DRUGS USED

IN
EMERGENCY
COMMON CASES IN EMERGENCY
I. ROAD TRAFFIC ACCIDENT
II. ACUTE PAIN ABDOMEN
III. SUDDEN INABLITY TO MOVE THE EXTREMITIES
IV. LOSS OF CONSCIOUSNESS
V. SEIZURES
VI. EPISTAXIS
VII. POISONONG- ORGANO-PHOSPHOROUS; SNAKE; PARACETAMOL
VIII. ACUTE GASTRO-ENTERITIS
IX. ACUTE EXACERBATION OF BRONCHIAL ASTHMA
X. ACUTE EXACERBATION OF COPD
EMERGENCY DRUGS
1. Local Anaesthetics
2. Sedatives & Induction Agents
3. Opiod Analgesics
4. Pain Management
5. Anti-emetics
6. Anticholinergics
7. Muscle Relaxants
8. Tetanus Prophylaxis
9. IV Fluids
10. Neuroleptics
11. Anti-epileptics
12. Anti-hypertensives
13. Ionotropic agents
14. Anti-arrythmics
15. Diuretics
16. Cortocosteroids
17. Anti-asthma drugs
18. Sodium Bicarbonate
1.LOCAL ANAESTHETICS
Lignocaine Lignocaine with Adrenaline

Local wound infiltration 2% concn. – digital nerve blocks

1%- local wound infiltration
 2. SEDATIVES & INDUCTION AGENTS
Ketamine
Anaesthetic &analgesic
Mild bronchodilator action
(in anaes. Pts. With asthma)
Iv bolus: 2mg/kg
Onset of action: 60 s
Duration of action: 20 mins
CI: increased ICP
IHD
S/E: increased salivation
Laryngospasm
Unpleasant hallucination after
recovery of consciousness
Thiopentone
Short acting barbiturate
Potent anticonvulsant
…DOC for anaesthetising pts. With
Status epilepticus
Iv bolus : 3-5mg/kg
30 sec
5-10 mins
Cardio-respiratory depression
Midazolam
Short acting benzodiazepine
Powerful amnestic properties
I.M or i.v bolus
Children-intranasal useful prior to
suturing
1-2 minutes
60-90 minutes
Adults:- i.v dose 2.5-15 mg
Smaller doses for elderly
Higher doses for alcoholics
i.M dose-5-10 mg
Children:-i.v dose 0.15-0.3mg/kg
upto 0.5 mg/kg
Intranasal dose:-0.2-0.4 mg/kg
max. 5mg
 3.OPIOD ANALGESIC
Analgesic & sedative action
Morphine Pethidine Fentanyl
Mainly analgesic
In Acute MI & Pulmonary edema Short acting narcotic to sedate
DOA: 2-3 hrs patients prior to painful
DOA: 3 hrs procedures or intubation (in
combination with midazolam)

DOA:-30-40 mins
Adults dose: 2.5 mg iv bolus Best method of admin.: Usual dose: 1mcg/kg
repeated every few mins to a incremental i.v bolus 0.5mg/kg
maxm 15 mg every 5 minutes to max 3 mg/kg

Children dose: 0.05mg/kg iv every Alternative, 2 mg/kg i.m

5 mins to max 0.2mg/kg
4.PAIN MANAGEMENT
 5.ANTI-EMETICS
Metoclopramide(Maxolon) Prochlorperazine(Stemetil) Promethazine(Phenargan)

Migraine Vertigo Weaker

Renal colic(passage of calculi) Nausea & vomiting

Usual dose:10mg iv bolus or i.m Oral dose:- 5 mg 8 hrly Usual dose 0.5 mg/kgi.v; i.m or
injection i.m or i.v dose: 12.5 mg 8 hrly orally

CI:- children < 16 yrs age d/t high CI:- children <16 yrs age
risk of dystonic rxns
Bowel obstruction
6.ANTICHOLINERGICS
block the effects of acetylcholine at muscarinic receptors
Atropine Benztropine Ipratropium

