RED ZONE BACK UP

BELONGS TO:
izxzamri
PPW 16 HTJS
GLYCERYL TRINITRATE
GROUP: Vasodilator

USES:
• This medication is an organic nitrate,
prescribed for ANGINA and HEART
FAILURE.
• It relaxes blood vessels and helps the
heart in pumping the blood easily.

GROUP OF MEDICATION
• Prevention and treatment of angina
pectoris
• Heart failure
• To improve blood flow in heart surgery
• Relief of pain associated with chronic
anal fissure (as the rectal ointment)
• Control of blood pressure during
operations (IV)

INDICATION
 • Tachycardia
• Headache • Bradycardia
• Dizziness • Fainting
• Feeling weak • Burning or stinging
sensation in mouth
• Postural
hypotension • Blistering or
ulceration of the
• Nausea
tongue
• Flushing of the face
• Allergic skin
reaction

SIDE EFFECT
 OR:
Preparation:
50mg/10mls Dilute 50mg GTN with
40ml Normal Saline 0.9%
(dilution=50ml)
Take 6mg (1.2ml) of
Nitrobid dilute with 50cc Therefore,
N/S. 50mg=50cc
50000mcg=50cc
Rate: 1mls/hour = 5mcg=0.005cc
2mcg/min
Rate:
5mcg/min: 0.005mlx60
Max Dose: 200mcg/min =0.3ml/hour
= 100ml/hour

DILUTION OF GTN INFUSION:

MIDAMORPHINE
MIDAZOLAM MORPHINE
GROUP: Benzodiazepine GROUP: Narcotic analgesic
(Sedative)
USES:
• Morphine is used to treat
USES: moderate to severe pain.
• Short-acting formulations
• Used to reduce anxiety are taken as needed for
or producing pain.
drowsiness or • Morphine is not for
treating short-term pain
anesthesia before just after surgery unless
certain medical the patient was already
procedures or surgery. taking morphine before
the surgery.

GROUP OF MEDICATION
MIDAZOLAM MORPHINE
• For preoperative • For the treatment of
sedation severe acute or chronic
pain.
• Induction of GA
• Mostly used parentally
• Sedation for for acute pain
ventilated patients in (myocardial infarction,
critical care unit multiple injuries, post-
• As an emergency operative)
control of seizures • Morphine can be
• To reduce anxiety and combined with other
restlessness (non-opioid) analgesics
or psychotropic drugs

INDICATION
MIDAZOLAM MORPHINE
• Blurred vision • Severe dyspnea
• Changes in blood pressure
breathing and heartbeats • Addiction
• Coughing • Confusion
• Dizziness & Drowsiness
• Pounding heart beats
• Dry mouth
• Headache & Nausea & • Headache
Vomiting • Vomiting
• Hiccups
• Low blood pressure
• Constipation
(children) • Nausea
• Short-term memory loss
• Slurred speech

SIDE EFFECT
Preparation:
Midazolam 5mg/ml OR 15mg/ml
Morphine 10mg/ml

STAT Dose:
Morphine 20mg + Midazolam 20mg
Dilute into 20mls Normal Saline

Infusion (Maintenance Dose):

Morphine 30mg + Midazolam (Dormicum) 30mg
Dilute into 30mls of Normal Saline in 50cc syringe

Rate:
1mls/hour= 1mg of Morphine and 1mg of Midazolam per
hour.

MIDAMORPHINE:
ADENOSINE
GROUP: Anti-arrhythmic and a
nucleoside.

USES:
• Used to treat patient with irregular
heart beats.

GROUP OF MEDICATION
• Treating certain types of irregular
heartbeat.
• Certain brands of adenosine are used
during a stress test of the heart.
• To treat irregular heartbeat by slowing
the electrical conduction in the heart,
slowing heart rate, or normalizing heart
rhythm.
• During a stress test of the heart its help
by improving blood flow to the heart.

