LIST OF EMERGENCY DRUGS

Epinephrine (1mg/10 mL)

Indications and usage: Epinephrine injection is indicated for (1) treatment of acute hypersensitivity
reactions to drugs, animal serum and allergens; (2) treatment of acute asthmatic attacks to relieve
bronchospasm; and (3) treatment and prophylaxis of cardiac arrest and transitory atrioventricular (A-V)
heart block with syncopal seizures.
Contraindications: Epinephrine is contraindicated in patients with known hypersensitivity to
sympathomimetic amines, in patients with angle closure glaucoma, and patients in shock
(nonanaphylactic). It should not be used in patients anesthetized with agents such as cyclopropane or
halothane, as these may sensitize the heart to arrhythmatic action of sympathomimetic drugs. It should
not ordinarily be used in cases where vasopressor drugs may be contraindicated.
Dosage and Administration: In cardiac arrest, epinephrine is injected into the left ventricular chamber or
via an endotracheal tube directly into the bronchial tree. In this case 0.51.0 mg (510 mL of 1:10,000
solution) may be given. During a resuscitation effort, 0.5 mg should be administered IV every five
minutes. In hypersensitivity reactions and bronchospasm, 0.10.25 mg (12.5 mL of 1:10,000 solution) is
injected slowly.

DIAZEPAM (VALIUM, 10 MG/2 ML)

Indications and Usage: Diazepam is indicated for the treatment of seizures and anxiety disorders or the
short-term relief of symptoms of anxiety. In acute alcohol withdrawal, it may be useful for symptomatic
relief of acute agitation, tremor, and hallucinosis. It is a useful adjunct for the relief of skeletal muscle
spasm, in status epilepticus and severe recurrent convulsive seizures. It is also useful for premedication
for the relief of anxiety in patients who are to undergo surgical procedures.
Contraindications: Diazepam is contraindicated in patients with hypersensitivity to this drug, acute
narrow angle glaucoma, or open angle glaucoma unless patients are receiving appropriate therapy.
Dosage and Administration: Dosage should be individualized for maximum beneficial effect. The usual
recommended doses in older children and adults range from 2 mg20 mg IV or IM, depending on the
indication and severity. In some conditions such as tetanus, larger doses may be required. In acute
conditions the injection may be repeated within one hour; otherwise, an interval of 34 hours is usually
satisfactory. Lower doses should be used for elderly patients and children. When diazepam is used
intravenously, facilities for respiratory assistance should be available.

DOPAMINE IN D5W (400 MG/250 ML)

Indications and usage: Dopamine Hydrochloride in 5% Dextrose Injection is indicated for the correction
of hemodynamic imbalance, present in shock due to myocardial infarction, trauma, endotoxic
septicemia, open heart surgery, renal failure and chronic cardiac decompensation (as in refractory
congestive failure). When indicated, restoration of circulatory volume should be instituted or completed
with a suitable plasma expander or whole blood, prior to administration of dopamine hydrochloride.
Dopamines direct inotropic effect on the myocardium increases cardiac output at low to moderate
doses. Low to moderate doses of dopamine, which has little effect on SVR, can also be used to manage
hypotension due to inadequate cardiac output.
Contraindications: Dopamine should not be used in patients with pheochromocytoma. Dextrose
solutions without electrolytes should not be administered simultaneously with blood through the same
infusion set because of the possibility of pseudoagglutination of red cells. Dopamine should not be
administered in the presence of uncorrected tachyarrhythmias or ventricular fibrillation.
Dosage and administration: Do not add sodium bicarbonate or other alkalinizing agents, because
dopamine is inactivated in alkaline solution. Dopamine drip is administered only IV via a suitable
catheter or needle infusion. The less concentrated 800 mcg/mL solution may be preferred when fluid
expansion is not a problem. The more concentrated 1,600 mcg/mL or 3,200 mcg/mL solutions may be
preferred in patients with fluid retention or when a slower rate of infusion is desired. When
administering dopamine by continuous intravenous infusion, it is advisable to use a precision volume
control IV set. Each patient must be individually titrated to the desired hemodynamic or renal response
to dopamine.
LIDOCAINE (100 MG/5 ML)
Indications and usage: Lidocaine hydrochloride injection is specifically administered IV and IM in acute
management of ventricular arrhythmia (such as those related to acute myocardial infarction), or during
cardiac manipulation (such as cardiac surgery).
Contraindications: Lidocaine is contraindicated in patients with a known history of hypersensitivity to
local anesthetics of the amide type. It should not be used in patients with Stokes-Adams syndrome,
Wolff-Parkinson-White syndrome, or with severe degrees of senoatrial, atrioventricular or
intraventricular block in the absence of an artificial pacemaker.
Dosage and administration: When administered as a single direct intravenous injection (bolus), the
usual dose is 50100 mg administered IV at a rate of 2550 mg/min and under ECG monitoring. For
continuous intravenous infusion, following the bolus dose, IV infusion may be initiated at the rate of 14
mg/min. Intramuscular injections of lidocaine should be limited to products specifically labelled for this
purpose. The recommended dose is 300 mg (approximately 4.3 mg/kg) in deltoid muscle.

