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EMERGENCY

DRUGS
MORPHINE SULFATE
• Emergent Indications: pain control
• Dose: 2-10 mg IV q 2-6 hours PRN;
recommended dose 0.1 mg/kg IV. Usual daily
dose is 12-10 mg
AMIODARONE
• AKA Cordarone
• Indication: used for refractory shockable arrest
rhythm.
• Pulseless VF/VT:.
• 300mg IV rapid push followed by 150mg IV rapid
push if necessary at next pulse check Stable wide
complex tachycardias: 150mg IV over 10 minutes,
followed by infusion of 1mg/min x 6hours, then
0.5 mg/min thereafter
• Maximum: 2.2 g in 24 hours
ATROPINE
• Emergent Indications: Organophosphate/carbamate
toxicity, bradycardia
• Dose: -Organophosphate/carbamate toxicity: 1-6 mg IV
q 3-5 minutes PRN, until dry secretions (can double
dose each time until adequate response achieved)
Maximum dose:
-Peds Bradycardia: 0.02 mg/kg IVx1; 0.5 mg maximum
single dose; 1 mg max cumulative dose -Adult
bradycardia: 0.5 mg IV, 3 mg max cumulative dose
EPINEPHRINE
• AKA adrenaline
• Emergent Indications: anaphylaxis, ACLS arrest,
PALS/NRP arrest, severe asthma
• Dose:ACLS: 1 mg 1:10,000 IV PALS: 0.01 mg/kg
1:10,000 IV Anaphylaxis: 0.1-0.5 mg 1:1,000
IM/SQ (IM preferred) Peds anaphylaxis/asthma:
0.01 mg/kg 1:1,000 IM/SQ (Hypotension
refractory to IVF: 1-10 mcg/min IV
• Max dose: 2-10 mcg/ kg/ min
CALCIUM GLUCONATE
• Emergent Indications: hyperkalemia,
hypocalcemia with dysrhythmia
• Dose: 10% IV solution (gluconate or chloride)
contains 1 gram per 10 mL
• The usual daily dosage ranges from 1000 to
15,000 mg (10 to 150 mL) in divided doses or
as a continuous infusion.
LIDOCAINE
• Indication:PVCs
• Dosage: 0.5-.75 mg/kg
• Every 5-10 mins
• Max dosage: 3mg/kg
Isordil and Isoket
• Indication: Anti-anginal, nitrate, vasodilator
• Dosage: advised is until 2-3 tabs per day only
• Preparation: (Isoket) pnss 90 cc + 10 mg Isoket
(1 amp) x desired rate
• Max dosage: maximum dose does not
normally exceed 8-10 mg/hr.
DIGOXIN
• AKA Lanoxin
• Indications: increased heart rate, a-fib
• Dosage: 0.5 – 1 mg given as 50% of the dose
initially and one quarter of the initil dose in
each 2 subsequent doses at 6-12 hr interval
DIAZEPAM
• Emergent Indications: Seizure abortion,
alcohol withdrawal, agitation, muscle spasm
• Dose: 2-10 mg PO/IV/IM q 6 hours PRN
MIDAZOLAM
• Emergent Indications: seizure abortion,
procedural sedation, ventilator sedation
• Dose: Usual continuous infusion: 1-10
mg/hour Procedural Sedation: 0.02 - 0.04
mg/kg IV
DOBUTAMINE
• Emergent Indications: decompensated heart
failure, refractory hypotension
• Dose: 2-20mcg/kg/min IV
• Preparation: Dw250 + 1 vial/ 2 vials x desired
titration
DOPAMINE
• Emergent Indications: decompensated heart
failure, hypotension
• Dose: < 5 mcg/kg/min IV dopaminergic effects
(not recommended) 5-10 mcg/kg/min IV
primarily beta effects 10-20 mcg/kg/min IV
primarily alpha effects
• Max dosage 20 mcg/kg/min
• Preparation: PrepaDw250 + 1 amp/ 2amps x
desired titration
NOREPINEPHRINE
• AKA Levophed
• Emergent Indications: hypotension refractory
to IVF
• Dose: 1-30 mcg/min IV
• Preparation: Dw250 + 1 amp/ 2amps x desired
titration
• More concentrated: pnss 96 cc + 1 amp
levophed x desired rate
NICARDIPINE
• Indication: used to treat hypertension
• Dosage:initially 5 mg/hr, if not effective
increase dose to 2.5 mg//hr every 5-15
minutes to a maximum of 15 mg hour.
• Nicardipine drip: d5w/pnss 90 cc +10 mg
nnicardipine, to titrate
HYDRALAZINE
• Indication: used for hypertensive emergencies,
used to control bp in pre eclampsia
• Dosage: in hypertensive emergencies: iv boluses
of 10-20 mg, repeated as necesary at 15 min
intervals, to maximum of 50 mg.
• In pre-eclampsia: 5 mg iv initially followed by 5-
10 mg every 20 minutes to a maximum of 40 mg.
• HYDRALAZINE DRIP : D5W250+2 AMPS @5-30
ugtts, maximum dose of 3.5 mg/kg/24 hrs
FUROSEMIDE
• Emergent Indications: pulmonary edema, CHF
exacerbation, hyperkalemia (if making urine)
• Dose: usual dose in ED 20-40 mg IV, reassess,
increase to desired effect (maximum single
dose 200mg)
• Can be used as a drip.
METOCLOPRAMIDE
• Emergent Indications: vomiting prevention
and treatment
• Maximum Dose: 10 mg IV q 6 hours PRN
NITROGLYCERIN
• Emergent Indications: CHF, angina
• Dose: apply one patch each day. Adjust to
higher doses by using patches that deliver
more drug.
MAGNESIUM SULFATE
• Emergent Indications: torsades, ventricular
dysrhythmias, eclampsia, status asthmaticus
• Dose: Eclampsia: 2-4 grams IV over 5 minutes
Pulseless torsades: 2 grams IV push Asthma
exacerbation: 2 grams over 15 minutes
SODIUM BICARBONATE
• Emergent Indications: hyperkalemia, TCA toxicity,
salicylate toxicity, metabolic acidosis
• Dose: Hyperkalemia or metabolic acidosis: 50
mEq IV x 1 (1 amp = 50 mEq) TCA toxicity: 1-2
mEq/kg IV bolus to achieve a serum pH of 7.45-
7.55 and QRS narrowing; effective serum
alkalinization unlikely with continuous infusion
Salicylate toxicity: 3 amps (150mEq) in 1 liter
D5W given as 10-20 ml/kg bolus, then 2-
3ml/kg/hr; goal urine pH 7.5-8.0