INDICATION
SIDE EFFECTS: WARNINGS:

• Fatal cardiac arrest,

• Dizziness ventricular
• Flushing arrhythmias, & MI
• Headache • SA & AV nodes block
• Hypotension
• Light-
• HPT
headedness
• Bronchoconstriction
• Stomach pain • Atrial fibrillation

SIDE EFFECT & WARNINGS

1 amp of ADENOSINE = 6mg/2ml

FIRST DOSE:
Adenosine 6mg & 20ml Normal Saline
(Different Syringe) - Given Together

SECOND DOSE:
Adenosine 12mg & 20ml Normal Saline
(Different Syringe) - Given Together

*Give the second dose if patient’s condition was not resolve after 2 minutes.

THIRD DOSE:
Adenosine 12mg & 20ml Normal Saline
(Different Syringe) – Given Together

*Give the third dose if patient’s condition was not resolve.

ADENOSINE:
HALF LIFE OF ADENOSINE IS ONLY 6 SECOND IN
HUMAN BLOOD!

• Set a large IV cannula minimum 18G at LEFT

ANTECUBITAL (nearest to heart side).
• Before push in Adenosine, make sure IV cannula
was connected to 2 way connector.
• Elevate patients hand at 45 degree.
• Push in Adenosine with Normal Saline in
preparation for flush at the 2 way connector
side.

HOW TO GIVE ADENOSINE ?

HEPARIN INFUSION
MOSTLY USED IN ICU
GROUP: Anti-Coagulant

USES:
• To interfere with the formation of
thrombi.

GROUP OF MEDICATION
• Atrial fibrillation with embolization.
• Treatment of acute and chronic consumption
coagulopathies (disseminated intravascular
coagulation).
• Prevention of clotting in arterial and heart surgery;
• Anticoagulant therapy in prophylaxis and treatment of
venous thrombosis and its extension.
• (In a low-dose regimen) for prevention of postoperative
deep venous thrombosis and pulmonary embolism in
patients undergoing major abdomino-thoracic surgery
or who for other reasons are at risk of developing
thromboembolic disease.
• Prophylaxis and treatment of pulmonary embolism.
• Prophylaxis and treatment of peripheral arterial
embolism.

INDICATION
• Hemorrhage
• Hypersensitivity
• Bluish-colored skin
• Mild pain, redness, warmth, or skin changes
when medication was injected
• Swelling
• Trouble breathing

SIDE EFFECT
BLUE LABEL RED LABEL

5000iu/ml 1000iu/ml

Syringe out 5mls Syringe out 5mls

(25000 iu) dilute with (5000iu) dilute with
50cc N/S in 50cc 50cc N/S in 50cc
syringe. syringe.

Dose: 1000iu/hour = Dose: 1000iu/hour =

2mls/hour 10mls/hour

HEPARIN:
ADRENALINE
OR EPINEPHRINE
GROUP: Alpha-and beta-adrenergic agonists.
(Sympathometric agents)

USES: along with emergency medical treatment to

treat life-threatening allergic reaction.

GROUP OF MEDICATION
• Emergency treatment in anaphylaxis:-
• Flushing
• Syncope
• Tachycardia
• Thready or unobtainable pulse associated with
hypotension
• Convulsion
• Vomiting
• Diarrhea
• Abdominal cramps
• Airway swelling
• Swelling of the eyelids, lips and tounge.
• Bronchospasm.
• Urticaria.
• Angioedema.
• Serum sickness.

INDICATION
SIDE EFFECTS:
PRECAUTION:

• Anxiety
• Cardiovascular
• Headache disease
• Palpitations • Hypertension
• Local necrosis • DM
• Pulmonary edema • Hyperthyroidism
• Hypertension • Psychoneurosis
• Cerebral hemorrhage • Pregnancy

SIDE EFFECTS & PRECAUTION

Preparation in 1 ampule: 1mg/ml = (1:1000)

Infusion:
Dilute 3.0mg (3 ampoules) of Adrenaline with 47cc of
N/S in 50cc syringe.

Rate: 1mls/hour = 1mcg/min

Dose: 20mcg/min = (1-20ml/hour)

*no max dose in resus of pulseless arrest

*ADULT: 1mg every 3-5 mins.
*PAEDS: 0.1ml/kg (1/10,000) OR 1ml/kg (1/100,000)
every 3-5 mins.