FUROSEMIDE (LASIX, 100 MG/10 ML)

Indications and Usage: Parenteral therapy should be reserved for patients unable to take oral
medication or for patients in emergency clinical situations. Furosemide is indicated in adults, infants,
and children for the treatment of edema associated with congestive heart failure, cirrhosis of the liver,
and renal disease, including nephrotic syndrome. It acts quickly by dilating veins, reducing pre-load and
decreasing shortness of breath in CHF even before any diuresis occurs. It is indicated as adjunctive
therapy in acute pulmonary edema. The IV use of furosemide is particularly useful when a rapid onset of
diuresis is desired, e.g., in acute pulmonary edema.
Contraindications: Furosemide is contraindicated in patients with anuria and with a history of
hypersensitivity to the drug.
Dosage and Administration: The usual initial dose is 2040 mg given as an IV or IM single dose. The IV
dose should be given slowly (12 minutes). Therapy should be individualized under close medical
supervision. In acute pulmonary edema, 40 mg is injected over 12 minutes IV and, if necessary, may be
increased to 80 mg. In infants and children, 1 mg/kg body weight is given slowly under close supervision.

MAGNESIUM SULFATE (50% IN 5 ML)

Indications and Usage: Magnesium sulfate is an effective anti-arrhythmic (VT) and is used to treat
torsade. It is also suitable for replacement therapy in magnesium deficiency, especially in acute
hypomagnesemia accompanied by signs of tetany similar to those observed in hypocalcemia. In such
cases, the serum magnesium level is usually below the lower limit of normal (1.52.5 or 3.0 mEq/L) and
the serum calcium level is normal (4.35.3 mEq/liter) or elevated. In total parenteral nutrition,
magnesium sulfate may be added to the nutrient admixture to correct or prevent hypomagnesemia,
which can arise during the course of therapy. Magnesium sulfate is also indicated as a parenteral
anticonvulsant for preventing and controlling seizures in severe toxemia of pregnancy (eclampsia).
Contraindications: Intravenous magnesium should not be given to mothers with toxemia of pregnancy
during the two hours preceding delivery.
Dosage and Administration: Both IV and IM administration are appropriate. IM administration of
undiluted 50% solution results in therapeutic plasma levels in 60 minutes, whereas IV doses will provide
a therapeutic level almost immediately. The rate of IV injection should not exceed 1.5 mL of a 10%
concentration per minute, except in severe eclampsia with seizures. Solutions for IV infusion must be
diluted to 20% or less with dextrose 5% or 0.9% saline solutions. In the treatment of magnesium
deficiency, the usual adult dose is 1 g, equivalent to 8.12 mEq of magnesium injected IM every 6 hours
for four doses. In hyperalimentation, the adult dose is normally 5 to 8 mEq magnesium/liter of TPN
solution. For infants, the recommended intake ranges from 0.25 to 0.6 mEq/kg/day. In severe preeclampsia, the total initial dose is 1014 g of magnesium sulfate. In nephritic seizures in children, the
50% solution should be diluted to a 20% solution for IM injection. The dose for children is 2040 mg/kg
of body weight administered IM to control seizures.

