Emergency medicines

 

1. DEXTROSE 

Dextrose 10%(D10%) + Dextrose 50%(D50%)

Indications:

Treatment of hypoglycemia.

Contraindications:

Contraindicated in documented hypersensitivity, Severe dehydration 

Not contraindicated in pregnancy and breastfeeding

Dosage/How to administer:

A. ADULTS:

IV: 20-50 ML of 50% (D50%) solution or 40-10 ML of 10 % (D10%) solution.

PO: 4-20g as a single dose.

B. PEDIATRICS:

Dilute before IV administration.

<6 months: 0.25-0.5g/kg/dose (1-2ML/kg/dose of D10% solution) IV.

infants >6 months and children: 0.5-1g/kg/dose (2-4ML/kg/dose of D10% solution) IV.

Adolescents:

IV: 20-50 ML of 50% (D50%) solution or 40-10 ML of 10 % (D10%) solution.

PO: 4-20g as a single dose.

2. ADRENALINE

Epinephrine.

0.1mg/ML (1mg/10ML) Solution or 1mg/ML solution available

Indications:

Cardiac arrest, Hypotension associated with septic shock, Anaphylaxis, Mydriasis 

Contraindications:

There is no contraindication for a life-threatening situation

Non anaphylactic shock 

Narrow-angle glaucoma

Not contraindicated in pregnant and breastfeeding women

Dosage/How to administer:

A. ADULTS:

Cardiac arrest (IV):

Recommended dose: 0.5-1mg (5-10 ML)

During resuscitation: 0.5mg(5ML) q5min

Hypotension associated with septic shock:

Recommended dose: 0.05-2mcg/kg/minute IV infusion

Anaphylaxis:

Indicated for treatment of allergic reaction (Type 1).

• 0.1mg/ML Solution: 0.1 mg IV at a rate of 4mcg/min for 5 min.
• 1mg/ML Solution: 0.3-0.5 mg (0.3-0.5 ML) SC /IM once.

Symptomatic bradycardia:

Unresponsive to atropine or pacing 

2-10mcg/min IV or 0.5-0.1mcg/kg/min IV

B. PEDIATRICS

Anaphylaxis:

Indicated for treatment of allergic reaction (Type 1).

• 1mg/ML Solution:

<30kg: 0.01mg/kg(0.01 ML/kg) SC/IM

>30kg: 0.3-0.5mg (0.3-0.5 ML) SC/IM

Asystole / Pulseless arrest:

• 0.1mg/ML solution: 0.01mg/kg (0.1 ML/kg) IO/IV, q3-5min PRN.

Symptomatic bradycardia:

• 0.1mg/ML solution: 0.01mg/kg IO/IV, repeat q3-5min.
• 1mg/ML solution: 0.1mg/kg (0.1 ML/kg) of endotracheal, q3-5min PRN.
• Neonate, 0.1mg/ML solution: 0.01-0.03mg/kg (0.1-0.3 ML/kg) IVP, repeat q3-5min.

3. MORPHINE

Tablet, Solution, Suppository, or injection both available

Indications:

For treatment of acute pain or chronic severe pain.

Contraindications:

Avoid use for extended periods in pregnant women.

Major side effects (>10%):

Pruritis, Urinary retention, Vomiting, Constipation, Headache, Somnolence

Dosage/How to use:

A. ADULTS:

Acute pain:

Tablet: 15-30mg PO q4hr PRN.

Oral solution: 10-20mg q4hr PRN.

Suppository: 10-20mg q4hr PRN.

IM/SC: 5-10mg q4hr PRN.

IV: 2.5-5mg q3-4hr PRN.

Chronic pain: 15-30 mg q8hr-12hr PO 

B. PEDIATRICS:

Analgesia/Cyanotic Tetralogy of Fallot (TOF):

Neonates: 0.3-1.2 mg/kg/day IM/SC q4hr

Infant & Children (PO solution): 0.2-0.5mg/kg PO q4-6hr PRN.

Infant & Children (SC/IM): 0.05-0.2mg/kg q2-4hr PRN.

Pain:

Continuous infusion:0.025-0.6 mg/kg/hr IV.

