Adult emergency drugs

Introduction: the emergency Intensive care unit is necessary require a great attention to crucially benefit the critical patients by using those highly recommended medications bellow.
No ACLS Medications Usual Dose Max Dose Drug Package Comments
1 Adenosine 6mg —- Vial May give additional 12mg dose if no conversion.

Defibrillator must be present. Decrease dose to

3mg if pt on dipyridamole or carbamazepine

2 Amiodarone 150 mg 300mg Vial 300mg for VFib or pulseless VT
3 Atropine 0.5mg

 

0.04 mg/kg

(or 3 mg)

Syringe No longer recommended in asystole and PEA
4

 

Epinephrine

 

1 mg —— Syringe Given every 3-5 minutes 2-2.5mg if given endotracheally
5 Lidocaine 1-1.5 mg/kg 3 mg/kg

(or 300 mg)

Syringe For VFib or pulseless VT, If persists after initial

dose, may give additional 0.5-0.75mg/kg every 5-10min to max dose

6 Vasopressin 40 units —- Vial May replace 1st or 2nd dose of epinephrine
7 Magnesium 1-2g 6g Vial For VFib/pulseless VT with Torsades only
Introduction on RSI
 

 

RSI Medication

RSI:Rapid sequence intubation

Usual Dose Max Dose Drug Package Comments
1

 

 

Etomidate

 

0.2 mg/kg 0.4 mg/kg

(or 20 mg)

Vial or Syringe Give 50% usual dose in hemodynamic instability

Decreases seizure threshold

2 Midazolam

 

0.03 mg/kg 0.1 mg/kg

(or 10 mg)

Vial Active metabolite is renally eliminated
3

 

Propofol

 

1 mg/kg 2.5 mg/kg

(or 200 mg)

Vial Associated with dose-related hypotension (*give in 20 mg increments)

Avoid in hypovolemic patients

Caution with peanut allergy (soy derivatives

4

 

Ketamine

 

1 mg/kg 2.5 mg/kg

(or 200 mg)

Vial  Not use in head injury, heart disease, or

hypertensive emergency patients

5 Rocuronium

 

1 mg/kg 1.2 mg/kg

(or 100 mg)

Vial Use adjusted BW if > 130% IBW

(Paralysis within 60 seconds)

6

 

Succinylcholine

 

1.5 mg/kg 2.0 mg/kg

(200 mg)

Vial Use total BW for dosing (onset within 30 seconds)

Do not use if history of malignant hyperthermia or

seizures, Caution if at risk for hyperkalemia

(muscle disorders, burn, etc)

8 Fentanyl

 

1 mcg/kg 2mcg/kg(100mcg) Ampoule For analgesia if needed with RSI/procedures
9 Vecuronium

 

0.1 mg/kg 0.1 mg/kg

(or 10 mg)

Vial Use adjusted BW if > 130% IBW

Prolonged effect in renal/hepatic impairment

10

 

Naloxone

 

0.04 mg 0.4 mg

(may repeat)

Vial or syringe Lower doses with re-dosing (q2-3 min) may be

needed in opiate-dependent patients

 
 

 

Miscellaneous

 

Usual dose Max dose Drug package Comments
1 Fentanyl 1 mcg/kg 2 mcg/kg

(100 mcg)

Ampoule For analgesia if needed with RSI/procedures
2

 

Vecuronium 0.1   mg/kg 0.1 mg/kg

(or 10 mg)

Vial Use adjusted BW if > 130% IBW

Prolonged effect in renal/hepatic impairment

3

 

Naloxone 0.04 mg 0.4 mg(can be repeated) Vial or syringe Lower doses with re-dosing (q2-3 min) may be

needed in opiate-dependent patients

 
  Drips Standard concentration Rate option Comments
Start Max
1 Cisatracurium 200mg/250mL 0.5mcg/kg/min 10mcg/kg/min Paralytic of choice in renal or hepatic insufficiency
2 Diltiazem 100mg/100mL 5mg/hr 15mg/hr May bolus 10-25 mg initially
3 Dobutamine

 

250mg/250mL 1-5mcg/kg/min 20mcg/kg/min Does not significantly raise blood pressure but

used for inotropic effects

4 Dopamine 400mg/250mL 1-5mcg/kg/min 20mcg/kg/min Central line
5 Epinephrine 4mg/250ml 0.5mcg/min 10mcg/min Central line
6 Esmolol 2500mg/250mL 25mcg/kg/min 300mcg/kg/min May bolus 50-500 mcg/kg initially
7 Isoproterenol

 

1mg/250mL 0.2mcg/min 20mcg/min Contraindicated in arrhythmia and angina, caution

in heart disease

8 Lidocaine

 

2000mg/250mL 1-4mg/min 5mg/min Caution if history of heart block

Caution in hepatic dysfunction

9 Milrinone 40mg/200mL 0.375mcg/kg/min 0.8mcg/kg/min Accumulates in renal failure
10 Nitroglycerin 25mg/250mL 5mcg/min 400mcg/min Increases ICP, caution in TBI
11 Nitroprusside

 

50mg/250mL 0.3mcg/kg/min 10mcg/kg/min Cyanide toxicity risk with renal insufficiency and

Prolonged infusion Max dose 10mcg/kg/min ≤10 min

12 Norepinephrine 8mg/250mL 1mcg/min 30mcg/min Central line
13 Phenylephrine 30mg/250mL 20mcg/min 200mcg/min Pure alpha agonist with least effect on heart rate
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