EMERGENCY MEDICINES Dr Mohan Kumar M S Ay

EMERGENCY MEDICINES Dr. Mohan Kumar M. S (Ay. )

ADRENALINE • The substance is adrenaline tartarate which is manufactured under the trademark of adrenaline. DOSE: • 0. 2 -0. 5 ml S/C or I/M • 0. 25 ml dil in saline slow I/V • 0. 5 ml intracardiac

INDICATIONS: • • • Allergic reactions Acute attack of bronchial asthma Cardiac arrest Homeostasis Along with local anesthetic To have bloodless field

ADVERSE REACTIONS • Palpitations , tremors, pallor, headache • If injected rapidly or I/V causes marked increase in BP • Ventricular arrhythmias • Acute pulmonary edema • Anginal pain

NOR ADRENALINE It is available as 0. 2% sol in 2 ml ampules. DOSE: • 2 ml of noradrenalin+1000 ml of 5% dextrose and administer at the rate of 0. 5 ml/minute • 2 ml of noradrenalin+N/S+vit C

INDICATIONS: • Treatment of hypotension of circulatory failure SIDE EFFECTS: • • • Palpitations, tremors, pallor, headache Ventricular arrythmias Acute pulmonary edema Anginal pain Extravasation in S/C tissues causes necrosis of skin

DOPAMINE DOSE: • It is available in 5 ml ampoules each containing 40 mg/ml solution INDICATIONS: • • Hypotension to increase peripheral circulation Open heart surgery Renal failures Cardiac failure

ADVERSE EFFECTS • It should be administered via central vein, extravasation may cause local ischemia • We should stop or decrease the dosage if the urine output is diminishing, tachycardia, or arrythmias.

PROPRANOLOL • It is available in 1 mg/ml ampoule INDICATIONS: • • Thyrotoxic crises Pheochromocytoma Cardiac arrythmias Acute MI

ADVERSE EFFECTS • Congestive heart failure, bradycardia, aggravation of A-V conduction defect • Bronchospasm • Hypoglycemia • Nausea and vomiting • Uterine hypomotility and prolonged labour • Thrombocytopenia and leucopenia

ATROPINE SULPHATE • • It is available in two strengths 0. 5 mg/ml ampoule 6 mg/ml ampoule 0. 5 mg tab INDICATIONS: • Pre anesthetic medication 30 min before surgery to prevent vasovagal shock and also 2 dryout the secretions • Before pleural and ascitic tap • In the treatment of colics and dysmenorrhea, bradyarrythmias and parkinsonism • Organophosphorus poisoning

ADVERSE EFFECTS • • • Dry mouth Dysphagia Retention of urine Blurring of vision, precipitate to glaucoma Skin rash and local dermatitis

NEOSTIGMINE • It is available in 0. 5 mg/ml solution in ampoule DOSE: • 0. 5 -2 mg I/M or SC INDICATIONS: • Myasthenia gravis • Acute congestive glaucoma • Treatment of NM paralysis due to snake bite

ADVERSE EFFECTS • • Salivation, sweating and lacrimation Nausea vomiting, diarrhea, abd pain Tremors and fasciculation HTN

HYDROCORTISONE • It is available in a bulb containing 100 mg hydrocortisone INDICATIONS: • Life threatening emergencies e. g anapylactic shock, status asthamaticus, hypoglycemia, thyrotoxic crises, addison’s crises, hypercalcemia • Intra-articularly in osteoarthritis • Topically in keloids • As retention enema

ADVERSE EFFECTS: • Gastritis, peptic ulcer, perforation and pancreatitis • HTN • Osteoporosis • Supresses immunity • Delays wound healing

AMINOPHYLLINE • It is available in 10 ml ampoule DOSE: • 10 ml dil in 20 ml of 10% dextrose is given I/V or slowly INDICATION: • Bronchial asthma • Cardiac asthma • Cheyne stroke respiration

ADVERSE EFFECTS: • Nausea, vomiting • Fits preceded by twitching of mouth or severe hyperventilation • Collapse and death

MORPHINE • It is available in 1 ml ampoule(15 mg/ml) DOSE: • 5 -20 mg S/C or I/M INDICATIONS: • As analgesic • As preanesthetic medication • Acute LVF

ADVERSE EFFECTS • • Vomiting Hypotension Respiratory depression Drug dependency Urinary retention Miosis bradycardia

PETHIDINE • Available in 2 ml ampoule(50 mg/ml) INDICATIONS: • Given I/M or I/V • As analgesic • As preanesthetic medication ADVERSE EFFECTS: • Same as that of morphine

DIAZEPAM • Available in 2 ml ampoule(5 mg/ml) DOSE: 10 mg I/V or I/M INDICATIONS: • • Muscle relaxant in tetanus Pre anesthetic medication Treatment of convulsions As tranquillizer

AVIL(CHLORPHENARAMINE MALEATE) • Available in 2 ml ampoule(22. 75 mg/ml) INDICATIONS: • Allergic reactions • Pruritis • Hypnotics ADVERSE EFFECTS: • • Sedation and fatigue Dryness of mouth and blurring of vision Nausea and vomiting Blood dyscrasias

INSULIN • Available in 40 units/ml and 100 units/ml in 10 ml bulb DOSE: Given S/C INDICATIONS: • Diabetic ketoacidotic coma • Glucose insuline drip in hyperkalemia • Diabetes ADVERSE EFFECTS: • Hypoglycemias

SODIUM BICARBONATE • Available in 10 ml ampoule INDICATIONS: • • Metabolic acidosis Lactic acidosis Respiratory acidosis Hyperkalemia ADVERSE EFFECTS: • Metabolic alkalosis • Edema due to Na+ retentions

LASIX(FRUSEMIDE) DOSE: 20 mg I/M or I/V INDICATIONS: • • • Pulmonary edema To induce forced diuresis in barbiturates poisoning Treatment of mannitol resistant acute oliguria Advanced RF Prostatectomy

ADVERSE EFFECTS • • • Water and elecrolyte disturbance Orthostatic hypotension Retention of urine Hepatic coma Cardiac arrest Hearing loss

MANNITOL: • It is a sugar available as 20% sol in 350 ml glass bottel DOSE: 0. 5 -1 g/kg INDICATIONS: • • • Induce diuresis in barbiturate poisoning Acute oliguric RF After severe traumatic injuries To reduce intracranial pressure After CVA, cerebral edema, hepatic encaphlopathy

ADVERSE EFFECTS • Precipitate CHF • Fluid overload causes the ARF CONTRAINDICATIONS: • Shock • Cardiac failure • Renal impairment

POTASSIUM CHLORIDE • Available in 10 ml ampoule(150 mg/ml) INDICATION: • Hypokalemia ADVERSE EFFECTS: • Cardiac arrest if given rapidly

CALCIUM GLUCONATE • Available in 10 ml ampoule(1 g) DOSE: • 2 g I/V slowly in tetany • 1 g I/V slowly in epididymo-orchitis INDICATIONS: • • • Tetany After 1000 ml of blood transfusion As inotropic drug in cardiac arrest Hyperkalemia Hypoparathyroidisim As a coagulant(factor 5)