Neonate: 0.01-0.02mg/kg/hr IV.

Post-operative: 0.01-0.04 mg/kg/hr IV.

Sickle cell disease or cancer:0.04-0.07 mg/kg/hr IV.

4. NALOXONE

Injectable and solution available

Indications:

Opioid antagonist, Opioid reversal agent 

Contraindication:

Hypersensitivity 

No known contraindications in pregnancy or breastfeeding.

Dosage/How to administer:

A. ADULTS:

Opioid overdose (Respiratory depression): 0.4-2mg/kg IV/IM/SC; repeat q2-3min PRN.

Respiratory depression with therapeutic opioid overdose:

0.04-0.4mg/kg IV/IM/SC, may repeat until the desired response is achieved.

Postoperative opioid overdose:

0.1-0.2mg IV q2-3min to the desired degree of reversal.

B. PEDIATRICS:

Acute opioid overdose:

<20kg or < 5 years: 0.1mg/kg/dose IV/IM/SC, may repeat q2-3 min PRN 

>20kg or > 5 years: 2mg IV/IM/SC/ET, may repeat q2-3 min PRN.

Post anesthesia acute opioid overdose:

Neonate: 0.01mg/kg IV/IM/SC

Children: 0.01mg/kg IV/IM/SC Once, may repeat with 0.1mg/kg

Respiratory depression with therapeutic opioid overdose: 

0.001-0.015mg/kg IV.

5. ATROPINE

Anesthetic premedication agents, cholinergic, toxicity antidotes.

Indications:

Anesthetic premedication agents, cholinergic, toxicity antidotes, Sinus bradycardia, Bronchospasm, Organophosphate or carbamate intoxication.

Contraindications:

No absolute contraindications.

No known contraindications in pregnancy or breastfeeding.

Dosage/How to use:

A. ADULTS:

Anesthesia premedication: 0.4-0.6 mg IV/IM/SC 30-60 min before anesthesia.

Sinus bradycardia: 0.5-1mg IV or 0.04mg/kg IV q5min.

Bronchospasm: 0.025 mg/kg in 2.5ml NS q6-8hr via nebulizer.

Organophosphate poisoning:

IM: Administer 1 injection(2mg) IM and wait 10-15 min for the drug to take effect.

B. PEDIATRICS:

Anesthesia premedication: 

• <5kg:0.02 mg/kg/dose IV/IM/SC 30-60 min before anesthesia, then q4-6hr PRN.
• >5kg: 0.01-0.02 mg/kg IV/IM/SC 30-60 min before anesthesia.

Sinus bradycardia: 0.02mg/kg IV/IO q5min for 2-3 doses PRN.

Bronchospasm: 0.025-0.05 mg/kg in 2.5ml NS q6-8hr via nebulizer.

Organophosphate poisoning:

IV:003-0.05mg/kg IV/IM/IO/ET q10-20min PRN to effect, then q1-4hr for at least 24 hours.

6. HYDROCORTISONE

Indications:

Inflammation, status asthmatics, Acute adrenal crisis, chronic adrenal insufficiency, allergies, ...

Contraindications:

No known contraindications in pregnancy or breastfeeding.

Dosage/How to use:

A. ADULTS:

Status asthmatics:

1-2mg/kg IV q6hr initially for 24 hrs, maintenance: 0.5-1mg/kg q6hr.

Other conditions:

Usual PO dosing range:10-320 mg/day q6-8hrs.

Usual IM/IV dosing range: 100-500mg PRN initially, may be repeated q2hr, q4hr, or q6hr.

B. PEDIATRICS:

Inflammation:

<12 years: 2.5 -10mg/kg/day PO divided q6-8hr

>12 years: 

• 20-240mg PO qDay
• 100-500 mg/dose IV/IM q2hr, q4hr, or q6hr

Status asthmaticus:

1-2 mg/kg iv q6hr for 24 hr. 

IV maintenance: 2 mg/kg/day IV q6hr.

PO maintenance: 0.5-1 mg/kg IV q6hrs.