For T /t of bradycardia d/t incr. T/t of oculogyric crisis Asthma

Vagal tone
Anticholinesterase poisoning
Adult dose: 0.6 mg i.v bolus Overdose cause
repeated in 5 mins if necessary Central anticholinergic syndrome
(dose of 3 mg-complete blockade (Confusion, hallucination)
of muscarinic cholinergic receptors
in an adult)
Pediatric dose: 20mcg/kg(max.
0.5mg)
Via ET tube in ER (2 *iv dose &
dilute in 10 ml of 0.9% saline)

Onset of action: within 5 mins

DOA: 2-4 hrs
7.MUSCLE RELAXANTS

DEPOLARISING NON-DEPOLARISING

Suxamethonium Vecuronium

Given i.v bolus i.V bolus onset in about 3 mins

- &lasts 20-30 mins
Max. Effect within 60 secs Usual dose : 0.1mg/kg

DOA: 1-1.5 mg/kg in adults

2mg/kg in children
-
CI: Hyperkalemia
LMN diz.
8.TETANUS PROPHYLAXIS
Non-immune patient with tetanus prone wound
• Give tetanus toxoid 0.5 ml intramuscularly and complete course (with repeat tetanus
toxoid injections at 6 weeks and 6 months)
PLUS
• Give tetanus immune globulin 250 units intramuscularly at a different site than that of
the tetanus toxoid injection
Non-immune patient with clean wound
• Give tetanus toxoid 0.5 ml intramuscularly and complete course (with repeat tetanus
toxoid injections at 6 weeks and 6 months)
Immune patient with tetanus prone wound
If more than 5 years since last tetanus toxoid booster then
• Give tetanus toxoid 0.5 ml intramuscularly
Immune patient with clean wound
If more than 10 years since last tetanus toxoid booster then
• Give tetanus toxoid 0.5 ml intramuscularly
 9.IV FLUIDS
0.9% saline 5% dextrose 3%dextrose with Hartmanns Colloids
0.3% saline
Isotonic & isomolar 50g/l of dextrose Haemmacel,
Gelofusion
Fluid of 1st choice in Distributed to total Maintenance fluid in
T/t of hypovolemia body water space, children -plasma volume
so, not suitable for Rehydration in mild expanding solution
emergency or moderate
rehydration dehydration
Usual dose: 10 ml/kg
as i.v bolus repeated
if necessary

Prolonged admin.:
cause hyponatremia
 10. NEUROLEPTICS
Haloperidol Chlorpromazine

Safest neuroleptic for sedation

i.m or i.v

Usual i.m dose in adults

2.5 mg repeated every 5 mins to max 10 mg
 11.ANTI-EPILEPTICS
Diazepam Phenytoin
1st line of drug in T/t of epilepsy

Safe &effective agent for termination of seizures i.v
or rectally
Usual i.v dose: 0.1 mg/kg repeated every 5 minutes if
required
Slow i.v injection
Infusion rate not more than 50 mg/min in adults
…1mg/kg/min in children
Usual loading dose: 15 mg/kg i.v

Usual rectal dose 0.5 mg/kg Rapid infusion cause hypotension

Onset of action: i.v. 1 to 2 minutes

rectal 5 to 10 mins
12.ANTI-HYPERTENSIVES
Glyceryl trinitrate Hydralazine Nifedipine Labetalol
Mainly a direct acting Combined a & b receptor
venodilator Direct acting Arterial dilator blicking drug
Higher arteriodilator
doses(>100mcg/min),
arteriodilator
Onset of action: Peak effects not seen for Orally i.V use in HTN
immediate 10- 20 mins after i.v inj. emergencies
T1/2: <5 mins
So, best given as infusion DOA: 4-8 hrs

