Emergency drugs

Emergency Nursing Procedures - Oxygen

• Indications: Cardiopulmonary arrest, chest pain, hypoxemia
• Action: Maximizes O2 delivery to cells
• Dosage: 2 to 15 L/minute via appropriate device
• Nursing Considerations:
  • Monitor O2 saturation regularly using pulse oximeter
  • Avoid high flow administration in patients with concurrent COPD
  • Use appropriate delivery device for appropriate amount of O2 ordered
  • Humidification, warming, and filtering the delivered oxygen
  • Monitor for signs of oxygen toxicity

Emergency Nursing Procedures - Aspirin

• Classification: Antipyretic and a non-opioid analgesic
• Indications: Treat Acute Coronary Syndrome (ACS)
• Action: Slows platelet aggregation, reducing the risk of further occlusion or re-occlusion of the coronary artery or a recurrent ischemic event
• Dosage: 160 to 325 mg (standard recommended dosage for treating ACS)
• Nursing Considerations:
  • Instruct patient to chew "baby" aspirin to speed absorption
  • Not given on empty stomach
  • Monitor platelet count

Emergency Nursing Procedures - Nitroglycerin

• Classification: Anti angina - vasodilator - anti hypertension
• Indications: Treat ACS, angina, hypertension, heart failure
• Action:
  • Anti-angina helps resolve chest pain from ACS
  • A potent vasodilator, relaxes vascular smooth-muscle beds, improving blood flow to ischemic areas
  • Decreases myocardial oxygen consumption, allowing the heart to work with a lower oxygen demand
  • Vasodilation in peripheral vascular beds reduces preload and afterload, decreasing cardiac workload
• Dosage:
  • Sublingual 0.15 to 0.6 mg
  • Transdermal patch 5mg or 10mg
  • IV 10-300mcg/min
• Nursing Considerations:
  • Dilute in compatible solution (preferred over undiluted)
  • Assess location, duration, intensity and precipitating factors of patient's anginal pain.
  • Continuous ECG and blood pressure monitoring for patients on IV nitroglycerin
  • Be alert for overdose symptoms (hypotension, tachycardia, warm flushed skin, cyanosis, headache, palpitations, confusion, nausea, vomiting, moderate fever, 48 paralysis, hypoxia leading to coma, convulsions)

Emergency Nursing Procedures - Morphine

• Classification: Opiate analgesia
• Indications: Analgesic of choice for pain in myocardial infarction
• Action:
  • Narcotic analgesic, providing immediate pain relief lasting for 2 hours.
  • Inhibits transmission of pain impulses
  • Relieves pulmonary congestion, lowers myocardial oxygen requirements, and reduces anxiety.
• Dosage:
  • Bolus IV 2-10mg, repeated every 2-4 hours if necessary
  • Infusion 2-5mg/hr in NS or D5W%
• Nursing Considerations:
  • Obtain baseline respiratory rate, depth, rhythm, and pupil size before administering
  • Monitor I&O ratio and pattern; report oliguria or urinary retention
  • Frequently assess blood pressure (hypotension) and vital signs
  • Oxygen and controlled respiratory equipment should be available
  • Assess for pain relief

Emergency Nursing Procedures - Amiodarone (cordarone)

• Classification: Anti dysrhythmia
• Indications: Atrial and ventricular tachy-dysrhythmias
• Action: Multichannel blocker (sodium, potassium, calcium channel, and non-competitive α & β blocker), Class III antiarrhythmic
• Dosage: (Specific dosage details omitted from the provided text)

Emergency Nursing Procedures - Atropine

• Classification: Anti cholinergic
• Indications: Symptomatic bradycardia (first choice)
• Action: Antidote for organ phosphorus insecticide poisoning; increases heart rate through anticholinergic effects
• Dosage: 0.5mg IV push, may repeat up to a total dose of 2mg
• Nursing Considerations:
  • Take frequent vital signs (particularly noting heart rate)
  • Monitor blood pressure for improvement
  • Follow administration with normal saline flush
  • Monitor intake and output in elderly patients (risk for urine retention)
  • Assess the patient routinely for abdominal distention and auscultate for bowel sounds

Emergency Nursing Procedures - Dopamine

• Classification: Sympathomimetic, vasopressin, inotropic
• Indications: Treat shock, correct hemodynamic imbalances, improve perfusion of vital organs, correct hypotension
• Action: Stimulates dopaminergic and α and β receptors of the sympathetic nervous system. Dose-dependent action (higher doses mainly α stimulation)
• Dosage: Dose-dependent:
  • Low rates (<5 mcg/kg/min): Vasodilation in renal, mesenteric, coronary, and intracerebral beds; increased glomerular filtration rate, renal blood flow, sodium excretion, and urine flow; no effect on blood pressure.
  • Intermediate rates (5-10 mcg/kg/min): Improved myocardial contractility, increased SA rate, enhanced impulse conduction; little beta-2 stimulation (less increase in myocardial oxygen consumption)
  • High rates (>10 mcg/kg/min): Vasoconstriction, increased blood pressure, effects first seen in skeletal muscle