7. DEXAMETHASONE

Indications:

Inflammation, multiple sclerosis, cerebral edema, shock, Allergic conditions, airway edema, croup, meningitis, respiratory distress syndrome in prematurity

Contraindications:

 Contraindications in pregnancy or breastfeeding. Consult Doctor before use

Dosage/How to use:

A. ADULTS:

Inflammation:

0.75-9mg/day IV/IM/PO q6-12hrs.

Cerebral edema:

10mg IV, then 4mg IM q6hr until clinical improvement.

Shock:

1-6mg/kg IV once or 40 mg IV q2-6hr PRN.

B. PEDIATRICS:

Airway edema:

0.5-2mg/kg/day PO/IV/IM q6hr.

Croup:

0.6 mg/kg PO/IV/IM once.

Inflammation:

0.08-0.3 mg/kg/day IV/PO/IM q6hr or q12hr.

Meningitis:

>6 weeks: 0.6mg/kg/day IV q6hr for first 2-4 days of antibiotics.

Cerebral edema due to brain tumor:

1-2 mg/kg IV/IM once, then maintenance: 1-1.5 mg/kg/day IV/IM q4-6hrs

Respiratory distress syndrome in premature infants:

Prophylaxis: 4mg IM q8hr administered to mother for 2 days before delivery.

8. Tranexamic acid 

Injectable solution 100mg/ML or Tablet 500mg

Indications:

Prevention of bleeding disorders

Contraindications:

Hypersensitivity, Acquired defective color vision, Subarachnoid hemorrhage.

There is no associated risk during second and third trimester and lactation  

Dosage/how to use:

A. ADULTS & CHILDREN: 

Dental extraction in patient with hemophilia:

IV:10mg/kg IV immediately before surgery or 10mg/kg IV q6-8h 1 day before surgery.

PO:25mg/kg PO q6-8hr 1day pre surgery and 2-8days post-surgery.

9. SALBUTAMOL

Indications:

Bronchospasm 

Contraindications:

Hypersensitivity to albuterol 

Severe hypersensitivity to milk proteins.

No known contraindications in pregnancy or breastfeeding.

Dosage/How to use:

A. ADULTS:

Bronchospasm:

Nebulize solution: 2.5 mg BID OR TID PRN for quick relief.

Aerosol metered-dose inhaler: 180mcg (2 puffs) inhaled PO q4-6hr.

Tablet and syrup: 2-4 mg PO q6-8hr.

Acute or severe bronchospasm:

Nebulizer solution: 2.5- 5mg q20min for 3 doses, followed by 2.5-10 mg q1-4hr PRN.

Metered-dose inhaler: 4-8 pudds inhaled q20min for up to 4hr and then q1-4hr PRN.

B. PEDIATRICS:

Bronchospasm:

Aerosol metered dose inhaled:

< 4 years: safety not established

>=4 years: 1-2 puffs inhaled PO q4-6hr.

Nebulizer solution:

<2 years: 0.2-0.6 mgkg/day q4-6hr

2-12 years and < 15 kg: 2.5 mg/0.5ml (0.5% solution) q6-8hr.

2-12 years and >15 kg: 2.5 mg/3ml q6-8hr

>12 years: 2.5mg q6-8hr PRN.

10. DIAZEPAM

 

Indications:

Anti-anxiety agent, muscle relaxant, antiseizure/Anti convulsions.

Contraindications:

Documented hypersensitivity, Acute narrow-angle glaucoma, and open-angle glaucoma.

Have some effects on neonates born from mothers who have been using diazepam.

Dosage/How to use:

A. ADULTS:

Muscle spasm:

2-10 mg PO q6-8hr PRN, OR 

Initially, 5-10 mg IV/IM, then 5-10 mg q3hr.

Seizure/convulsion disorder:

• Diazepam(rectal):0.2mg/kg PR or 10-20 mg as single dose.

Status epilepticus:

• IV:5-10 mg initially (IV preferred), may repeat at 10-15 min with a maximum dose of 30mg.
• Rectal:0.2-0.5 mg/kg PR.

B. PEDIATRICS:

Potentially toxic dose in patients < 6 years.

