Emergency

DRUGS

Epinephrine
Indication
VF, pulseless VT, PEA, or asystole
1 mg I.V push every 3-5 min
Intermediate dosing: 2-5 mg IV push over 3-5 min
Escalating dosing: 1mg, 3mg, 5 mg IV push 3 min
apart
High dosing: ,1 mg/kg IV push every 3 5 min
Symptomatic Bradycardia: continous infusion at 2-10
mcg/min

Nsg. consideration
Each dose is followed by 20 mL iv fluid flush.
Can be given via ET tube 2-2.5 x the IV dose,
followed with 10 mL Flush PNSS
IC when no other route is available
It increases systemic vascular resistance, BP,
Cardiac elec. Activity, strenth of contraction,
automaticity, and myocardial O2 requirement

Lidocaine
Indication

VF or Pulseless VT: Initially 1-1.5 mg/kg IV

push: every 3-5 mins, max of 3mg/kg

Stable VT or Stable wide-complex

tachycardia: repeat doses are half the original
dose.
If lidocaine succesfully converts the VF/VT:
begin continous infusion at 2-4 mg/min

Nsg consideration
Toxicity( Slurred speech, altertered LOC, Muscle
twitching, and seizures), stop the drug/reduce
dose
Via ET: 2-2.5 times the iv dose, flush with 10 ml
PNSS
Dont give if PVC occurs with bradycardia or
escape rhythm.
No longer recommended for VT/VF prophylaxis
in acute MI

Atropine
Symptomatic Bradycardia
.5-1 mg iv push q 3-5 min, not to exceed .04 mg/kg

Asystole/PEA
1 mg iv push q 3-5 min, not to exceed a total dose
of .04mg/kg

Nsg consideration
Dont give less than .5 mg dose may further
slow heart rate
Via ET: dilute 1-2 mg in 10 mL sterile water of
PNSS, flush with 10 mL PNSS

Adenosine
PSVT or wide-complex tachycardia:
Initially 6 mg rapid iv push; if no response in 1-2
min, give 12 mg iv push; may be followed by a
third 12 mg dose given in 1-2 min.

Nsg consideration
Given rapidly over 1-3 sec ( half life is 5 sec)
Follow dose with a 20 ml PNSS flush
If methylxanthines, dipyridamole and
carbamazepine are present higher dose may be
needed
A brief period of Asystole is common after
administration

Bretylium
VF/ of pulseless VT unresponsive to
defibrilation, epi and lido
5mg/kg iv push; is arhythmia persists, increase to
10 mg/kg q 5-10 min, to a max dose of 35 mg/kg

Stable VT or Stable wide-complex tachycardia:

5-10 mg/kg over 8-10 min, to max 35 mg/kg over
24 hrs, if loading dose converts arhythmia start
infusion of 2 mg/min.

Dobutamine
Heart Failure
2-20 mcg/kg/min

Nsg considerations
May cause tachycardia and other arhythmias, BP
fluctuations, nausea and hypokalemia
Monitor heart closely; increases in heart heart
rate more than 10% may induce or exacernate
Myocardial Ischemia

Dopamine
Hypotension c symptomatic bradycardia, heart
failure or after spontaneous return of circulation
Initially, 1-5 mcg/kg/min; max is 20 mcg/kg/min
Enhances renal blood flow 1-2 mcg/kg/min

Nsg consideration
May induce tachycardia, - dose
reduction/withdrawal
Extravasation may cause severe tissue sloughing and
necrosis
Norepinephrine should be added is more than max
dose is needed to maintain BP
Use slowest infusion first
Can exacerbate pulmonary congestion and
compromise cardiac output
Eliminate hypovolemia as a cause of hypotension
before treating

Magnesium
VF/VT with hypomagnesemia
1-2 grams diluted in 10 mL D5W given IV push
over 1-2 min

Torsades de pointes: 5-10 grams iv

Acute MI with hypomagnesemia
Intermitent of continous infusions

Nsg consideration
Flushing, sweating, mild bradycardia, and
hypotension may develop from rapid
administration in non arrest situations

Procainamide
PVCs or recurrent VT with pulse
Initially, 20 mg/min until

Hypotension occurs
QRS complex
PR interval
QT interval is widened by 50 %
Total of 17mg/kg of the drug was administered

Maintenance infusion 1-4 mg/min

Nsg consideration
Monitor BP closely during administration; may
cause precipitous hypotension, infuse cautiously
in patients with acute MI
Contraindicated in patients with preexisting long
QT intervals and torsades de pointes

 Torsades de pointes, or simply torsades is a

French term that literally means "twisting of the
points". It was first described by Dessertenne in
1966[1] and refers to a specific, rare variety of
ventricular tachycardia that exhibits distinct
characteristics on the electrocardiogram (ECG).
Characteristics
Rotation of the heart's electrical axis by at least 180
Prolonged QT interval (LQTS)
Preceded by long and short RR-intervals
Triggered by an early premature ventricular
contraction (R-on-T PVC)

Toxicology
Poisoning

Occurrence of Poisoning
Unintentional
Intentional

Most common poisons

Unintentional
Intentional

Antidotes Used In Toxicology

Antidote

Toxin

Special Info

Botulinum Antitoxin

Botulism

Given for confirmed

cases. Several types
available. Must
obtain from CDC

Deferoxamine

Iron

Based on levels and

symptomatology

Digibind/Digoxin Fab Digoxin

Fragments

Used for severe

toxicity

Flumazenil

Use with caution,

many
contraindications

Benzodiazepines

Antidotes Used In Toxicology

Antidote

Toxin

Special Info

Glucagon

Beta Blockers

Used with significant

symptoms

NAC/Mucomyst/NAcetylcysteine

Acetaminophen

Given diluted orally.

IV route not FDA
approved

Naloxone
Nalmefene

Opiates, Clonidine

Short- acting.
Longer-acting.

Octreotide

Sulfonylureas

Inhibits growth
hormone and insulin
secretion

Antidotes Used In Toxicology

Antidote

Toxin

Special Info

Physostigmine

Anti-cholinergics

Used only in rare and

severe poisonings

Protamine Sulfate

Heparin

In severe overdose
and marked lab
indications

Pyridoxine

Isoniazid

Dose often
dependent on
amount INH ingested

Vitamin K 1

Anticoagulants/Rat
Poisons/Warfarin

Given

Emergency
DRUGS