Emergency Nursing Procedures - Dobutamine (dobutrex)

• Classification: Inotropic, β1-agonist
• Indications: Heart failure, cardiac decompensation (avoid in shock without adequate fluid replacement)
• Action: Increases myocardial contractility and cardiac output without significantly changing blood pressure; increases coronary blood flow and myocardial oxygen consumption, mild vasodilation
• Nursing Considerations: • Monitor blood pressure, pulse, respiration, ECG, and hemodynamic parameters every 5-15 minutes during and after administration. • Monitor urine output frequently. • Palpate peripheral pulses, and assess the appearance of extremities routinely; note color and temperature. • Correct acidosis and hypovolemia before dopamine infusion. • Use large veins; check frequently for blanching or pallor (indicates extravasation) • Gradually wean infusion to prevent sudden hypotension

Emergency Nursing Procedures - Epinephrine (adrenaline)

• Classification: Cardiac stimulant, vasopressor, bronchodilator, beta-2 adrenergic agonist
• Indications: Cardiac arrest, hypersensitivity reaction, anaphylaxis, acute asthma attacks, symptomatic bradycardia, severe hypotension
• Action: Increases myocardial contractility, heart rate, SBP, and cardiac output; relaxes bronchial smooth muscle.
• Dosage: For cardiac arrest: 1 mg IV, every 3-5 minutes, followed by 5 forceful inhalations. As vasopressor: 2-10 mcg/min IV, titrated to desired response (1mg/250ml D5Wyeilds 4 mcg/ml)

Emergency Nursing Procedures - Noradrenaline (nor-epinephrine, levophed)

• Classification: Sympathomimetic, vasopressor
• Indications: Hypotension (trauma, shock, severe cardiogenic shock)
• Action: Produces vasoconstriction, increases myocardial contractility, and increases blood flow to vital organs without increasing workload or output of the heart
• Dosage: 4-10 mcg/min initially, adjusted to maintain desired blood pressure (2-4mcg/min diluted in 250 to 1000ml of D5% as IV infusion)

Emergency Nursing Procedures - Calcium Chloride

• Classification: Electrolyte
• Indications: Acute hyperkalemia, acute hypocalcemia, calcium channel overdose, antidote for magnesium sulfate
• Action: Increases cardiac contractility; calcium chloride replacement and maintenance of calcium in body fluids
• Dosage: 2-4 mg/kg of a 10% solution; equivalent to 13.6 meq of calcium; may be repeated every 10 minutes
• Nursing Considerations:
  • Flush IV line between calcium chloride and sodium bicarbonate administrations.
  • Administer calcium slowly via central line
  • Monitor blood pressure (peripheral vasodilation occurs)
  • Continuous ECG monitoring for dysrhythmias
  • Observe for adverse effects (bradycardia, cardiac arrest, constipation, fatigue, venous irritation, depression, tingling)

Emergency Nursing Procedures - Magnesium Sulfate

• Classification: Electrolyte, anti-dysrhythmia, anti-convulsant
• Indications: Seizure associated with eclampsia, hypomagnesemia, torsade de pointes, life-threatening ventricular dysrhythmias secondary to digitalis toxicity.
• Action: Replaces and maintains magnesium levels in body fluids; depresses the central nervous system, producing anticonvulsant effects, decreasing dysrhythmias incidence
• Dosage: Cardiac arrest: 1-2 g diluted in 10 ml D5W IV push. Seizures: 1-4 g as a 10% solution IV over 1-5 minutes. Hypomagnesemia: 5 g/1000 ml D5W over 3 hours (maximum 3 ml/min).
• Nursing Considerations:
  • Monitor ECG, heart rate, and blood pressure every 2-5 minutes during titration
  • Monitor respiration (at least 16 breaths/minute before dose)
  • Monitor urine output (at least 25 ml/hour)
  • Calcium (5-10 meq) may reverse respiratory depression/heart block

Emergency Nursing Procedures - Sodium Bicarbonate

• Classification: Electrolyte replenisher and systemic alkalizer
• Indications: Correction of severe metabolic acidosis (renal disease, uncontrolled diabetes, circulatory insufficiency due to shock, cardiac arrest, severe primary lactic acidosis).
• Action: Alkalinizing agent by releasing bicarbonate ions
• Dosage: In emergency, can be administered undiluted via direct IV injection or diluted in 0.9% sodium chloride, 5% glucose
• Nursing Considerations:
  • Fluid balance throughout therapy
  • Central line administration preferred
  • Obtain arterial blood pH, PO2, PaCO2, serum calcium, sodium, potassium, and renal function before and during therapy.
  • Flush line before and after administration
  • Observe for adverse effects (e.g., restlessness, tetany, hypokalemia, alkalosis, hypernatremia, fluid overload).