Emergency Drugs Year 3

Question 1

STEMI (with post-MI bradycardia)

Answer 1

Morphine IV 5-10mg at 1-2mg/min (slow infusion).
- Repeat if required. Half dose in elderly/frail patients.
Aspirin 300mg orally
- then 75mg for life
Clopidogrel 300mg orally
- then 75mg for 4 weeks
(Atropine IV 500 micrograms every 3-5 mins up to max of 3mg AKA 6 times)

Other relevant info that is not on emergency drugs list:
GTN spray sublingually
Metoclopromide IV
Oxygen if appropriate
Insulin if hyperglycaemia (over 11mmol/L)
Primary Percutaneous Coronary Intervention (PCI) if within 12 hours of Sx onset, or within 2 hours of time when fibrinolysis could have been given, is preferred strategy for most patients.
or Coronary Artery Bypass Graft (CABG) are often appropriate alongside drug treatment for ACS

NSTEMI and unstable angina are treated with:
Aspirin 300mg orally
Glyceryl trinitrate (GTN) spray sublingually
Clopidogrel (NSTEMI)

Question 2

Anaphylaxis

Answer 2

Adrenaline 500 micrograms IM, repeat after 5 mins (normal concentration is 1mg/ml, 1 in 1000)
Hydrocortisone 100-300mg IV
Clorphenamine 10mg IM or IV, up to 4 x a day

Question 3

Adrenal crisis

Answer 3

Hydrocortisone 100mg IV

Question 4

Acute severe hyperkalaemia (6.5mmol/L or more, or in presence of ECG changes)

Answer 4

10% Calcium gluconate 30ml IV (slow infusion of single dose), repeat if no ECG improvement within 5-10 mins
Soluble Insulin 5-10 units IV
50ml of 50% glucose IV given over 5-15 mins

Question 5

Opioid overdose

Answer 5

Low dose OD (e.g palliative care or post op - accidentally gave too much of a morphine dose they were going to have anyway):
Naloxone 100-200 micrograms IV initially (100 micrograms for up to 2 doses 1 min apart), then can titrate up to 2mg. If still no response give a further 2mg dose (so that’s a total of 4mg for seriously poisoned patients.

High dose:
Naloxone 400 micrograms IV initially, then 800 micrograms for up to 2 doses 1 min apart, then increase to 2mg for one dose if still no response. (4mg dose may be required in seriously poisoned patients)

Question 6

Hypoglycaemia

Answer 6

If conscious and able to swallow:
15-20g of Fast acting carbs orally, repeat after 15 mins if necessary
Slower release carbs orally once above 4.0mmol/L

If unable to swallow/unconscious:
Glucagon 1mg IM
If not effective within 10 mins then give 100ml of 20% dextrose IV over 15 mins

Question 7

Acute asthma attack

Answer 7

Nebulised salbutamol 5mg through an oxygen driven nebuliser, repeat every 20-30 mins if necessary.
Hydrocortisone 100mg IV every 6 hours until they can take 40-50mg Prednisolone orally daily for at least 5 days.

Other info that isn’t necessarily on emergency drug list:
Oh - Oxygen
Shit - Salbutamol 5mg nebulised
I - Ipratropium bromide inhaled
Hate - Hydrocortisone 100mg IV or Prednisolone 40-50mg orally for 5 days
My - Magnesium sulphate IV
Asthma - Aminophylline IV or theophylline orally

Question 8

Acute alcohol withdrawal

Answer 8

Diazepam 10mg IM or IV (IV into a large vein at no more than 5mg/min)
Repeat after at least 4 hours if required

If delirium tremens present (agitation, confusion, paranoia, and visual and auditory hallucinations), oral lorazepam is first line

Question 9

Status epilepticus

Answer 9

Lorazepam 4mg IV, repeat once after 5-10mins if required (slow infusion into large vein)

Diazepam 10mg IV then repeat once after 10mins if required (slow infusion at 1ml/min)
or Diazepam 10-20mg rectally then repeat after 5-10 mins if required