Sedative/muscle relaxant:

• <6 years: not recommended
• > 6 years: 1-2.5 mg PO q6-8hr or 5-10mg (0.04-0.2mg/kg) IV/IM q3-4hr.

Seizure/Convulsion disorder:

• <2 years: not recommended.
• 2-6 years (Per rectal): 0.5 mg/kg PR (Potentially toxic > 0.5mg/kg).
• 6-12 years (PR): 0.3mg/kg PR.
• >12 years: 0.2mg/kg PR.

Status epilepticus:

PR:

• 2-6 years: potentially toxic 
• 6-12 years: 0.3mg/kg, may repeat in 4-12 hrs PRN 
• >12 years: 0.2mg/kg, may repeat in 4-12 hrs PRN

IV: 

• <6 years: potentially toxic.
• >6 years: 1mg IV given slowly every 2-5min.

11. PHENOBARBITAL 

Indications: 

Anticonvulsant, barbiturates

Contraindications:

Hypersensitivity, porphyria, intra-arterial or subcutaneous administration, severe hepatic failure, dyspnea.

Generally acceptable in pregnancy and breastfeeding. But you may consult your doctor before use

Dosage/How to use:

A. ADULTS:

Status epilepticus:

• 15-20mg/kg IV loading dose infused at 25-100mg/min. may repeat after 10 Mn with an additional 5-10mg/kg.

Seizures:

• 1-3mg/kg/day PO/IV in 1-2 divided doses.

B. PEDIATRICS:

Status epilepticus:

• Infants and children: 15-20mg/kg IV loading dose at 2mg/kg/min rate. if <60kg: IV rate is at <30mg/min.
• May repeat with 5-10mg/kg Bolus dose after 15-30 mi PRN.

Seizures:

• Infants: 5-6mg/kg/day IV/PO 1-2 divided dose.
• 1-5 years: 6-8mg/kg/day IV/PO in 1-2 divided dose
• 6-12 years:4-6mg/kg/day IV/PO 1-2 divided dose.
• >12 years: 1-3mg/kg/day IV/PO 1-2 divided dose.

Neonatal seizure:

• Loading dose (in 15 min): 15-20mg/kg IV. May repeat after 15min 15-20mg/kg.
• Maintenance dose:1.5 mg/kg IV q8hr or 2.25 mg/kg IV q12hr for up to 5 days.

Hyperbilirubinemia:

• Neonate: 5mg/kg/day PO/IV qDay, or q12hr for 3-6 days.
• <12 years (chronic cholestasis): 1.5-4 mg/kg po q12hrs.

BEST ASTHMA MEDICATIONS

1. SERETIDE SPRAY EVOHALER

Salmeterol + Fluticasone (25mcg / 50mcg, 25mcg / 125mcg, 25mcg / 250mcg).

Indications:

Used in treating asthma where long-acting beta 2 agonists and inhaled corticosteroids are appropriate.

Contraindications:

It is contraindicated in pregnancy unless the benefits outweigh the risks.

Dosage/How to use:

Adults and Adolescents>12 years: 2 puffs twice daily.

2. SERETIDE DISKUS

Salmeterol + Fluticasone (50mcg/100mcg, 50mcg/250mcg, 50mcg/500mcg).

Indications:

Used in treating asthma where long-acting beta 2 agonists and inhaled corticosteroids are appropriate.

Contraindications:

It is contraindicated in pregnancy unless the benefits outweigh the risks.

Dosage/How to use:

Adults and Adolescents>12 years: 1 puff twice daily.

3. SYMBICORT TURBUHALER

Formoterol 4.5mcg + Budesonide 160mcg

Indications:

Used in treating asthma where long-acting beta 2 agonists and inhaled corticosteroids are appropriate.

Contraindications:

It is not contraindicated in pregnancy and breastfeeding. Consult the Doctor before use.

Dosage/How to use:

Symbicort maintenance therapy:
Adults & Adolescents>12 years: 1-2 inhalations twice daily.
Symbicort maintenance therapy and relief therapy:
Adults & Adolescents>12 years: 2 inhalations twice daily.

Ask a Doctor for medical advice