ADRENALINE:
AMINOPHYLINE
GROUP: Xanthine derivative.

USES: treating active symptoms & blockage of

airway due to asthma or other lung disease such
as emphysema or bronchitis.

GROUP OF MEDICATION
• Asthma
• Bronchitis
• Emphysema
• Chronic lung disease

INDICATION
SIDE EFFECTS:
WARNINGS:
• Difficulty in breathing
• Swelling
• Patient with history of
• Restlessness
heart disease
• Headache
• Epilepsy
• Increased or irregular
HR • Heart failure
• Nausea, vomiting & • HPT
abdominal pain • Alcohol addiction
• Dizziness • Over active thyroid
• Epilepsy

SIDE EFFECTS & WARNINGS

Preparation: 1 ampule equals to 250mg/10mls

Slow bolus: 125mg-250mg (6mg/kg) in 50cc N/S

syringe pump run over 20-30 min.

Infusion:
Dose: 0.5-0.9mg/kg/hour dilute 250mg in 50cc
syringe with N/S = 50cc dilution.

1mls = 250/50 = 5m.

AMINOPHYLINE:
STREPTOKINASE
GROUP: Anti thrombolytic

USES: to dissolve blood clots that have formed in

the blood vessels.

GROUP OF MEDICATION
• AMI
• Congestive cardiac failure
• Pulmonary embolism
• Deep vein thrombosis
• Arterial thrombosis or embolism
• Occlusion of arteriovenous cannulae

INDICATION
 WARNINGS:
SIDE EFFECTS:
• Active internal bleeding
• Bleeding • Patients with history of
• Respiratory CVA, intracranial or
intraspinal surgery within
depression 2 months
• Bronchospasm • Intracranial neoplasm
• Urticaria • Severe uncontrolled HPT
• Flushing • Patients with AAA (Aortic
Abdominal Aneurysm)
• Nausea • Patient that have been
• Edema use STK less than 6
months.

SIDE EFFECTS & WARNINGS

1 vial STK = 1.5 mega unit

To dilute with 100cc N/S.

Run at 100ml/hour.

CAUTIONS:
• Pastikan tiada buih semasa penyediaan STK.
• Monitor VS setiap 5-15 min.
• Tiada alahan semasa pemberian STK.

STREPTOKINASE:
INSULIN CHASE OR
LACTIC COCKTAIL
FOR HYPERKALAEMIA
USES: for HYPERkalemia patient

GROUP OF MEDICATION
Hyperkalemia signs and symptoms:
• Serum potassium >6.0 to 6.5 meq/l
• Neurologic changes:
• Weakness
• Paresthesias
• Areflexia
• Ascending paralysis
• Respiratory failure
• CVS changes:
• Bradycardia to asystole or ventricular fibrillation.
• AV prolonged transmission to complete heart block.
• Patient with tall T wave (ECG).

INDICATION
• Heart complication
• Cardiac arrhythmias
• SOB

SIDE EFFECTS
 Iv slow bolus 10mls of Calcium Gluconate 10%
(slow bolus over 10 mins)

Iv bolus 50mls of Detrose 50%

Iv bolus insulin 10iu 2.5mg = 0.5ml

INSULIN CHASE OR LACTIC COCKTAIL:

NORADRENALINE
GROUP: Alpha/Beta adrenergic agonist.

USES:
• Peripheral vasoconstriction and stimulation of
heart rate and contractility.
• Coronary vasodilation occurs secondary to
enhanced myocardial contractility.

GROUP OF MEDICATION
• Restoration of blood pressure in
certain acute hypotensive states.
• Adjunct in treatment of cardiac
arrest and profound hypotension.

INDICATION
SIDE EFFECTS: WARNINGS:
• Hypotension
• Increased vascular • Hypovolemic states
resistance except temporarily
• Precordial pain until blood volume
• Ventricular arrhythmias replacement is
• Reflex bradycardia accomplished.
• Headache, dizziness, • Mesenteric or
tremor, insomnia & peripheral vascular
anxiety thrombosis
• Metabolic acidosis
• Profound hypoxia or
• Hyperglycemia
hypercarbia
• Respiratory difficulties

SIDE EFFECTS & WARNINGS

 PT’S WEIGHT DOSE NEEDED Ml of NORAD
Preparation: 4mg/4mls (ESTIMATED) (mg), ?

