Emergency Drugs

Teguh S Effendi Anestesiologi dan Reanimasi RSUD Tasikmalaya

Whats in the crash cart?

Emergency Drugs IV drip sets Gauze Skin stapler Tape Syringes Needles

PRN Adaptors Catheters Pen light and eye lube Fluids (LRS & NaCL) Ambu-bag Defibrillator Laceration pack

Emergency Drugs
Atropine/Glycopyrrolate Dobutamine Dopamine Ephedrine Epinephrine Lidocaine Phenylephrine

Atropine

Anticholinergic Decreases secretions, bronchodilates Suppresses vagal influence on the heart Dilates pupils (except birds), decreases tears Increases heart rate, can increase cardiac dysrhythmias and sinus tachycardia Glycopyrrolate longer onset, longer duration Treatment for sinus bradycardia, SA arrest, incomplete AV block

Dobutamine
b1-agonist, positive inotrope Has some b2 and a1 effects, so there is little effect on the systemic vasculature Increases blood pressure by increasing cardiac output Very short plasma half-life (~2 min) so given as an infusion Some chronotropic activity, if heart rate increases slow infusion

Dopamine
b-agonist, also stimulates release of NE (a effects), also dopaminergic effects Low doses- increased RBF and diuresis (dopaminergic) Intermediate doses- positive inotrope and chronotrope (b effects) Higher doses- vasoconstriction and can decrease RBF (a effects) May cause cardiac arrhythmias

Ephedrine
a, b-adrenergic agonist Sympathomimetic, converted to NE Vasoconstricts and increases blood pressure Also increases heart rate Lasts about 20 minutes Can cause cardiac arrythmias

Epinephrine

a and b-adrenergic agonist so it is a positive inotrope and causes peripheral vasoconstriction Causes increase in myocardial oxygen demand Vasoconstriction, bronchodilation Used for emergency therapy of cardiac arrest (alpha effects) and anaphylactic shock Will most likely cause ventricular arrhythmias

Lidocaine
An amide local anesthetic, also a class 1B antiarrhythmic Reduces the automaticity in the conductive system of the heart by slowing down the diastolic depolarization. Used for ventricular fibrillation and VPC

Phenylephrine
a-adrenergic agonist, can have b-effects at high doses Causes intense vasoconstriction, increases blood pressure Can cause reflex bradycardia and small decreases in CO

Other drugs in the crash cart

Bicarbonate Calcium Dextrose Digoxin Diphenhydramine Doxapram Furosemide

Isoproterenol Mannitol Naloxone Procainamide Propranolol Steroids Yohimbine/ Atipamazole

Bicarbonate and Calcium

BICARBONATE Buffer solution 0.3 x Base deficit X BW (kg) = mEq Bicarb Treatment for metabolic acidosis, hyperkalemia and hypercalcemia

CALCIUM Essential element Positive inotrope, raises BP (mild) Treatment for hyperkalemia

Diphenhydramine and Doxapram

DIPHENHYDRAMINE

Antihistamine Also has sedative, anticholinergic, antitussive and antiemetic effects For treatment of anaphylaxis

DOXAPRAM General CNS stimulant Increases respiration? Not an anesthetic reversal Used for neonatal resucitation

Digoxin
Cardiac glycoside Positive inotrope, increases CO, increased diuresis (reduces edema), decreases conduction velocity through the AV node Treatment for CHF, atrial fibrillation, supraventricular tachycardia Overdoses may cause any cardiac arrhythmia

Furosemide (Lasix)
Loop diuretic Increases renal excretion of water, Na, K, Cl, Ca, Mg, H, NH3, and HCO3 Transiently increases GFR Can cause hyperglycemia Used for diuretic activity in treatment of congestive cardiomyopathy, pulmonary edema, hyperkalemia, antihypertensive?

Isoproterenol
b1 and b2-agonist, no a activity at therapeutic doses Positive inotrope and chronotrope, relaxes bronchial SM, peripheral vasodilation Used for treatment of acute bronchial constriction, cardiac arrythymias (complete AV block), occasionally shock and Hfailure Dial a heart rate

Mannitol
Osmotic diuretic May have a nephro-protective effect by preventing the concentration of nephrotoxins Can decrease intraocular pressure and ICP from osmotic effects Water is excreted at a higher rate, but electrolytes are also lost

Naloxone
Pure opioid antagonist Highest affinity for mu receptor but also binds to kappa and sigma Reverses undesirable opioid side effects and also reverses analgesia Dilute and give slowly to effect

Procainamide
Class 1A antiarrhythmic, anticholinergic properties Prolongs refactory times in atria and ventricles, decreases myocardial excitability, decreases conduction velocity Slight increase or no change in heart rate Treatment of VPC, ventricular tachycardia, some supraventricular tachycardias

Propranolol
b1 and b2 blocker Decreases sinus heart rate, depresses AV conduction, decreases CO, decreased myocardial O2 demand Decreases hepatic and RBF, decreases BP, inhibits isoproterenol induced tachycardia Treatment for APC, VPC, supraventricular premature complexes, atrial fibrillation

Steroids
Souludelta and Dexamethasone Glucocorticoids Many, many effects Have been used to treat practically every malady that afflicts man or animal Treatment for sudden hemmorrhagic shock or anaphylaxis (vasodilates small capillaries and improves tissue perfusion?)

Yohimbine/Atipamazole

YOHIMBINE a2-adrenergic antagonist Reduces sedation, increases heart rate and blood pressure Labeled for xylazine reversal

ATIPAMAZOLE Competitively inhibits a2-adrenergic receptors Reduce sedation, increase heart and respiratory rates Labeled for metdetomidine reversal