MIDAZOLAM (VERSED, 2 MG/2 ML)

Indications and Usage: Injectable Versed is indicated IM for preoperative sedation and to impair
memory of perioperative events. Intravenous injections are given prior to therapeutic or endoscopic
procedures, such as bronchoscope, gastroscopy, cystoscopy, coronary angiography and cardiac
catheterization, either alone or with narcotics. It is administered intravenously for induction of
anesthesia, before administration of other anesthetic agents.
Contraindications: Versed is contraindicated in patients with known hypersensitivity to the drug, and in
those with narrow angle glaucoma and other eye diseases. Versed is not intended for intrathecal or
epidural administration due to the presence of the preservative benzyl alcohol in the dosage form.
Dosage and Administration: Versed should not be administered by rapid or single bolus intravenous
administration. It should not be used during pregnancy due to the potential hazard to the fetus. It
should only be used IV and IM. Versed injection may be mixed in the same syringe with the following
frequently used premedications: morphine sulfate, meperidine, atropine sulfate. Versed at a
concentration of 0.5 mg/mL is compatible with 5% dextrose in water and 0.9% sodium chloride for up to
24 hours and with Lactated Ringers solution for up to 4 hours. Both the 1 mg/mL and 5 mg/mL
formulations may be diluted with saline and 5% dextrose in water. In all cases, the dose must be
individualized for patients, because individual response will vary with age, physical status and
concomitant medications. Only the 1 mg/mL formulation is recommended for conscious sedation, to
facilitate slower injection.

ATROPINE (1 MG/10 ML)

Indications and Usage: Atropine Sulfate Injection is indicated (1) as an anti-sialagogue for preanesthetic
medication to prevent or reduce secretions of the respiratory tract; (2) to restore cardiac rate and
arterial pressure during anesthesia, when vagal stimulation produced by intra-abdominal surgical
traction causes a sudden decrease in pulse rate and cardiac action; (3) to lessen the degree of
atrioventricular (A-V) heart block when increased vagal tone is a major factor in the conduction defect,
as in some cases due to digitalis; (4) to overcome severe carotid sinus reflex; and (5) as an antidote for
cardiovascular collapse from the injudicious use of a cholinergic drug.
Contraindications: Atropine is generally contraindicated in patients with glaucoma, pyloric stenosis or
prostatic hypertrophy, except in doses ordinarily used for preanesthetic medication.
Dosage and Administration: Atropine Sulfate Injection may be administered subcutaneously,
intramuscularly or intravenously. The average adult dose is 0.5 mg (5 mL of a 0.1 mg/mL solution), and
ranges from 0.4 to 0.6 mg (4 to 6 mL). As an antisialagogue, it is usually injected intramuscularly prior to
induction of anesthesia. This produces only minimal blocking of vagal activity. In young patients, the
dosage ranges from 0.1 mg in the newborn to 0.6 mg in a child age 12 years, injected subcutaneously 30
minutes before surgery. During surgery, the drug is given intravenously when reduction in pulse rate and
cessation of cardiac action are due to increased vagal activity. However, if the anesthetic is
cyclopropane, doses of atropine less than 0.4 mg should be used and should be given slowly to avoid the
possible development of ventricular arrhythmia. Usual doses are used to reduce severe bradycardia and
syncope associated with hyperactive carotid sinus reflex. For bradyarrhythmia, the usual intravenous
dosage ranges from 0.4 to 1 mg every one to two hours as needed. Larger doses up to a maximum of 2
mg may be required. In children, intravenous dosage ranges from 0.01 to 0.03 mg per kg of body weight.