(1mg/1ml) 50kg 1.5 1.5

Calculations: 60kg 1.8 1.8

0.03xBodyweight (kg) = ?mg
70kg 2.1 2.0 or 2.1
dilute with N/S to make
dilution of 50mls.
80kg 2.4 2.5 or 2.4

Rate: 1ml/hour = 90kg 2.7 2.7

0.01mcg/kg/min
100kg 3.0 3.0

Dose: 0.05-0.5mcg/kg/min 120kg 3.6 3.5 or 3.6

NORADRENALINE:
AMIODARONE
GROUP: Anti-arrhythmic agent

USES: Used in the treatment of a wide range of

cardiac tachyarrhythmias, including both
ventricular and supraventricular (atrial)
arrhythmias.

GROUP OF MEDICATION
• Ventricular tachycardia
• Ventricular fibrillation

INDICATION
SIDE EFFECTS: WARNINGS:

• Dizziness, vision • Serious heart conditions

(AV blocks) unless with
problems, seeing halos pacemaker
around lights
• History of slow heart beats
• Loss coordination, • Asthma or lung disorders
feeling weak or tired
• Liver disease
• Nausea, vomit and • Thyroid disorder
constipation
• Vision problems
• Numbness or tingling • High/low BP
• Tremors • Electrolyte imbalance
• Abnormal LFT • Pregnant

SIDE EFFECTS & WARNINGS

Preparation: 150mg/3mls

Loading dose: 150mg in 10mins

Maintenance dose:
• 1mg/min = 60mg/hour for 6 hours (360mg for 6H)
• 0.5mg/min = 30mg/hour over next 18 hours (540mg for 18H)

Alternatively:
• 900mg run over 24H
• 300mg run over 8H

Maximum: 1.2g in 24H (10mg/kg/day)

FOR USE IN PULSELESS VT OR VF:

• 300MG (1st bolus) with saline push.
• 150mg (2nd bolus) with saline push.

AMIODARONE:
SODIUM BICARBONATE
FOR METABOLIC ACIDOSIS
GROUP: Electrolytes.

USES: neutralizing excess acid in

the blood and also replace
bicarbonate when there are
excess losses from the body.

GROUP OF MEDICATION
• metabolic acidosis
• certain drug intoxications
• replacing bicarbonate lost due
to severe diarrhoea.

INDICATION
• No common side effects
• If severe:
• Rash
• Hives
• Difficulty in breathing
• Chest tightness
• Swelling of the mouth, lips, face or
tongue
• Muscle spasm or twitching

SIDE EFFECTS
Preparation:
• Sodium Bicarbonate 8.4% (10mls) .
• 1mls contain 1mmol (1mEq/l) of Sodium &
Bicarbonate ions.

Dose Adult :-
• Dose (mmol) = Base deficit (mEq/l) x Bodyweight
(kg) ÷ 3 = ?mls of 8.4% Sodium Bicarbonate.

Administer :-
• ½ (half of the calculated amount) over 20-30 min in
syringe pump

Monitor the acid base balance.

SODIUM BICARBONATE:
PHENYTOIN
GROUP: Anti-convulsant

USES: as treatment for epilepsy

GROUP OF MEDICATION
• Tonic clonic seizures
• Partial seizures
• Status epilepticus

INDICATION
• Nausea, vomiting, constipation
• Tremors, slurred speech, loss of
balance or coordination
• Rash
• Headache
• Confusion, dizziness, nervousness
• Insomnia

SIDE EFFECTS
Preparation: 250mg/5mls (50mg/ml)

Adult:
• Loading dose: 10-15mg/kg (max:1.5gm) dilute in
100cc N/S use Microchamber and run over 1
Hour.

Maintenance dose: 100mg/8hourly

Paeds:
• Loading dose: 15-20mg/kg dilute in 50cc N/S use
syringe pump and run over 1 hour.

