patient daily
of 20 activates α- Dopamine is a to determine
mcg/kg/mi adrenergic 2nd line drug accurate infusion
n. receptors pro after atropine dose.
ducing for • Calculate infusion
vasoconstricti bradycardias. drips and doses
on carefully. Double-
(increasing sy check calculations
stemic with another nurse
vascular or pharmacist.
resistance or • IV site should not be
left ventricular used for any other
afterload) infusions or IV
therapies.
• Extravasation of
dopamine may
cause tissue
necrosis to
skin. Therefore,
monitor IV site every
hour. Have phentol
amine close to the
bedside of the
patient.
DRUG NAME ACTION INDICATIONS CONTRAINDICATI SIDE NURSING
ONS EFFECTS/ADVER CONSIDERATIONS
SE EFFECTS
Epinephrine • α- • Anaph • Tachydysrh • Cardiac: • Epinephrine may
adrenergi ylactic ythmias hypertensio exacerbate chest
Classification: c shock (heart rate n, pain, hypertension,
Sympathomimetic stimulatio • Acute > tachycardia and
Agent n asthma 100/minute) , tachydysrhythmias.
produces attack • Narrow- palpitations • Contact lenses
Dosage: vasoconst • 1st or angle , angina, should be removed
• Intravenous riction 2nd glaucoma tachydysrh prior to instilling eye
:1 mg (which degree • Hemorrhagi ythmias drops.
(1:10,000) can also heart c, traumatic, • Neurologic • Patients should be
IVP for reduce blocks or al: monitored for heart
cardiac bleeding) • Cardia cardiogenic restlessnes rate, cardiac rhythm,
arrest or and c arrest shock s, and blood pressure
heart block mydriasis. • Wide- • Cerebral nervousnes frequently if an IV drip
or • β1- angled arterioscler s, anxiety, is to be infused.
anaphylacti adrenergi Glauco osis tremors, • Never interrupt an
c shock c ma • Coronary headache intravenous infusion
(can also be stimulatio • Topical insufficiency • Respiratory of medication to
given n ly to • 2nd stage : pulmonary administer an IVPB
intraosseou produces control of labor edema or other medication.
s or positive bleedin • Local • Skin: • Extravasation of
endotrache inotropic g (e.g., anesthesia necrosis epinephrine may
al) and nasal of fingers, from cause tissue necrosis
• IV Drip: 1 chronotro hemost toes, ears, vasoconstri to skin. Therefore,
mg pic asis) nose, or ction monitor IV site every
(1:1,000) in effects. A genitalia hour. Have phentola
500 ml NS lso mine close to the
or D5W enhances bedside of the
beginning conductivi patient.
with 1 ty and • MAO inhibitors will
mcg/min irritability counteract the effects
infusion of of epinephrine.
titrated to
 effect (2-10 myocardi • β-adrenergic
mcg/min um. blocking agents will
range) • β2- block the actions of
• Subcutaneo adrenergi epinephrine on the
us c heart.
(SC): adult stimulatio
0.1 – 0.5 mg n
(1:1,000); produces
child 0.01 bronchial
mg/kg relaxation
(1:1,000) for and
bronchospa dilation
sms reversing
• Ophthalmic: bronchos
1-2 drops pasms.
0.25-2%
solution
• Inhalation:
Aerosol 1
inhalation q
4 hr for
bronchospa
sms
• SC for local
anesthetic:
0.001%
(1:100,000)
combined
with local
anesthetic
DRUG NAME ACTION INDICATIONS CONTRAINDICATI SIDE NURSING
ONS EFFECTS/ADVE CONSIDERATIONS
RSE EFFECTS
Magnesium Sulfate • Depresse • Torsade’s de • Myocardial • Flushing • Check serum
s the pointes damage • Sweating magnesium
Classification: central (polymorphic • Heart • Extreme level prior to
Electrolyte nervous ventricular blocks thirst administration.
