Emergency cases
ƒ Labetalol : preferred
ƒ Nitroprusside
ƒ Nifedipine / Verapamil
ƒ Phentolamine
ƒ Since duration of HBP often brief, may not
need treatment
ƒ Note : Pure Beta blockers may cause increased
BP (from unopposed alpha effect)
Medical Therapy in
5. Acute Myocardial Infarction
MONA + BAH
• Morphine (class I, level C)
• Analgesia
• Reduce pain/anxiety—decrease sympathetic tone,
systemic vascular resistance and oxygen demand
• Careful with hypotension, hypovolemia, respiratory
depression
– Hallucinations
– Disorientation
– Tachycardia
– Hypertension
– Low grade fever
– Agitation
– Diaphoresis
Treatment
• **Benzodiazepines-
• Limitations:
Not better than BZDs
Side effects
Cost
Limited data in AW seizures/delirium
Nonpharmacological Treatment
• Quiet environment
• Nutrition and hydration:
Oral thiamine (prevents Wernicke-Korsakoff) /
folic acid
Oral fluids / electrolytes
• Orientation to reality
• Brief interventions / motivate to change
• Referral to AA / relapse prevention tx.
ASTHMA
Symptoms and Signs
Clinical features of acute severe asthma in adults
include:
• Inability to complete sentences in one breath.
• Respiratory rate > 25 per minute.
• Tachycardia (heart rate > 110 per minute).
Clinical features of life threatening asthma in adults
include:
• Cyanosis or respiratory rate < 8 per minute.
• Bradycardia (heart rate < 50 per minute).
• Exhaustion, confusion, decreased conscious level.
Recommended Minimal Emergency
Drugs / Equipment for the Office
ƒ Oxygen masks / nasal prongs
ƒ Reliable O2 tank supply
ƒ Suction catheters : flexible and Yankauer
ƒ IV catheters : 20 g, 18 g (22 g if children treated)
ƒ 500 cc or 1000 cc bags of NS
ƒ IV tubing sets
ƒ Epinephrine 1 : 1000 vials (1 mg per cc)
Optional Meds for Office
Emergencies
ƒ Antihistamines amps
ƒ Alupent or albuterol solution for
aerosols or MDI's
ƒ Hydrocortisone 100 mg amps
ƒ Glucagon 1 mg amps