Download - Drugs used in emergency cases
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DRUGS USED IN EMERGENCY CASES
MAYA FE NG-DARJUAN, MD-RN
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EMERGENCY DRUGS LIST
OXYGEN DRUGS FOR CARDIAC DISORDERS DRUGS FOR POISONING DRUGS FOR SHOCK DRUGS FOR HYPERTENSIVE CRISIS
AND PULMONARY EDEMA
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OXYGEN
w/o OXYGEN - Brain death within 6 min
Pulse oximeter – measures oxygen saturation WHAT’S THE IDEAL O2 SAT?95%
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OXYGEN
for severe physiologic stressShockTraumatic injuryAcute myocardial infarctionCardiac arrest
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OXYGEN
DEVICE: Breathing spontaneously: non- rebreather mask with O2 reservoir
10-15L/minFor those who needs ventillation
Bag-valve mask – 15L/min
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OXYGEN
CAUTION IN COPD PATIENTS
May lose their hypoxic respiratory drive
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OXYGEN
Emergency but no severe stress (angina, arrhythmia)Nasal cannula – 1-6L/minFace tent (high O2 flow) - children
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DRUGS FOR CARDIAC DISORDERS
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DRUGS FOR CARDIAC DISORDERS
NITROGLYCERIN - vasodilatorANGINA PECTORISMYOCARDIAL INFARCTION
SUBLINGUAL – 0.3-0.4 mg to be repeated after 5 min (max: 3 doses)
Translingual aerosol spray – 0.4mg
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DRUGS FOR CARDIAC DISORDERS
NITROGLYCERIN – vasodilatorShould not be use along with Sildenafil (VIAGRA)
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DRUGS FOR CARDIAC DISORDERS
MORPHINE SULFATENarcotic analgesic given for chest pain assoc with MI
Dose: 1-4mg IV over 1-5min to be repeated q 5-30’ until chest pain is relieved
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DRUGS FOR CARDIAC DISORDERS
MORPHINE SULFATE Adverse effects: respiratory
depression and hypotension
NALOXONE (NARCAN)Reverses the action of morphine
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DRUGS FOR CARDIAC DISORDERS
ATROPINE SULFATE Inhibits action of VAGUS nerve for treatment of bradycardia,
asystole and AV block dose: 0.5-1mg q 3-5 min
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DRUGS FOR CARDIAC DISORDERS
ISOPROTERENOL beta adrenergic drug – increase
heart rate – for HYPOTENSION monitor heart rate
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DRUGS FOR CARDIAC DISORDERS
EPINEPHRINE Improves perfusion of the
heart and brain, bronchodilation
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DRUGS FOR CARDIAC DISORDERS
EPINEPHRINE “E” drug for hypotension,
pulseless Vtach, V fibrillation, status asthmaticus
monitor cardiac and hemodynamics
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DRUGS FOR CARDIAC DISORDERS
SODIUM BICARBONATEFor metabolic/respiratory acidotic
statedose: 1meq/kg IV, maybe
repeated at 0.5meq/Kg every 10 min prn
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DRUGS FOR CARDIAC DISORDERS: ANTI-ARRHYTHMICS
ADENOSINE VERAPAMIL DILTIAZEM LIDOCAINE AMNIODARONE PROCAINAMIDE
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DRUGS FOR NEURO-SURGICAL DISORDERS : INCREASE ICP
MANNITOLOsmotic diuretic – for cerebral
edema may inc ICP initial dose – 0.5-1g/kg IV of 25%
solutionNote: highly irritating to the veins
forms crystals
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METHYLPREDNISOLONEIndication: spinal cord
injury/cerebral edema
Contraindications: HIV infection pregnancy Uncntrolled diabetes
DRUGS FOR NEURO-SURGICAL DISORDERS : INCREASE ICP
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Poisoning
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Poisoning: Ingested Poisons May be corrosive (alkaline and acid
agents that cause tissue destruction) Alkaline products: Lye, drain and
toilet bowl cleaners, bleach, non-phosphate detergents, button batteries
Acid products: toilet bowl and metal cleaners, battery acid
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Poisoning Management Control the airway, ventilation and
oxygenation. ECG, VS, and neurologic status
monitored for changes. Note for
amount time since ingestion signs and symptoms age and weight health history are determined.