Usual dose in adults: 19

mg i.v every 20 mins to
max. 50 mg
S/E: Tachycardia, Nausea S/E Nausea ,tachycardia Not to be used in HTN
emergencies
CI : IHD
13.INOTROPIC AGENTS
T/t of cardiogenic & distributive shock

Adrenaline Dopamine Dobutamine

Inotrope of choice in pts. With MI
A & b adrenergic agonist
Cause increase in CO & HR ; +ve chronotropic & ionotropic
vasoconstriction rffects balanced by mild degrre of
vasodilation
Infusion (into large veins) at rate 1- Ysual dose: 2-20 mcg/kg/ min
70 mcg/min titrated to effect

Tachycardia at higher doses

14.ANTI-ARRYTHMICS
Class I Class II Class III Class IV
Reduce conduction Consists b adrenergic prolong AP duration Calcium channel
vekocity of myocardium antagonists antagonists
Amiodarone
Divided a/c to their effect 10mcg/kg i.v. every 2 T/t of both ventricular &
on AP duration minutes to a max. 100 atrial arrythmias Verapamil
mcg/kg
IA. Quinidine Propranolol Usual loading dose Usual dose in adults: 1 mg
Prolong AP duration . to delay conduction via 5mg/kg i.v. over 30 min i.v bolus every minute to
Not usedin ER AV node in T/t of SVT or a max. Of 10 mg
Atrial Fib.
IB. Lignocaine, Phenytoin .In VT d/t theophylline If SBP<95 mm Hg then
Shorten AP duration overdose epinephrine given.
DOC in T/t of Vent. Tachy.

CI:- LVF IV admin. a/w CI:- <2 yrs age

Asthma hypotension d/t LVF
Bradyarrythmias vasodilation Bradycardia
Hypotension
15.DIURETICS
Frusemide: potent loop diuretic
T/t of fluid overload
i.v. frusemide
Onset of action: 5 min
Peak effect: about 30 mins
DOA: 2 hrs
#Dosage varies a/c to renal function
# Pts. w/o renal impairment have significant diuresis after
40 mg i.v
#Doses >250 mg required to diurese pts. with severe renal
failure
 16.CORTICOSTEROIDS
anti-inflammatory effects

Hydrocortisone Prednisolone Dexamethasone

Usual dose 0.1 mg/kg 8 hrly Orally i.V over 5 mins

i.M or i.v Usual dose 1 mg/kg daily to max. Usual dose 3 mg/kg 8 hrly
50 mg

S/E : mineralocorticoid/aldosterone Minimal effects

like effects
Sodium retention
Oedema
Hypokalemia
 17.ANTI-ASTHMA DRUGS
Salbutamol Corticosteroid Aminophylline

B adrenergic agonist T/t of asthma

Inhaled form best (either via
inhaler or nebuliser) Restricted in severe asthma

i.V used for severe asthma

Usual dose: 5 mg in adults & older

children

2.5 mg in children<5 yrs old

Sose dilated upto 2ml using 0.9%

saline

i.V dose 5mcg/kg(max.250 mcg)

over 1-2 mins & repeated once 15
minutes later if necessary
18.SODIUM BICARBONATE
i. Metabolic Acidosis a/w cardiac arrest
ii. Acute Renal Failure
iii. Hyperkalemia
iv. Tricyclic Antideppresant overdose

Usual dose: 1 mmol/kg i.v over 1-2 mins

IMPORTANT THINGS IN ER
i. First priority is to check vitals of the pt. if stable or not.
If SpO2 <90% O2 supplementation is necessary, either via nasal
prong or face mask.
ii. Two or one wide bore cannulas are to be opened to adminster
fluids or medications to the patient.
iii. UPT is mandatory in case of female pts. in reproductive age group
and very important before administring Inj. Diclofenac.
iv. In case of poisoning, Gastric lavage is required except in cases of
Corrosives, Carbolic acid & children.
v. In case of RTA, cervical immobility is the must.