List of Emergency Drugs & Their Actions
The Emergency drug guidelines overlap with some conditions already covered in the other booklets – particularly those in the cardiovascular, diabetes, and respiratory guidelines. Some, like the management of cardiac arrest, are treated more fully in the Emergency Guidelines but the information in each set of guidelines is consistent.
Emergency drugs may be divided into two categories. The first category is drugs that are essential and should be part of every emergency drug kit. The second category consists of drugs that are useful but are optional depending on the practitioner’s training in emergency medical procedures and whether sedation and general anesthesia are used for behavior and anxiety management. WHO Emergency Drug Guidelines were requested as a “stand-alone” booklet by the medical staff of Tungaru Hospital, Kiribati.
List of Emergency Drugs & Their Actions by WHO
| Drug (concentration) and Indication | Dose | Administration / Remarks |
|---|---|---|
| Adenosine (3 mg/ml) Acute treatment of supraventricular tachycardia |
|
Rapid IV push over 1-2 seconds Flush line immediately with 5-20 ml NS Infuse as close to IV site as possible IO administration also successful |
| Atropine (0.1 mg/ml) Bradycardia |
0.02 mg/kg/dose IV | May repeat x 1 dose in 3 minutes |
| Calcium gluconate (100 mg/ml)= 9.4 mg elemental calcium /ml Cardia arrest Hypocalcemia |
100 mg/kg/dose IV Not for IM or SQ use |
May repeat x 1 dose, then dose per ionized calcium results Administer by slow IV push for cardiac arrest, infuse over 30-60 minutes for other indications. Stop infusion if HR is greater than 100 bpm. Do not give intra-arterially. |
| Dextrose 10% (0.1 Gm/ml) Hypoglycemia Hyperkalemia in combination with insulin |
0.2 Gm/kg/dose IV as D10W Then continuous infusion of D10W at a GIR of 4-8 mg/kg/min. Titrate to attain normoglycemia. | 2 ml/kg of Dextrose 10% Hyperkalemia: Continuous infusion of 0.5 g/kg/hr dextrose and 0.1-0.2 units/kg/hr regular insulin. Dextrose and insulin dosages are adjusted based on serum glucose and potassium concentrations. Abrupt discontinuation of dextrose infusion is not recommended due to the risk of rebound hypoglycemia. Glucose concentrations less than D15 should be administered via a central vein to minimize risk of phlebitis and thrombosis. |
| Dopamine To give 10 mcg/kg/min. @ 1 ml/hr : weight x 30 = mg of dopamine (in kg) in 50 ml D5W/NS Hypotension |
Begin at 5 mcg/kg/min. May increase in increments of 2.5 – 5 mcg/kg/min. as needed up to 20 mcg/kg/min. |
Consider if poor peripheral perfusion, evidence of shock, or thready pulses after epinephrine and volume expansion (and bicarbonate) Administer into a central vein when possible. Phentolamine used for treatment of IV infiltrates. |
| Epinephrine 1 : 10,000 (0.1 mg/ml) Resuscitation Severe bradycardia Short term use for systemic hypotension |
0.1 – 0.3 ml/kg/dose IV, IO (0.01 – 0.03 mg/kg), – For continuous infusion – start at 0.05 mcg/kg/min to a maximum of 1 mcg/kg/min. |
Rapid IV push followed by 0.5-1 ml NS flush May repeat every 3-5 minutes ALWAYS use the diluted 1:10,000 (0.1 mg/ml) concentration for individual doses. Only use the 1:1,000 (1 mg/ml) for continuous infusion solutions NEVER inject into an artery Do not mix with bicarbonate Effectiveness of drug increases if acidosis is corrected May mix dose volume with 3-5 ml NS Follow ET administration with several positive pressure ventilations. Do NOT administer these higher doses intravenously. |
| Fentanyl (50 mcg/ml) Analgesia Sedation Anesthesia |
1 mcg/kg | Consider 10 mcg/ml for doses less than 5 mcg |
| Hydralazine (20 mg/ ml) Hypertension by vasodilation |
0.1-0.5 mg/kg | Doses greater than 2 mg; consider 0.4 mg/ml |
| Lorazepam (2 mg/ml) Sedation Seizures |
0.05-01 mg/kg | Slow IV push Seizures, may repeat q 10-15 minutes |
| Morphine (1 mg/ml) Pain Sedation |
0.05-0.1 mg/kg | Slow IV push over 5-10 minutes, IM, SQ |
| Naloxone (1 mg/ml) Narcotic antagonist |
0.1 ml/kg rapid IV push, IM | May repeat in 3 – 5 minutes if no response during resuscitation. Duration of reversal is brief; may need repeated doses. |
| Phenobarbital (65 mg/ml) Anticonvulsant |
15 – 20 mg/kg -For refractory seizures- Additional 5 mg/kg doses, up to a total of 40 mg/kg can be given. |
IV push over 10-15 minutes, no faster than 1 mg/min. Drug can be administered by slow IV push, IM, PR, or PO. Diluted IV product can be used orally. |
| Sodium Bicarbonate 4.2% (0.5 mEq/ml) Metabolic acidosis |
1 – 2 mEq/kg | Slow IV push over 30 minutes. Use only 0.5 mEq/ml solution for infants Infuse 1 mEq/kg over ≥ 1 minute CAUSTIC; don’t infuse faster than 2 ml/kg/minute. NOT routinely given for resuscitation. Can also be given by continuous infusion, IO, or PO |
| Vecuronium ( 1mg/ml) Paralysis Rapid Sequence Intubation* |
0.1 mg/kg | IV push over less than 1 minute |
| Volume Expanders RBCs, NS Hypotension Hypovolemia With evidence of acute blood loss or a decrease in effective volume |
RBCs: 15 ml/kg IV NS: 10 ml/kg IV |
RBCs: Infuse over 4 hours NS: Infuse over at least 10 minutes, but preferably over 30-60 minutes. Consider if poor response to resuscitative efforts or weak pulses with a good heart rate |
Emergency Drugs List
| Drug | Indication | Dose | Quantity |
|---|---|---|---|
| Oxygen | Almost any emergency | 100% inhalation | 1 “E” cylinder with adjustable regulator (0-15L) |
| Epinephrine | Anaphylaxis Asthma unresponsive to albuterol/salbutamol |
1: 1000 (1mg/ml), auto-injector 0.3 mg/ml (EpiPen), 0.15 mg/ml (EpiPen Jr) | 1:1000 mg/ml ampule, 1 EpiPen, 1 EpiPen Jr auto-injectors |
| Nitroglycerin | Angina pain | 0.4 mg sublingual every 3-5 minutes | 1 metered spray bottle (0.4 mg) |
| Diphenhydramine | Allergic reactions | 1 mg/kg IM/IV; max 50 mg (See table 2 for dosage by age) |
50 mg/ml vials and 1 box 25 mg tablets |
| Albuterol/salbutamol | Asthmatic bronchospasm | 2 puffs; repeat as needed | Metered-dose inhaler 2.5 mg/3ml nebulized solution |
| Aspirin | Myocardial infarction | 81 mg chewable tablet | Chewable tablet, bottle baby aspirin (81 mg) |
| Glucose | Hypoglycemia (patient unconscious) |
37.5 mg; repeat as needed | 1 tube (37.5 mg) |
Download the Emergency Drugs & their Actions in PDF format using the link given below.