BRETYLIUM TOSYLATE (BRETYLOL, 500 MG/10 ML)

Indications and Usage: Bretylium Tosylate Injection is indicated in the prophylaxis and therapy of
ventricular fibrillation. It is also indicated in the treatment of life-threatening ventricular arrhythmias,
such as ventricular tachycardia, that have failed to respond to adequate doses of a first-line
antiarrhythmic agent such as lidocaine. Use of bretylium should be limited to intensive care units (ICU),
coronary care units (CCU) or facilities where equipment and personnel for constant monitoring of
cardiac arrhythmias and blood pressure are available. Following injection of bretylium tosylate, there
may be a delay of 20 minutes to 2 hours in the onset of antiarrythmic action. However, it appears to act
within minutes in ventricular fibrillation. The delay in effect appears to be longer after intramuscular
than intravenous injection.
Contraindications: There are no contraindications to use in the treatment of ventricular fibrillation or
life-threatening refractory ventricular arrhythmias.
Dosage and Administration: For immediately life-threatening ventricular arrythmias, such as ventricular
fibrillation of hemodynamically unstable ventricular tachycardia, undiluted bretylium tosylate injection
is administered at a dosage of 5 mg/kg of body weight by rapid intravenous injection. For continuous
suppression, it is diluted with dextrose or sodium chloride and administered as a constant infusion of 1
2 mg per minute. For intravenous use, a dilute solution at a dosage of 5 to 10 mg per kg of body weight
is infused over a period greater than 8 minutes. More rapid infusion causes nausea and vomiting.

CALCIUM CHLORIDE (10%, 1 G/10 ML)

Indications and Usage: Calcium Chloride Injection is indicated (1) for the treatment of hypocalcemia in
conditions requiring a prompt increase in blood plasma calcium levels; (2) in the treatment of
magnesium intoxication due to overdose of magnesium sulfate; (3) to combat the deleterious effects of
hyperkalemia as measured by electrocardiography (ECG), pending correction of increased potassium
level in the extracellular fluid; and (4) for use in cardiac resuscitation when weak or inadequate
contractions return following defibrillation or when epinephrine has failed to strengthen myocardial
contractions.
Contraindications: Calcium chloride is contraindicated for cardiac resuscitation in the presence of
ventricular fibrillation or in patients with the risk of existing digitalis toxicity.
Dosage and Administration: Calcium chloride is injected by slow IV push, not to exceed 1 mL/min. into
the ventricular cavity. It must not be injected into myocardium. If time permits, the solution should be
warmed to body temperature. The injection should be stopped if the patient complains of any
discomfort. The usual adult dosage in hypocalcemia ranges from 500 mg to 1 g (5 to 10 mL) at intervals
of 1 to 3 days. Repeated injections may be required because of rapid excretion of calcium. In magnesium
intoxication, an initial dose of 500 mg (5 mL) should be given promptly. The patient should be observed
for signs of recovery before more doses are given. In hyperkalemic ECG disturbances of cardiac function,
the dose should be titrated by constant monitoring. For cardiac resuscitation, the usual adult dose
ranges from 500 mg to 1 g intravenously, or 200 to 800 mg when injected into the ventricular cavity.

DEXTROSE (50%, 25 G/50 ML)