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Poisoning Management
Insert Foley catheter - to monitor renal function
blood examinations - test for poison concentration
Treat SHOCK
Poisoning Management
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Poisoning ManagementIngestion of corrosive poison give water or milk - for dilution
not attempted if patient has acute airway obstruction, or if with evidence of gastric or esophageal burn or perforation.
Ipecac syrup - induce vomiting in the alert patient
Gastric lavage for the obtunded patient aspirate is tested
Activated charcoal administration if poison can be absorbed by it
Cathartic - when appropriate
Poisoning Management
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Ingested Poison Warnings!!!
Vomiting is NEVER induced after ingestion of caustic substances or petroleum distillates.
Contact poison control center - PGH if an unknown toxic agent has been taken if it is necessary to identify an antidote for
a known toxic agent.
Poisoning Management
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National Poison Control & Information ServicePhilippine General Hospital, ManilaTel. No. (02) 524-1078 (Hotline) (02) 521-8450 Local 2311
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1. NALOXONE – anti-dote for opiates overdose
2. FLUMAZENIL – reverses respiratory depression secondary to benzodiazepines
3. ATROPINE - reverses organophosphate poisoning
Poisoning Management
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DRUGS FOR SHOCK
DOPAMINE DOBUTAMINE NOREPINEPRHINE EPINEPHRINE ALBUTEROL
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Epinephrine: α-adrenergic effects can increase
coronary and cerebral perfusion pressure by vasoconstriction
β-adrenergic can increase myocardial contractility
Given 1 mg per IV/IO every 3-5 minutes
DRUGS FOR SHOCK
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DRUGS FOR SHOCK: DOPAMINE
Sympathomimetic For hypotension (shock) It can increase heart rate when
atropine has not been effective Dose: 1-20mcg/kg/min (in 250ml D5W)
Wean patient gradually – can result to severe hypotension if abruptly stopped
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DRUGS FOR SHOCK: DOPAMINE
Assess IV site q1 hrExtravasation can lead to tissue necrosis
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DRUGS FOR SHOCK: DOBUTAMINE
sympathomimetic with beta 1 effects (inc. heart rate)
no vasoconstriction, only increase cardiac output
dose: 250-1000mg in 250ml D5W or NSS
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DRUGS FOR SHOCK:
NOREPINEPRHINE AN EXTREMELY POTENT
VASOCONSTRICTOR GIVEN WHEN DOPAMINE AND
DOBUTAMINE HAVE FAILED DOSE: 4-8mg to 250ml D5W or
NSS and infused at 0.5-30mcg/min
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DRUGS FOR SHOCK: DOPAMINE
Assess IV site q1 hrExtravasation can lead to tissue necrosis
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ANAPHYLACTIC SHOCK
ALBUTEROL Reverses bronchoconstriction administered via nebulizer side effects: tremors,
tachycardia, dysrhythmia, hypertension
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ANAPHYLACTIC SHOCK
DIPHENHYDRAMINEAnti-histamineReduce histamine induced
tissue swelling and pruritus25-50mg IV or deep IM
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DRUGS FOR HYPERTENSIVE CRISIS
Diastolic pressure that exceeds 110-120mmHg and pulmonary edema
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DRUGS FOR HYPERTENSIVE CRISIS
LABETALOLBeta blockerLowers heart rate, BP, myocardial
contractility, and myocardial O2 consumption
Dose: 10mg IV push for 1-2 min(max dose: 150mg)
Contraindicated in patients with Asthma
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DRUGS FOR HYPERTENSIVE CRISIS
SODIUM NITROPRUSSIDEReduces arterial BPEffect: immediate vasodilation
and BP goes down but immediately goes up once the drug is stopped
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DRUGS FOR HYPERTENSIVE CRISIS
SODIUM NITROPRUSSIDE inactivated by light – wrap in
aluminum foilBlue or brown discoloration –
means drug is degraded prolonged use – can lead to
cyanide poisoning
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DRUGS FOR HYPERTENSIVE CRISIS
FUROSEMIDE loop diuretic For acute pulmonary edema due
to left ventricular dysfunction or hypertensive crisis
diuresis may start within 20 mins
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DRUGS FOR HYPERTENSIVE CRISIS
FUROSEMIDEAdverse effects:
hypotension, dehydration and electrolyte imbalances
can result to allergic reaction
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THE END