Emergency drugs

Question 1

What is the fluid given in the first hour of DKA?

Answer 1

1L 0.9% sodium chloride - 1000ml over 1hr

Question 2

What is the fluid given in the second hour of DKA?

Answer 2

1L 0.9% sodium chloride + potassium chloride - 1000ml over 1hr

Question 3

What is the insulin management in DKA?

Answer 3

FRII at 0.1unit/kg/hr
Alongside FRII- give long term insulin but stop short term

Question 4

When is dextrose added in DKA management and at what rate?

Answer 4

When CBG is <14mmol/L add 10% dextrose at 125mls/hr alongside insulin at 0.1units/kg/hr

Question 5

When should you swap to subcut insulin?

Answer 5

When pt is eating/drinking

Question 6

When do you use insulin in HHS and at what rate?

Answer 6

If presence of ketones / hyperglycemia is not controlled/ decreasing with fluids
0.05 units/kg/hr

Question 7

When do you use insulin in HHS and at what rate?

Answer 7

If presence of ketones
0.05 units/kg/hr

Question 8

What is given in Addisonian crisis and at what dosages?

Answer 8

100mg hydrocortisone
(alongside IV 0.9% saline infusion 1L/hr until haemoynamic improvement )

Question 9

Dose of adrenaline in CPR

Answer 9

1mg every 3-5 mins
(1 in 10,000) IV?

Question 10

Dose of adrenaline in acute anaphylaxis and route of administration

Answer 10

500micrograms (1 in 1000) repeated every 5 min
IM into anterolateral thigh

Question 11

Hydrocortisone dose in thyrotoxic crisis

Answer 11

100mg every 6hrs IV

Question 12

Hydrocortisone in anaphylaxis

Answer 12

100-300mg IV

Question 13

Hydrocortisone in adrenal crisis

Answer 13

100mg initally then 200mg every 24hrs diluted in 5% glucose IV
OR
50mg IV or IM every 6hrs

Question 14

Chlorphenamine in anaphylaxis (angioedema)
(H1 antagonist)

Answer 14

10mg repeated up to 4 times/ day if needed IV or IM

Question 15

atropine in Bblocker OD

Answer 15

0.5-1.2mg IV

Question 16

atroprine in bradycardia after MI
(how often)

Answer 16

500micrograms every 3-5 min up to a max of 3mg

Question 17

aspirin for suspected TIA

Answer 17

300mg

Question 18

aspirin for MI

Answer 18

300mg chewed then 75mg OD for life

Question 19

aspirin for acute ischemic stroke

Answer 19

300mg OD for 14 days orally

Question 20

clopidogrel acute NSTEMI

Answer 20

300mg then 75mg for up to 12 months orally

Question 21

calcium gluconate in acute severe hyperkalemia
(+why is it given)

Answer 21

potassium >6.5mmol/L
IV 30ml calcium gluconate 10% (6.8mmol Ca) given as single dose
repeat if no improvement on ECG after 5-10min
(stablise the myocardium)

Question 22

how do you lower K+ temporarily

Answer 22

give salbutamol nebs

Question 23

insulin dextrose infusion in acute severe hyperkalemia
(+why is it given)

Answer 23

10 units insulin + 25g dextrose IV
(shifts K+ from ECF > ICF short term)

Question 24

glucagon in hypoglycemia

Answer 24

1mg IM, if no response in 10 mins then give 15-20g of 10-20% glucose over 15 min IV (use large vein bc irritant)

Question 25

glucagon in Bblocker OD

Answer 25

5-10mg over 1-2mins

Question 26

diazepam in status epilipticus and convulsions

Answer 26

10mg then another 10mg after 10 mins if required

Question 27

diazepam for tetanus

Answer 27

300 micrograms /kg every 1-4 hrs IV

Question 28

lorazepam in acute panic attack

Answer 28

25-30micrograms/kg every 6hrs

Question 29

lorazepam in status epilipticus

Answer 29

4 mg for 1 dose, then 4 mg after 5–10 minutes if required for 1 dose, to be administered into a large vein

Question 30

salbutamol nebs in moderate, severe or LT asthma

Answer 30

5 mg, repeat every 20–30 minutes or when required, give via oxygen-driven nebuliser if available

Question 31

prednisolone in asthma

Answer 31

oral 40–50 mg daily for at least 5 days.

Question 32

morphine in MI

Answer 32

2.5–5 mg, followed by 2.5–5 mg if required, dose to be administered at a rate of 1–2 mg/minute IV

Question 33

morphine in acute pulmonary oedema

Answer 33

Adult 5–10 mg, dose to be administered at a rate of 2 mg/minute, use dose for elderly in frail patients. Elderly 2.5–5 mg, dose to be administered at a rate of 2 mg/minute.

Question 34

naloxone in opioid OD

Answer 34

400 micrograms then 800 micrograms up to 2 doses 1 minute apart if no response - 2mg for 1 dose