Mastering Emergency medications

Mastering emergency medications

 

List of some common emergency medications along with their dosages and dilutions for different conditions:

Epinephrine (Adrenaline)

Indications: Anaphylaxis, cardiac arrest, asthma exacerbation

• Anaphylaxis:
• Adult: 0.3-0.5 mg IM, repeated every 5-15 minutes as needed.
• Pediatric: 0.01 mg/kg IM, up to a maximum of 0.3 mg per dose, repeated every 5-15 minutes as needed.
• Concentration: 1 mg/mL (1:1,000)
• Cardiac Arrest:
• Adult: 1 mg IV/IO every 3-5 minutes during resuscitation.
• Pediatric: 0.01 mg/kg IV/IO every 3-5 minutes during resuscitation.
• Concentration: 0.1 mg/mL (1:10,000)
• Asthma Exacerbation:
• Adult: 0.3-0.5 mg IM or SC every 20 minutes for up to 3 doses.
• Pediatric: 0.01 mg/kg IM or SC, up to a maximum of 0.3 mg per dose, every 20 minutes for up to 3 doses.
• Concentration: 1 mg/mL (1:1,000)

Norepinephrine (noradrenaline) is primarily used in the management of acute hypotension and shock. Here’s a summary of its dosage and dilution for different conditions:

Acute Hypotension and Shock (e.g., Septic Shock)

• Adult Initial Dose: 8-12 mcg/min IV infusion.
• Adult Maintenance Dose: 2-4 mcg/min IV infusion, titrated to desired blood pressure and clinical response.
• Pediatric Dose: Initial dose of 0.05-0.1 mcg/kg/min IV infusion, titrated to desired effect, with typical doses ranging from 0.05 to 2 mcg/kg/min.

Dilution Guidelines

• Norepinephrine is typically available in a concentration of 1 mg/mL (4 mg in 4 mL ampoule or vial).
• For IV infusion, dilute the desired amount of norepinephrine in 5% dextrose or 0.9% normal saline.

Example Dilutions:

1. 4 mg in 250 mL of 5% dextrose or normal saline: This results in a concentration of 16 mcg/mL.
2. 8 mg in 500 mL of 5% dextrose or normal saline: This results in a concentration of 16 mcg/mL.

Administration

• Administer norepinephrine via a central venous line whenever possible to avoid the risk of extravasation and subsequent tissue necrosis.
• Continuous blood pressure monitoring is essential to adjust the dosage and ensure the desired therapeutic effect.
• If extravasation occurs, local infiltration with phentolamine is recommended to mitigate tissue damage.

Dobutamine is a sympathomimetic drug primarily used in cases of heart failure and cardiogenic shock to improve cardiac output. Here’s a summary of its dosage and dilution for different conditions:

Heart Failure and Cardiogenic Shock

• Adult Initial Dose: 2-5 mcg/kg/min IV infusion.
• Adult Maintenance Dose: 2-20 mcg/kg/min IV infusion, titrated according to the patient’s response. In some cases, doses up to 40 mcg/kg/min may be used.
• Pediatric Dose: 0.5-1 mcg/kg/min IV infusion initially, titrated up to 20 mcg/kg/min based on clinical response.

Dilution Guidelines

Dobutamine is typically available in a concentration of 12.5 mg/mL (20 mL vial).

Example Dilutions:

1. For adults:
• Add 250 mg (20 mL) of dobutamine to 230 mL of 5% dextrose or normal saline, resulting in a final volume of 250 mL with a concentration of 1,000 mcg/mL.
• Alternatively, add 500 mg (40 mL) of dobutamine to 460 mL of 5% dextrose or normal saline, resulting in a final volume of 500 mL with a concentration of 1,000 mcg/mL.
2. For pediatrics:
• Adjust the dilution proportionally to achieve a suitable concentration for the desired infusion rate. For example, add 50 mg (4 mL) of dobutamine to 196 mL of 5% dextrose or normal saline, resulting in a final volume of 200 mL with a concentration of 250 mcg/mL.

