EMERGENCY MEDICATIONS

Atropine

Treatment of sinus pulseless electrical activity, bradycardia, or asystole..

Neonates and children: 0.02mg/kg

intratracheal (max: 0.5mg); may repeat5min later, one time

• Cardiac pacing is required in neonates with ventricular rates of 50 beats/min or

experience heart failure after birth. to increase the heart rate temporarily until pacemaker
placement can be arranged

• Preoperative medication to inhibit secretions and salivation

• Antidote to organophosphate poisoning.

0.02-0.05 mg/kg every 10-20min until atropine effect is seen then q1-4h for at least 24hr.

• Cautions: gastrointestinal obstruction, thyrotoxicosis, and tachycardia.

• Adverse events: Tachycardia, palpitations, delirium, ataxia, dry hot skin, tremor, urinary
retention
Epinephrine

Indications: Treatment of cardiac arrest, bronchospasm, anaphylactic reaction

For asystole or for failure Epinephrine (0.1- 0.3mL/kg of a 1:10,000 solution, intravenously
or intratracheally) is given to respond to 30sec of combined resuscitation. The dose may be
repeated every 5 min

Routes- IV, intratracheal, continuous infusion and nebulisation

Adverse events:

• Tachycardia, hypertension, nervousness, restlessness, irritability, headache, tremor,

weakness, nausea, vomiting, acute urinary retention.

Peripheral soft tissue damage if they extravasate from peripheral lines into the local tissues

Hydrocortisone

• Indications: Status asthmaticus, shock [50mg/kg/dose 4h], Treatment of adrenal

insufficiency, congenital adrenal hyperplasia,

Caution: Abrupt withdrawal -acute adrenal insufficiency.

• Adverse events: Hypertension, hyperglycemia, hypokalemia, euphoria, insomnia,

headache, Cushing syndrome, peptic ulcer, cataracts, immunosuppression, skin and
muscle atrophy, acne, edema.
Dopamine

• Indication: hypotension and shock 1-20µg/kg/min IV

• Adverse events: Tachycardia, ectopic beats, ventricular arrhythmias, tissue necrosis with
extravasation, vasoconstriction, gangrene of extremities, excess urine output (doses
<5µg/kg/min), oliguria (doses 10µg/kg/min).
Furosemide

• Indications: Pulmonary edema-cardiac failure, SIADH, reduction of ICT in combination

with mannitol, broncho-pulmonary dysplasia

• Adverse events: Dehydration, electrolyte loss, hyperuricemia, photosensitivity, ischemic

hepatitis, hypercalciuria, renal stones, ototoxicity (IV infusion rate >4mL/min),
gastrointestinal intolerance

Digoxin

• Indications: Treatment of systolic heart failure and supraventricular tachyarrhythmias

• Cautions: Contraindicated in AV block, idiopathic hypertrophic subaortic stenosis, or

constrictive pericarditis

• Adverse events: Anorexia, nausea, vomiting,

diarrhea, feeding intolerance, bradycardia, arrhythmias, lethargy, depression, vertigo,

blurred vision, diplopia, photophobia, yellow or green vision

• The drug crosses the placenta, and therefore a fetus with heart failure(secondary to
arrhythmia) can be treated by administering digoxin to the mother.

• The kidney eliminates digoxin, so dosing must be adjusted according to the patient'srenal
function.
Digoxin in heart failure

• Rapid digitalization of infants and children in heart failure may be carried out
intravenously. The recommended schedule is to give half the total digitalizing dose
immediately and the succeeding two one-quarter doses at 12hr intervals later.

• Maintenance digitalis therapy is started approximately 12hr after full digitalization. The
daily dosage is divided in two and given at 12hr.The dosage is one quarter of the total
digitalizing dose

• Slow digitalization -patient not critically ill or initiation of a maintenance digoxin schedule
without a previous loading dose.full digitalization in 7-10 days

Monitoring:

Dosing should be guided by measuring serum digoxin concentrations: therapeutic: 0.8-

2ng/mL; toxic: >2- 2.5ng/mL.

DLIS - elevate digoxin levels, so pretreatment digoxin levels can be obtained and
subtracted from treatment levels or samples can be run through a free-level filter to remove
DLIS before assay.

Check post-distribution levels (drawn at least 6-8hr post dose) at steady-state (2-4 wk) or if
ECG or clinical signs of toxicity. Check ECG, serum electrolytes, calcium, and magnesium.

Digoxin Immune Fab

• Treatment of digitalis intoxication from digoxin

• Dose is based on amount of digoxin ingested or estimated total body load based on post-
distributive serum concentration
Adverse events: Worsening of heart failure or atrial fibrillation, hypokalemia, facial swelling,
and redness.

Naloxone

• Indication: opiate excess (overdose, poisoning).

Neonates and children: 0.1mg/kg IV (max dose: 2mg). If no response, repeat q 2-3min until
desired effect. May give by continuous IV infusion

• Adverse effects May precipitate acute opiate withdrawal. Duration of effect of many
opiates may be longer than naloxone requiring individualized naloxone dosing.

• Cautions:

Infuse slowly IV; variable oral bioavailability; chewable tablet most consistent. Must shake
oral suspension very well before use.

Certain disease states (renal failure, acute head trauma) may lead to imbalance between
free and protein-bound drug.