replacement system tachycardia) • In • Sedation • Cardiac monitor
(anticonvulsant, • Depresse –1st line pregnancy, • Confusio should be used
antidysrhythmic) s skeletal drug of IV n on patients
and choice administrati • Depresse receiving
Dosage: smooth during on during 2 d reflexes MgSO4 intrave
• IV bolus: (for muscles cardiac hours • Flaccid nously.
dysrhythmias • Decrease arrest before paralysis • Have injectable
or s amount • Hypomagne delivery • Respirato form of calcium
hypomagnes of semia • Safety ry gluconate
emia) acetylchol during paralysis available to
ine in pregnancy • Heart reverse
• Torsade’s de neuromus (Category block paralyzing
pointes cular A). effects of
• Cardiac
during synapses magnesium
arrest
cardiac sulfate.
arrest: 1-2 • Blood pressure
gm diluted to may drop if
10 ml with MgSO4 is
D5W IV or IO administered
over 5 – 20 too rapidly.
minutes. • Check blood
• Torsade’s de pressure and
pointes with pulse every 10-
pulse or 15 minutes
hypomagnes during therapy.
emia: 1-2 gm • Normal serum
in 50-100 ml plasma level of
D5W IV MgSO4 is 1.8 –
infusion over 3.0
5 – 60 mEq/L. Respira
minutes. tory paralysis
occurs at 12-15
mEq/L. Cardiac
arrest occurs at
25 mEq/L.
• Assess patellar
reflexes hourly
to monitor for
evidence of
toxicity.
• Monitor hourly
urine output.
• Do not breast
feed while
receiving
MgSO4.
DRUG ACTION INDICATIONS CONTRAINDICA SIDE NURSING
NAME TIONS EFFECTS/ADVERSE CONSIDERATI
EFFECTS ONS
Metoprolol • Primarily • Acute • Bronchosp • Bradycardia, pal • Monitor
blocks β1 adrener coronary astic pitation, cold blood
Classificatio gic receptors on syndrome/my diseases extremities, pressure
n: the myocardium ocardial (e.g., Raynaud's and
Beta- (negative infarction– asthma) phenomenon, apical
adrenergic chronotropic and decreases • Cardiogeni intermittent pulse
blocking negative oxygen c shock claudication, prior to
agent inotropic agent) demand of the • Right intensification of administr
(Antidysrhyt • Blocks myocardium ventricular AV blocks, heart ation.
hmic Drug β2 receptors of • Supraventricul heart failure • Cardiac
Class II) bronchi and blood ar failure • Dizziness, monitor
vessels at higher tachycardias secondary fatigue, should
Dosage: doses (PSVT, atrial to insomnia be used
• PO: fibrillation, pulmonary • Heartburn, on
100 atrial flutter) hypertensi nausea, patients
– [second line on headache receiving
200 drug following • 2nd or 3rd • Laryngospasms, metoprol
mg adenosine] degree respiratory ol IV
daily • Left heart block distress, boluses.
in 2 ventricular • Sinus bronchospasms
divid heart failure bradycardi
ed (better long- a
dose term • Safety
s management during
• IV with lower pregnancy
bolu doses) , lactation
s: 5 • Hypertension or with
mg children
slow not
IVP establishe
at 5- d
minu (Category
te C).
inter
vals
until
total
dose
of 15
mg
DRUG NAME ACTION INDICATIONS CONTRAINDICATI SIDE NURSING
ONS EFFECTS/ADVE CONSIDERATIO
RSE EFFECTS NS
Lidocaine • Blocks Antidysrhythmic medication • Prophylactic • Drowsine • Check BP
sodium for: use in acute ss and
Classification: channels • Ventricular ectopy MI is • Confusion cardiac
Class IB of the (PVC's) contraindica • Paresthes monitor
antidysrhythmic heart's • Stable ventricular ted. ia prior to
agent conductio tachycardia • Idioventricul administr
n system • alternative to ar rhythm ation of
Dosage: • Slows amiodarone • Complete lidocaine.
• Intraveno conductio during pulseless (3rd degree) • For stable
us: 1 – 1.5 n in the ventricular heart block patients,
mg/kg first atria, tachycardia/fibrillatio • Hypersensiti doses
IV push or ventricles, n code vity to should be
intraosse and __amide given
ous during Purkinje anesthetics slow IV
codes; fibers • Safety push at
second • Reduces during 25
dose may automatici pregnancy mg/minut
be 0.5 – ty in the or lactation e.