PHENYTOIN:
DOPAMINE
GROUP: Neurotransmitter

USES: a chemical messenger that helps in the

transmission of signals in the brain and other vital
areas.

GROUP OF MEDICATION
• To treat low pressure (shock)
which may be caused by heart
attack, trauma, surgery, heart
failure, kidney failure, and other
serious medical conditions.

INDICATION
• nausea and vomiting.
• constipation.
• headaches.
• drowsiness and sudden 'attacks' of sleepiness.
• dizziness or fainting due to low blood pressure.
• hallucinations or delusions and confusion.
• existing dyskinesias (uncontrolled movements)
becoming more troublesome initially

SIDE EFFECTS
Preparation: 200mg in 5mls. PT’S DOSE ml of DOPA
WEIGHT NEEDED
(ESTIMATED (mg), ?
3xbodyweight(kg) = ?mg 50kg 150 3.75-3.80

?mg dilute in 50cc N/S or 60kg 180 4.5

Dextrose Saline
70kg 210 5.0

Rate: 1mls/hour = 1mcg/kg/min 80kg 240 6.0

Dose: 5.0mcg/kg/min- 90kg 270 6.75-6.80

20mcg/kg/min
100kg 300 7.5
*Titrate with response
120kg 360 9.0

DOPAMINE:
DOBUTAMINE
GROUP: Beta-1 receptors.

USES: Stimulates receptors (beta-1 receptors) on

the heart

GROUP OF MEDICATION
• Reversible heart failure (septic
or cardiogenic shock)
• CCF
• Testing agent to identify
coronary artery disease

INDICATION
SIDE EFFECTS: WARNINGS:

• Hypotension • Arterial fibrillation

• Angina as it has the effect
• Arrhythmias of increasing the
AV conduction
• Tachycardia
• Patients with
arrhythmias

SIDE EFFECTS
 PT’S DOSE ml of DOBU
Preparation: 250mg in 20mls WEIGHT NEEDED
(ESTIMATED (mg), ?
50kg 150 12
3xbodyweight(kg) = ?mg
60kg 180 14.5
?mg dilute in 50cc N/S or
Dextrose Saline 70kg 210 16.8

Rate: 1mls/hour = 1mcg/kg/min 80kg 240 19.2

90kg 270 21.6

Dose: 5.0mcg/kg/min-
20mcg/kg/min 100kg 300 24

*Titrate with response 120kg 360 28.8

DOBUTAMINE:
LABETOLOL
GROUP: Alpha/Beta adrenergic
antagonist

GROUP OF MEDICATION
• to treat high blood
pressure

INDICATION
SIDE EFFECTS: WARNINGS:

• 2nd or 3rd degree

• Dizziness complete heart block
• Indigestion • Moderate to severe 1st
• Lightheadedness degree heart block after
a heart attack
• Nausea • Heart failure
• Swelling or redness at • Prolonged QT interval in
the injection site ECG
• Stuffy nose • Asthma, obstructive
airway disease, or
• Temporary tingling of breathing disorders
the scalp • Severe slow heart beats
• Unusual tiredness or severe low BP

SIDE EFFECTS
Preparation: 25mg/5ml (pure).

Dose:
• Bolus IV Labetolol 5mg over 1-5 mins.
• Repeat every 5-10 mins.
• Up to 200-300mg

Infusion:
• For 0.5-2mg/min: Prepare 100mg (4 ampoules) into 20ml
syringe (undiluted):-
• 0.5mg/min = 6ml/hour
• 1.0mg/hour = 12ml/hour
• 1.5mg/min = 18ml/hour
• 2.0mg/min = 24ml/hour

*titrate to response every 5 min.

LABETOLOL:
INSULIN
• To treat DM

INDICATION
• Headache
• Hunger
• Dizziness
• Sweating
• Irritability
• trouble concentrating
• rapid breathing
• fast heartbeat
• Fainting
• seizure (severe hypoglycemia can be fatal)
• hypoglycemia

SIDE EFFECTS
Preparation: 100iu/ml

Take 50iu of insulin (0.5mls) dilute

with 50cc N/S in 50cc syringe.

