Emergency drugs

Question 1

What is the dose of
Adrenaline in anaphylaxis?

Answer 1

Adult
500 micrograms, using adrenaline 1 in 1000 (1 mg/mL) injection, repeat dose after 5 minutes if no response; if life-threatening features persist, further doses can be given every 5 minutes until specialist critical care available, to be injected preferably into the anterolateral aspect of the middle third of the thigh.

By intramuscular injection

Question 2

What is the dose of
Adrenaline in cardiac arrest?

Answer 2

Adult
1 mg every 3–5 minutes as required, a 1 in 10 000 (100 micrograms/mL) solution is recommended.

By slow intravenous injection (5-10 minutes)

Question 3

What is the dose of an Epipen autoinjector 0.3mcg?

Answer 3

Adult
300 micrograms, then 300 micrograms after 5 minutes as required.

By intramuscular injection

Question 4

What dose of Hydrocortisone do you give in an adrenal crisis?

Answer 4

Initially 100 mg, then (by continuous intravenous infusion) 200 mg every 24 hours, diluted in Glucose 5%, alternatively (by intramuscular injection or by intravenous injection) 50 mg every 6 hours, dose increased to 100 mg every 6 hours in patients who are severely obese.

Initially by intramuscular injection, or by intravenous injection

Question 5

What dose of Hyrdocortisone do you give in acute hypersensitivity reactions such as angioedema of the upper respiratory tract and anaphylaxis?

Answer 5

100–300 mg, to be administered as sodium succinate.

By intravenous injection

Question 6

What dose of Hydrocortisone do you give in a thyroid storm?

Answer 6

100 mg every 6 hours, to be administered as sodium succinate.

By intravenous injection

Question 7

What dose and method of Chlorphenamine do you give in anaphylactic reactions?

Answer 7

10 mg, repeated if necessary; maximum 4 doses per day.

By intramuscular injection, or by intravenous injection

Question 8

What dose and method of Atropine do you use for bradycardia following an MI?

Answer 8

500 micrograms every 3–5 minutes; maximum 3 mg per course.

By intravenous injection

Question 9

What is the dose and method of Aspirin in unstable angina, NSTEMI and STEMI?

Answer 9

300 mg, chewed or dispersed in water.

By mouth

Question 10

What dose and method of Clopidogrel do you give in unstable angina and NSTEMI (given with Aspirin)?

Answer 10

Initially 300 mg for 1 dose, then 75 mg once daily for up to 12 months.

By mouth

Question 11

What dose and method of Clopidogrel do you give in STEMI (with Aspirin)?

Answer 11

Adult 18–75 years
Initially 300 mg for 1 dose, then 75 mg once daily for at least 4 weeks.

Adult 76 years and over
75 mg once daily for at least 4 weeks.

By mouth

Question 12

What dose and method of Clopidogrel do you give in Prevention of atherothrombotic events in percutaneous coronary intervention (adjunct with Aspirin) in patients not already on Clopidogrel?

Answer 12

Loading dose 300 mg for 1 dose, to be taken prior to the procedure, alternatively loading dose 600 mg for 1 dose, to be taken prior to the procedure, higher dose may produce a greater and more rapid inhibition of platelet aggregation.

By mouth

Question 13

What dose and method of Calcium Gluconate do you give in acute severe hyperkalaemia [plasma-potassium concentration 6.5 mmol/litre or greater, or in the presence of ECG changes]?

Answer 13

30 mL, calcium gluconate 10% (providing approximately 6.8 mmol of calcium) should be administered as a single dose, repeat dose if no improvement in ECG within 5 to 10 minutes.

By slow intravenous injection

Question 14

What dose and method of Insulin/dextrose do you give in acute severe hyperkalaemia (plasma-potassium concentration 6.5 mmol/litre or greater, or in the presence of ECG changes)?

Answer 14

An intravenous injection of soluble insulin (5–10 units) with 50 mL glucose 50% given over 5-15 minutes, reduces serum-potassium concentration; this is repeated if necessary or a continuous infusion instituted.

Question 15

How do you treat severehypoglycemia when blood glucose is less than 4mmol/L. Patient is unconscious/fitting/agressive or nil by mouth.

Answer 15

IF IV access secured:
200ml of 10% glucose over 15 minutes or 100ml of 20% glucose over 15 minutes. 800ml/hr

If unable to secure IV access give 1mg of IM glucagon

Check CBG every 15 minutes until it is greater than 4mmol/L
IF CBG is still less than 4 and patient is unwell, give 150ml of 10% glucose over 15 minutes and can be repeated 3 times.

Question 16

How do you treat blood-glucose concentration less than 4 mmol/litre with or without symptoms, and who is conscious and able to swallow?

Answer 16

Should be treated with a fast-acting carbohydrate by mouth. Fast-acting carbohydrates include Lift® glucose liquid (previously Glucojuice®), glucose tablets, glucose 40% gels (e.g. Glucogel®, Dextrogel®, or Rapilose®), pure fruit juice, and sugar (sucrose) dissolved in an appropriate volume of water. Oral glucose formulations are preferred as absorption occurs more quickly.

If necessary, repeat treatment after 15 minutes, up to a maximum of 3 treatments in total. Once blood-glucose concentration is above 4 mmol/litre and the patient has recovered, a snack providing a long-acting carbohydrate should be given to prevent blood glucose from falling again (e.g. two biscuits, one slice of bread, 200–300 mL of milk (not soya or other forms of ‘alternative’ milk, e.g. almond or coconut), or a normal carbohydrate-containing meal if due). Insulin should not be omitted if due, but the dose regimen may need review.

