Emergency Medications: Adrenaline and Atropine

• Study notes on common emergency medications, including indications, contraindications, preparation, administration, and nursing responsibilities.

Adrenaline (Epinephrine)

• Indicated for cardiac arrest, anaphylaxis, and severe bradycardia with hypotension.
• No contraindications in emergency situations, but use caution with cardiovascular disease.
• For anaphylaxis, administer 1:1000 (1 mg/mL) intramuscularly (IM).
• For cardiac arrest, administer 1:10,000 intravenously (IV).
• For bradycardia, dilute to 2 μg/mL for continuous IV infusion.
• Closely monitor vital signs, especially heart rate and blood pressure.
• Ensure proper IV access and titrate doses as needed.

Atropine

• Indicated for hypotensive bradycardia and cardiac arrest.
• No contraindications in emergency situations, but use caution with glaucoma and myasthenia gravis.
• Administer 0.5 to 1 mg IV every 3 to 5 minutes as needed.
• Monitor heart rate and blood pressure.
• Watch for side effects such as tachycardia and confusion.

Hydrocortisone

• Indicated for severe asthma, anaphylaxis, and adrenal insufficiency.
• No contraindications in emergency situations, but use caution with systemic infections.
• Administer 250 mg (or 4 mg/kg) IV for severe asthma.
• Monitor for signs of adrenal insufficiency.
• Ensure proper administration of oxygen therapy.

Dexamethasone

• Indicated for raised intracranial pressure, severe asthma, and anaphylaxis.
• No contraindications in emergency situations, but use caution with diabetes and hypertension.
• Administer 4 to 8 mg IV as needed.
• Monitor for signs of increased intracranial pressure.
• Ensure proper administration of other supportive therapies.

Salbutamol (Albuterol)

• Indicated for acute asthma and bronchospasm.
• No contraindications in emergency situations, but use caution with tachycardia.
• Administer 5 mg/2.5 mL via nebulizer driven by oxygen every 15 minutes as needed.
• Monitor oxygen saturation and respiratory status.
• Ensure proper oxygen therapy.

Ipratropium Bromide

• Indicated for acute asthma and chronic obstructive pulmonary disease (COPD).
• No contraindications in emergency situations.
• Administer 500 μg/1 mL via nebulizer every 2 hours as needed.
• Monitor respiratory status.
• Ensure proper administration of other bronchodilators.

Lidocaine

• Indicated for ventricular arrhythmias.
• No contraindications in emergency situations, but use caution with heart block.
• Administer 50 to 100 mg IV bolus, followed by infusion as needed.
• Monitor cardiac rhythm.
• Ensure proper administration of other anti-arrhythmic medications.

Naloxone

• Indicated for opioid overdose and respiratory depression.
• No contraindications in emergencies due to the risk-benefit ratio favoring reversal of life-threatening respiratory depression.
• For IV administration, dilute 0.4–2 mg in 10 mL saline and titrate every 2–3 minutes.
• For intranasal administration, use 2–4 mg via mucosal atomizer.
• Closely monitor respiratory rate and prepare for rebound sedation.

Dopamine

• Indicated for cardiogenic shock and severe hypotension.
• Contraindicated in cases of pheochromocytoma and ventricular arrhythmias.
• Dilute 400 mg in 250 mL normal saline (1600 µg/mL).
• Infuse at 5–20 µg/kg/min via a central line.
• Requires continuous cardiac monitoring.
• Avoid extravasation as it may cause tissue necrosis.

Magnesium Sulfate

• Indicated for severe asthma, eclampsia, and torsades de pointes.
• Contraindicated in myasthenia gravis and renal failure.
• For asthma, administer 2 g IV over 20 minutes.
• For eclampsia, administer a 4–6 g IV bolus followed by a 1–2 g/hr infusion.
• Monitor reflexes, respiratory rate, and serum magnesium levels.

Furosemide

• Indicated for pulmonary edema and hypertensive crisis.
• Contraindicated in anuria and severe hypokalemia.
• Administer 20–80 mg IV push over 1–2 minutes.
• Avoid rapid administration in cases of renal impairment.
• Monitor urine output and electrolyte levels, especially potassium (K+).

Midazolam

• Indicated for status epilepticus and procedural sedation.
• Contraindicated in acute narrow-angle glaucoma and shock.
• Administer 2.5–5 mg IV slowly (over 2 minutes).
• Administer 0.2 mg/kg intranasally.
• Have flumazenil readily available as a reversal agent.
• Monitor SpO₂ and respiratory effort.

Phenytoin

• Indicated for seizure prophylaxis and status epilepticus.
• Contraindicated in sinus bradycardia and AV block.
• Administer a loading dose of 15–20 mg/kg IV at a rate of ≤50 mg/min.
• Use an in-line filter during administration.
• Incompatible with dextrose solutions.
• Monitor electrocardiogram (ECG) for arrhythmias and avoid extravasation.

Tranexamic Acid

• Indicated for traumatic hemorrhage and postpartum bleeding.
• Contraindicated in active thrombosis and disseminated intravascular coagulation (DIC).
• Administer 1 g IV over 10 minutes and repeat in 30 minutes if needed.
• The maximum dose is 3 g/24 hours.
• Monitor for thromboembolic signs and avoid rapid infusion.

Calcium Gluconate

• Indicated for hyperkalemia and calcium channel blocker toxicity.
• Contraindicated in digitalis toxicity and hypercalcemia.
• Administer a 10% solution (10 mL IV) over 5–10 minutes.
• Warm to body temperature if stored cold.
• Administer via a central line if possible.
• Monitor ECG.

Labetalol

• Indicated for hypertensive emergency and aortic dissection.
• Contraindicated in asthma and decompensated congestive heart failure (CHF).
• Administer an IV bolus of 20 mg over 2 minutes, repeating every 10 minutes (the maximum dose is 300 mg).
• Administer via infusion at a rate of 0.5–2 mg/min.
• Conduct frequent blood pressure checks (every 5 minutes initially).

Lorazepam

• Indicated for alcohol withdrawal and status epilepticus.
• Contraindicated in severe respiratory depression.
• Administer 4 mg IV slowly over 2–5 minutes.
• Administer 0.05 mg/kg IM (the maximum dose is 4 mg/dose).
• Monitor for paradoxical reactions, especially in elderly patients.