Fosphenytoin has advantages over the older formulation - it is water soluble, less irritating
after IV injection, and well absorbed after intramuscular injection

• Adverse effects: Lethargy, dizziness, nystagmus, hypotension, hirsutism, gingival

hyperplasia, rash, Stevens-Johnson syndrome, hepatitis, thrombophlebitis.
Drug interactions:

May increase metabolism of certain hepatically cleared drugs; griseofulvin,

corticosteroids, cyclosporin;

Highly protein boundand may cause displacement interaction.

Monitoring: Phenytoin concentrations: therapeutic 8- 20µg/mL.

Phenobarbitone

• Indications: anticonvulsant, sedative, hypnotic, anesthetic, hyperbillubinemia

• Anticonvulsant

loading dose Children:15-20mg/kg PO, IV.

Maintenance dose

Neonates: 3-4mg/kg, Children: 5- 6mg/kg/24hr PO, IV, q12-24h.

Cautions: Dose titrated to desired effect. Administer IV =30mg/min

• Adverse effects: Hypotension, drowsiness, respiratory depression, paradoxical

hyperactivity
Drug interactions:

May increase metabolism of many hepatically cleared drugs; griseofulvin, corticosteroids.

Certain drugs may interfere with phenobarbital

metabolism: valproic acid, chloramphenicol, felbamate.

Potassium chloride

• Indications:

Hypokalemia

< 2.5meq/l, cardiac rhythm disturbances

40mEq/L @ 0.6 mEq/kg/hr under continuous EEG monitoring

Tachyarrhythmias - chronic use of digoxin [max 100m mol)

Sodium bicarbonate

Presence of a severe metabolic acidosis(1mEq/kg,) as documented by arterial blood gas

analysis and during a prolonged resuscitation when it may be given every 10 min during the
arrest
Symptomatic hyperkalemia(>7meq/L),

hypermagnesemia, tricyclic antidepressant drug intoxications, or with adverse events due

to sodium channel blocking agents

• Alkalinization of urine with sodium bicarbonate increases effectiveness of

aminoglycosides against in the urinary tract

• Alkali therapy may result in hypernatremia, skin slough from infiltration, increased serum
osmolarity, hypocalcemia, hypokalemia,

• Liver injury when oncentrated solutions are administered rapidly through an umbilical
vein catheter wedged in the liver

Calcium gluconate

• Hyperkalemia- counteracts the potassium-induced increase in myocardial irritability

Calcium gluconate 10% solution, 1.0mL/kg IV, over 3-5 min

• Neonatal tetany consists of intravenous injections of 5-10mL of a 10% solution of calcium

gluconate at the rate of 0.5-1mL/min while the heart rate is monitored.

• Symptomatic hypocalcemia in neonates, calcium gluconate is given at a dose of 100-

200mg/kg (1- 2mL/kg of a 10% solution).dose may be repeated every 6-8hr until the
calcium level stabilizes

• Alternatively, intravenous infusion can be given

• Adverse effects :hypercalcemia

Ibuprofen

• Uses - To relieve pain, lower raised temperature and reduce inflammation of soft tissue
injuries, also in NICU to close patent ductus arteriosus

• Who can have it - From one month

• How is it given - By mouth or IV

• Who can't have it - Not to asthmatics, those with renal failure, gastrointestinal problems,
lupus, liver problems, low platelets (oncology) also caution with cardiac impairment.

Paracetamol (Acetaminophen)

The Most Commonly used medication both in hospitals and in the community

Uses - To relieve pain and lower raised temperature.

• Who can have it - From neonates (28 weeks) onwards.

How is it given most commonly by mouth, also given rectally and by IV

. Who can't have it alcohol dependents

2+
Calpol

Infant Suspension

Paracetamol - Is It All Good??

Pre-emptive administration before vaccinations is thought to reduce antibody response.

Mounting evidence linking use of paracetamol to the increases in prevalence of childhood

asthma.

• Should only be used for comfort not to reduce fever - no evidence to show that it reduces
risk of febrile convulsions.

Midazolam /benzodiazapine

• Uses - Given to children with convulsions lasting > 5mins also a sedative for procedures,
pre med and anti epilepsy medication

• Who can have it - From neonate

• How is it given - By I.V and buccal cavity

• Side Effects - respiratory depression

Warning in a few patients can cause opposite affect to sedation

Flucloxacillin (penicillin)

Uses Bacterial infections such as skin infections, umbilical flare in NICU

Who can have it From neonates

How is it given - Given by PO, I.M, I.V

• Who can't have it Contraindications - liver or kidney problems

Caution - Check allergy to penicillin - hypersensitivity which causes rashes and

anaphylaxis and can be fatal. Allergic reactions to penicillin's occur in 1-10% of exposed
individuals; anaphylactic reactions occur in fewer than 0.05% of treated patients. May
cause diarrhoea
References

NICE 2007

BNF children 2012

Pirmohamed, M., James, S., Meakin, S., Green C. (2004). Adverse drug reactions as cause
of admission to hospital: prospective analysis of 18 820 patients. BMJ, 2004.

Rashed, A., Wong, I., Cranswick, N., Tomlin, S., Rascher, W., & Neubert , A. (2012). Risk
factors associated with adverse drug reactions in hospitalised children: international
multicentre study. European journal of clinical pharmacology, 68 (5).

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