Indications and Usage: Dextrose 50% is indicated in the treatment of insulin hypoglycemia to restore
blood glucose levels. The solution is also indicated, after dilution, for intravenous infusion as a source
of CARBOHYDRATE calories in patients whose oral intake is restricted or inadequate to maintain
nutritional requirements. Slow infusion of hypertonic solutions is essential to ensure proper utilization
of dextrose and avoid development of hyperglycemia.
Contraindications: A concentrated dextrose solution should not be used when intracranial or intraspinal
hemorrhage is present, nor in the presence of delirium tremens if the patient is already dehydrated.
Dextrose injection without electrolytes should not be administered simultaneously with blood through
the same infusion set because of the possibility of pseudoagglutination of red cells.
Dosage and Administration: For peripheral vein administration, the solution should be injected slowly.
The maximum rate at which dextrose can be infused without producing glycosuria is 0.5 g/kg of body
weight/hour. About 95% of the dextrose is retained when it is infused at a rate of 0.8 g/kg/hr. In insulininduced hypoglycemia, intravenous injection of 1025 g of dextrose is usually adequate. Blood glucose
level should be determined before the dextrose injection.
DIPHENHYDRAMINE (BENADRYL, 50 MG/VIAL)
Indications and Usage: Diphenhydramine is used as an antihistaminic for amelioration of allergic
reactions to blood and plasma, in anaphylaxis as an adjunct to epinephrine and when the oral form is
impractical.
Contraindications: This drug should not be used in newborn, premature infants and nursing mothers.
Because of risk of local necrosis, this drug should not be used as a local anesthetic nor should it be used
in patients with known allergy to antihistamine.
Dosage and Administration: The dosage should be individualized according to the needs and response
of the patient. In children, the average dose is 5 mg/kg/24 hours. The maximum daily dosage is 300 mg
divided into four doses, administered IV or by deep IM injection. In adults, 1050 mg IV or by deep IM
injection; 100 mg if required, maximum daily dosage is 400 mg.
HETASTARCH (HESPAN, 500 ML/BAG)
Indications and Usage: 6% Hetastarch in 0.9% sodium chloride is indicated in the treatment of
hypovolemia when plasma volume expansion is desired. It is not a substitute for blood or plasma. The
adjunctive use of hetastarch in leukapheresis has also been shown to be safe and efficacious in
improving the harvesting and increasing the yield of granulocytes by centrifugal means.
Contraindications: Hetastarch is contraindicated in patients with (1) known hypersensitivity to hydroxyethyl starch, (2) bleeding disorders, or (3) congestive heart failure, where volume overload is a potential
problem. Hetastarch should not be used in renal disease with oliguria or anuria not related to
hypovolemia.
Dosage and Administration: Hetastarch is administered by IV infusion only. Total dose and rate of
infusion depend on the amount of blood or plasma lost and the resultant hemoconcentration. In adults,
the amount usually administered is 500 or 1,000 mL. Higher doses have been used in postoperative and
trauma patients where severe blood loss has occurred.

ISOPROTERENOL (ISUPREL, 1 MG/5 ML)

Indications and Usage: Isoproterenol HCl is indicated for (1) mild or transient episodes of heart block
that do not require electric shock or pacemaker therapy; (2) serious episodes of heart block and AdamsStokes attacks (except when caused by ventricular tachycardia or fibrillation); (3) use in cardiac arrest
until electric shock or pacemaker therapy or the treatment of choice is available; (4) for bronchospasm
occurring during anesthesia; and (5) as an adjunct to fluid and electrolyte replacement therapy.
Contraindications: Isoproterenerol is contraindicated in patients with tachyarrhythmia, tachycardia or
heart block caused by digitalis intoxication; ventricular arrhythmias which require inotropic therapy; and
angina pectoris.
Dosage and Administration: Isuprel injection 1:5,000 should generally be started at the lowest
recommended dose. The rate of administration should be gradually increased while the patient is
carefully monitored. For bolus IV injection, dilute 1 mL (0.2 mg) to 10 mL with sodium chloride or 5%
dextrose. Initial dose is 1 mL to 3 mL of diluted solution; subsequent dose range is 0.5 mL to 10 mL of
diluted solution. For IV infusion, dilute 10 mL in 500 mL of 5% dextrose. For IM and SC injections, use
solution of 1:5000 undiluted.
ACETAMINOPHEN (TYLENOL, ANACIN-3)
Description: ANALGESIC, ANTIPYRETIC
Acetaminophen is a clinically proven analgesic/antipyretic with little effect on platelet function.
Indications: For mild to moderate pain and fever when aspirin is otherwise not tolerated.
Contraindications: Hypersensitivity, children under 3 years.
Precautions: Patients with hepatic disease; children under 12 years with arthritic conditions; alcoholism;
malnutrition; and thrombocytopenia.
Dosage/Route: 325 to 650 mg. PO/4 to 6 hours. 650 mg PR/4 to 6 hours.
AMINOPHYLLINE (AMINOPHYLLINE, SOMOPHYLLIN)/METHYLXANTHINE
Description: (Bronchodilator)
Aminophylline is a methylxanthine that prolongs bronchodilation and decreased mucus production and
has mild cardiac and CNS stimulating effects. Indications:Bronchospasm in asthma and COPD refractory
to sympathomimetics and other bronchodilators and in CHF.
Contraindications: Hypersensitivity to methylxanthines or uncontrolled cardiac dysrhythmias.
Precautions: Cardiovascular disease, hypertension, or taking theophylline, hepatic impairment,
diabetes, hyperthyroidism, young children, glaucoma, peptic ulcers, acute influenza or influenza
immunization, and the elderly. Watch for PVCs or tachycardia. May cause hypotension.
Dosage/Route: 250 to 500 mg IV over 20 to 30 min. Ped: 6 mg/kg over 20 to 30 min. Max 12 mg/kg/day.
DIGOXIN (DIGOXIN, LANOXIN)/CARDIAC GLYCOSIDE
Description: Digoxin is a rapid-acting cardiac glycoside used in the treatment of CHF and rapid atrial
dysrhythmias. It increases the force and velocity of myocardial contraction and cardiac output. It also
decreases conduction through the AV node, thus decreasing heart rate.
Indications: Increase cardiac output in CHF and to stabilize supraventricular tachydysrhythmias.
Contraindications: Hypersensitivity, ventricular fibrillation, or ventricular tachycardia except due to CHF.
Precautions: Reduce dosage if digitoxin taken within 2 weeks. Toxicity potentiated by an MI and with
hypokalemia, hypocalcemia, advanced heart disease, incomplete heart block, corpulmonale,
hyperthyroidism, respiratory impairment, children, elderly or debilitated patients, and
hypomagnesemia. Dosage/Route: 0.25 to 0.5 mg slowly IV. Ped: 10 to 50 mcg/kg IV