Administration

• Administer dobutamine via a central venous line or a large peripheral vein to reduce the risk of extravasation.
• Start with a lower dose and titrate gradually while monitoring the patient’s hemodynamic response, including blood pressure, heart rate, and cardiac output.
• Continuous ECG and blood pressure monitoring are recommended during infusion.

Atropine

Indications: Bradycardia, organophosphate poisoning

• Bradycardia:
• Adult: 0.5 mg IV every 3-5 minutes, up to a maximum of 3 mg.
• Pediatric: 0.02 mg/kg IV, with a minimum dose of 0.1 mg and a maximum single dose of 0.5 mg for children and 1 mg for adolescents.
• Concentration: 0.1 mg/mL or 1 mg/mL
• Organophosphate Poisoning:
• Adult: 2-6 mg IV or IM initially, then 2-6 mg every 5-15 minutes until atropinization.
• Pediatric: 0.05 mg/kg IV or IM, repeated every 10-30 minutes until atropinization.
• Concentration: 0.1 mg/mL or 1 mg/mL

Naloxone (Narcan)

Indications: Opioid overdose

• Adult: 0.4-2 mg IV/IM/SC every 2-3 minutes as needed, up to a total of 10 mg. For intranasal administration, 4 mg (1 spray) in one nostril, may repeat every 2-3 minutes.
• Pediatric: 0.1 mg/kg IV/IM/SC, up to a maximum of 2 mg per dose, may repeat every 2-3 minutes.
• Concentration: 0.4 mg/mL or 1 mg/mL

Magnesium Sulfate

Indications: Torsades de pointes, eclampsia, asthma exacerbation

• Torsades de Pointes:
• Adult: 1-2 g IV over 15 minutes.
• Pediatric: 25-50 mg/kg IV over 10-20 minutes, up to a maximum of 2 g.
• Concentration: Typically 500 mg/mL
• Eclampsia:
• Adult: 4-6 g IV over 20 minutes, followed by a continuous infusion of 1-2 g/hour.
• Concentration: Typically 500 mg/mL, diluted in D5W or normal saline for infusion.
• Asthma Exacerbation:
• Adult: 2 g IV over 20 minutes.
• Pediatric: 25-50 mg/kg IV over 10-20 minutes, up to a maximum of 2 g.
• Concentration: Typically 500 mg/mL

Sodium Bicarbonate

Indications: Metabolic acidosis, hyperkalemia, tricyclic antidepressant overdose

• Metabolic Acidosis:
• Adult: 1 mEq/kg IV bolus, followed by 0.5-1 mEq/kg every 10 minutes based on arterial blood gases.
• Pediatric: 1 mEq/kg IV bolus.
• Concentration: 1 mEq/mL (8.4%)
• Hyperkalemia:
• Adult: 50 mEq IV over 5 minutes.
• Pediatric: 1 mEq/kg IV.
• Concentration: 1 mEq/mL (8.4%)

Calcium Gluconate

Indications: Hypocalcemia, hyperkalemia, calcium channel blocker overdose

• Hypocalcemia:
• Adult: 1-2 g IV over 10-20 minutes.
• Pediatric: 60-100 mg/kg IV over 5-10 minutes.
• Concentration: 100 mg/mL (10% solution)
• Hyperkalemia and Calcium Channel Blocker Overdose:
• Adult: 1-3 g IV over 5-10 minutes.
• Pediatric: 60-100 mg/kg IV over 5-10 minutes.
• Concentration: 100 mg/mL (10% solution)

Diazepam (Valium)

Indications: Seizures, anxiety, muscle spasms

• Seizures:
• Adult: 5-10 mg IV, repeated every 10-15 minutes as needed, up to a maximum of 30 mg.
• Pediatric: 0.2-0.5 mg/kg IV every 2-5 minutes, up to a maximum of 5 mg for infants and 10 mg for children.
• Concentration: 5 mg/mL

Dextrose

Indications: Hypoglycemia

• Adult: 25-50 mL of 50% dextrose (D50W) IV.
• Pediatric: 0.5-1 g/kg of 25% dextrose (D25W) IV for children, or 10% dextrose (D10W) IV for neonates.
• Concentration: D50W (50%), D25W (25%), D10W (10%)

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