0.75 ventricles (class B) not • Monitor
mg/kg IV • Raises established. blood
or IO electrical pressure
• IV Drip: 1 stimulatio and
– 4 n cardiac
mg/min threshold monitor
diluted in of the during
D5W or ventricles therapy
NS during with
• (Can be diastole lidocaine.
administer • Accelerat • Assess
ed via es neurologi
endotrach repolariza cal and
eal tube, tion respirator
but not a shortenin y status
preferred g action frequently
route) potential for signs
duration of toxicity.
• (No • When
anticholin treating a
ergic patient for
effects) ventricula
r
dysrhyth
mias with
lidocaine,
an IV
infusion
(drip)
must be
started
soon after
the bolus
or serum
level will
drop
below
therapeuti
c range
and
ventricula
r
dysrhyth
mias will
return.
• Therapeu
tic serum
level is
1.5 – 5
mcg/ml.
• If patient
appears
upset or
agitated,
consider
lidocaine
toxicity. If
toxicity is
evident,
simply
discontinu
e IV
infusion–
serum
levels
drop in
10-20
minutes.
DRUG NAME ACTION INDICATIONS CONTRAINDICATIONS SIDE NURSING
EFFECTS/ADVERSE CONSIDERATIONS
EFFECTS
Procainamide • Blocks Antidysrhythmic • Myasthenia • Dizziness, • Check apical
cardiac medication for: gravis or SLE psychosis pulse, BP,
Classification: sodium • Stable • Hypersensitivity • Hypotension, and cardiac
Class IA channels ventricul to procainamide ventricular monitor prior
antidysrhythmic • Decreas ar or procaine fibrillation, AV to
agent es tachycar • Blood dyscrasias blocks, flushing administratio
conducti dia • 2nd or 3rd • Agranulocytosi n of
Dosage: on • Paroxys degree AV block s with chronic procainamid
• Intravenou velocity mal SVT • Use caution if use, e.
s: 20 in the uncontr renal, cardiac, or thrombocytope • Monitor
mg/min ventricles olled by liver impairment nia blood
slow IV • Delays adenosi is • (PO doses) pressure,
bolus until: myocardi ne or present. Procain bitter taste, QRS
1) al vagal amide may nausea, duration, and
maximum repolariz maneuv precipitate vomiting, QT interval
dose of 17 ation ers hypotension in anorexia, frequently for
mg/kg • Widening • Stable left ventricular diarrhea patients
(around of QRS wide failure or • SLE receiving
600 mg), and QRS impaired Syndrome if procainamid
2) prolonge tachycar function. used for e.
dysrhythmi d QT dia • May cause prolonged • Serum
a is interval • Atrial dysrhythmias in periods > 1 procainamid
suppresse fibrillatio the presence of year e levels
d, 3) n with acute MI, (inflammation should be
hypotensio rapid hypokalemia, or of joints, fever, between 3 –
n ventricul hypomagnesemi pericarditis, 10 mcg/ml
develops, ar rate a. hepatomegaly, • Quinidine is
4) QRS in Wolff- antinuclear preferred
widens > Parkins antibodies = over
50% on- ANA's) procainamid
• IV Drip: 1 White e for long
– 4 mg/min
diluted in syndro • Anticholinergic term
D5W or NS me effects suppression
(tachycardia, of
mydriasis, dysrhythmia
constipation, s due to
urinary probability of
retention)–not SLE
as common as syndrome
with quinidine and blood
dyscrasias.
• Obtain
baseline
cardiac
rhythm strip,
CBC, lab
tests for liver
and renal
functions,
and blood
pressure.
• When
converting
from IV
infusion to
oral doses,
allow 3 hours
after
termination
of infusion
before
administerin
g first oral
dose.
• During
conversion
of atrial
fibrillation,
patient may
develop
thromboemb
olism
(sudden
chest pain,
dyspnea, or
CVA).