GLUCAGON (GlucaGen)/Hormone
Description: (Antihypoglycemic) Glucagon is a protein secreted by pancreatic cells that causes a
breakdown of stored glycogen into glucose and inhibits the synthesis of glycogen from glucose.
Indications: Hypoglycemia without IV access and to reverse beta-blocker overdose.
Contraindications: Hypersensitivity to glucagon or protein compounds.
Precautions: Cardiovascular or renal impairment. Effective only if there are sufficient stores of glycogen
in the liver.
Dosage/Route: Hypoglycemia: 1 mg IM/SC repeat/5 to 20 min. Ped: 0.1 mg/kg 1 m/SC/IV for child
< 10 kg; 1 mg/kg 1 m/SC/IV for child > 10 kg.
Beta-blocker overdose: 50 to 150 mg/kg IV over 1 min. Ped: 50 to 150 mg/kg IV over 1 min.
HEPARIN (Heparin)/Anticoagulant
Description: Heparin is a rapid-onset anticoagulant, enhancing the effects of antithrombin III and
blocking the conversion of prothrombin to thrombin and fibrinogen to fibrin.
Indications: To prevent thrombus formation in acute MI.
Contraindications: Hypersensitivity; active bleeding or bleeding tendencies; recent eye, brain, or spinal
surgery; shock.
Precautions: Alcoholism, elderly, allergies, indwelling catheters, elderly, menstruation, pregnancy, or
cerebral embolism.
Dosage/Route: 5,000 units IV, then 20,000 to 40,000 units over 24 hours.
INSULIN (REGULAR INSULIN, HUMULIN)/HORMONE
Description: Insulin is a naturally occurring protein that promotes the uptake of glucose by the cells.
Indications: Hyperglycemia and diabetic coma.
Contraindications: Hypersensitivity and hypoglycemia.
Dosage/Route: 5 to 10 units IV/IM/SC. Ped: 2 to 4 units IV/IM/SC
IPECAC SYRUP/EMETIC
Description: Ipecac syrup is a gastric irritant and acts on the emetic centers of the medulla to induce
vomiting. Emesis usually occurs within 5 to 10 minutes.
Indications: Poisoning and overdose.
Contraindications: Reduced level of consciousness, corrosive ingestion, petroleum distillate ingestion,
alkali ingestion, or antiemetic ingestion (especially phenothiazine).
Precautions: Monitor the airway and have suction ready. Administer activated charcoal only after
emesis. Caution with heart disease patients.Dosage/Route: 30 mL PO, followed by 1 to 2 glasses of
water, repeat in 20 min as needed.
Ped: 15 mL PO followed by 1 to 2 glasses of water, repeat in 20 min as needed.