Rate: 1ml/hour = 1iu/hour

INSULIN:
BLOOD SCALE SCALE SCALE SCALE SCALE SCALE SCALE SCALE
GLUCOSE
(mmol/l)
1 2 3 4 5 6 7 8

≥22 3.0 4.0 5.0 6.0 7.0 8.0 10.0 11.0

18 2.5 3.5 4.0 5.0 6.0 6.0 8.0 9.0

14 2.0 3.0 3.0 4.0 5.0 5.0 6.0 7.0

12 1.5 2.5 2.5 3.0 4.0 4.0 4.0 5.0

10 1.0 2.0 2.0 2.0 3.0 3.0 3.0 4.0

8 1.0 1.5 1.5 1.5 2.0 2.0 2.5 3.0

6 0.5 1.0 1.0 1.0 1.5 1.5 2.0 2.0

INSULIN SCALE
LASIX (FRUSEMIDE)
GROUP: Loop diuretic

USES: to treat fluid retention

GROUP OF MEDICATION
• Acute pulmonary edema
• Edema associated with CHF,
hepatic cirrhosis, and renal
disease ( IV only)
• Hypertension ( PO only)

INDICATION
 SIDE EFFECTS:

• Hypotension CONTRAINDICATIONS:
• Dizziness, headache,
paresthesia, restless, • Hypersensitivity to any
vertigo. component of the
• Blurred vision product (anuria).
• Nausea
• Glycosuria

SIDE EFFECTS & CONTRAINDICATIONS

Preparation: 20mg in 2mls.

Take 200mg (10ampoules = 20mls) in 20cc syringe.

Rate: 0.5mls/hour = 5mg/hour

Dose:
• 5mg/hour = 0.5ml/hour
• 10mg/hour = 1ml/hour
• 15mg/hour = 1.5ml/hour

*titrate to effect

FRUSEMIDE:
MIDAFENTANYL
MIDAZOLAM MORPHINE
GROUP: Benzodiazepine GROUP: Opiate
(Sedative) painkiller and
tranqulizer
USES:
• Used to reduce anxiety USES:
or producing
drowsiness or • anesthesia to help
anesthesia before prevent pain after
certain medical surgery or other
procedures or surgery. medical procedure.

GROUP OF MEDICATION
MIDAZOLAM FENTANYL
• For preoperative • For use as a pain
sedation reliever as well as an
• Induction of GA anesthetic in
• Sedation for combination with a
ventilated patients in benzodiazepine.
critical care unit
• As an emergency
control of seizures
• To reduce anxiety and
restlessness

INDICATION
MIDAZOLAM
• Blurred vision
• Changes in blood pressure
breathing and heartbeats
• Coughing
• Dizziness & Drowsiness
• Dry mouth
• Headache & Nausea &
Vomiting
• Hiccups
• Low blood pressure
(children)
• Short-term memory loss
• Slurred speech
SIDE EFFECT
FENTANYL
• Diarrhoea, nausea,
constipation, dry mouth
• somnolence
• Confusion
• asthenia (weakness) & sweating
• abdominal pain
• Headache, fatigue, anorexia
• Dizziness, nervousness
• Hallucinations, anxiety
• Depression
• SOB
• Hypoventilation
• Urinary retention
Preparations:
Midazolam 15mg/3ml, Midazolam 5mg/1ml
& Fentanyl 0.1mg/1ml

Dilution:
Midazolam 20mg + Fentanyl 0.1mg dilute in
50cc N/S in 50cc syringe.

MIDAFENTANYL:
INTUBATION DRUGS
F+M+S
1. Fentanyl 0.1mg PURE
2. Midazolam 5mg dilute in 5cc N/S
3. Scoline 100mg PURE

*ASK IF YOU ARE UNSURE!

Post intubation drug:

• Midamorphine:
• Morphine 20mg + Midazolam 20mg dilute in 20cc N/S

• Midafentanyl:
• Midazolam 20mg + Fentanyl 0.1mg dilute in 50cc N/S