Question 17

Why should orange juice not be given to patients following a low-potassium diet?

Answer 17

Chronic kidney disease
Orange juice

Question 18

Why should chocolate biscuits be avoided?

Answer 18

They have a lower sugar content and their high fat content may delay stomach emptying.

Question 19

What do you do if hypoglycaemia which does not respond (blood-glucose concentration remains below 4 mmol/litre after 30–45 minutes or after 3 treatment cycles)?

Answer 19

Should be treated with intramuscular glucagon or glucose 10% intravenous infusion. In alcoholic patients, thiamine supplementation should be given with, or following, the administration of intravenous glucose to minimise the risk of Wernicke’s encephalopathy.

Question 20

What do you do in a hypoglycemic emergency where the patient is unconsciousness?

Answer 20

Patients who are unconscious, having seizures, or who are very aggressive, should have any intravenous insulin stopped, and be treated initially with glucagon. If glucagon is unsuitable, or there is no response after 10 minutes, glucose 10% intravenous infusion, or alternatively glucose 20% intravenous infusion should be given. Glucose 50% intravenous infusion is not recommended as it is hypertonic, thus increases the risk of extravasation injury, and is viscous, making administration difficult.

Question 21

What should you do after an emergency and you have gotten blood sugar levels back to normal?

Answer 21

A long-acting carbohydrate should be given as soon as possible once the patient has recovered and their blood-glucose concentration is above 4 mmol/litre (e.g. two biscuits, one slice of bread, 200–300 mL of milk (not soya or other forms of ‘alternative’ milk, e.g. almond or coconut), or a normal carbohydrate-containing meal if due). Patients who have received glucagon require a larger portion of long-acting carbohydrate to replenish glycogen stores (e.g. four biscuits, two slices of bread, 400–600 mL of milk (not soya or other forms of ‘alternative’ milk, e.g. almond or coconut), or a normal carbohydrate containing meal if due). Glucose 10% intravenous infusion should be given to patients who are nil by mouth.

Blood-glucose monitoring should be continued for at least 24–48 hours.

Question 22

What dose and method of Diazepam do you use with severe acute anxiety, control of acute panic attacks and acute alcohol withdrawal?

Answer 22

10 mg, then 10 mg after at least 4 hours if required, intravenous injection to be administered into a large vein, at a rate of not more than 5 mg/minute.

By intramuscular injection, or by slow intravenous injection

Question 23

What dose of Diazepam (intravenous) do you use for Status epilepticus,
Febrile convulsions,
Convulsions due to poisoning?

Answer 23

10 mg, then 10 mg after 10 minutes if required, administered at a rate of 1 mL (5 mg) per minute.

Question 24

What dose of Diazepam (rectum) do you use for Status epilepticus,
Febrile convulsions,
Convulsions due to poisoning?

Answer 24

Adult
10–20 mg, then 10–20 mg after 5–10 minutes if required.
Elderly
10 mg, then 10 mg after 5–10 minutes if required.

Question 25

What dose and method of Lorazepam do you give for Status epilepticus,
Febrile convulsions,
Convulsions caused by poisoning?

Answer 25

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

Slow intravenous injection

Question 26

What dose and method of Lorazepam do you give for an acute panic attack?

Answer 26

Adult
25–30 micrograms/kg every 6 hours if required; usual dose 1.5–2.5 mg every 6 hours if required, intravenous injection to be administered into a large vein, only use intramuscular route when oral and intravenous routes not possible.

By intramuscular injection or slow intravenous injection

Question 27

What dose of Salbutamol nebuliser do you give in moderate, severe and life-threatening asthma?

Answer 27

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

Question 28

What dose and method of Prednisolone do you give in moderate, severe and life-threatening asthma?

Answer 28

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

By mouth

Question 29

What dose and method of Morphine do you give in a myocardial infarction?

Answer 29

Adult
5–10 mg, followed by 5–10 mg if required, dose to be administered at a rate of 1–2 mg/minute, use dose for elderly in frail patients.
Elderly
2.5–5 mg, followed by 2.5–5 mg if required, dose to be administered at a rate of 1–2 mg/minute.

By slow intravenous injection

Question 30

What dose and method of Morphine do you give in acute pulmonary oedema?

Answer 30

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.

By slow intravenous injection

Question 31

What dose and method of Morphine do you give in acute pain?

Answer 31

Adult
Initially 10 mg every 4 hours, adjusted according to response, subcutaneous injection not suitable for oedematous patients, dose can be given more frequently during titration, use dose for elderly in frail patients.

Elderly
Initially 5 mg every 4 hours, adjusted according to response, subcutaneous injection not suitable for oedematous patients, dose can be given more frequently during titration.

By mouth, or by subcutaneous injection, or by intramuscular injection

Question 32

What dose of Morphine do you give (slow intravenous injection) for acute pain?

Answer 32

By mouth, or by subcutaneous injection, or by intramuscular injection

Question 33

What dose and method do you give Naloxone in acute opioid overdose–high-dose regimen [when rapid titration with naloxone is necessary to reverse potentially life-threatening effects]?

Answer 33

Adult
Initially 400 micrograms, then 800 micrograms for up to 2 doses at 1 minute intervals if no response to preceding dose, then increased to 2 mg for 1 dose if still no response (4 mg dose may be required in seriously poisoned patients), then review diagnosis; further doses may be required if respiratory function deteriorates following initial response, intravenous administration has more rapid onset of action, doses may be given by intramuscular route but only if intravenous route is not feasible.

By intravenous injection