Emergency Drugs in OT and ICU.pptx

Emergency Drugs

1. Emergency Drugs used in Operation Theatre & ICU Dr. Suresh Pradhan Anaesthesiologist

2. Emergency Drugs are those chemical entities used in patients during life threatening conditions so that the symptoms can be controlled and life can be saved are usually available in those kind of dosage forms which have short onset of action for rapid effect

3. Emergency Drugs Name a drug that should be present in ALL emergency trays of every department of hospital!!!

4. Emergency Drugs Purpose : To provide initial treatment for broad spectrum of illness and injuries, most of which are life threatening. To save life of patient. To control symptoms of patient. To reach the site of action as soon as possible To normalize the vital body functions. To diverge the patient from possible risk.

5. Emergency Drugs Oxygen without O 2 brain death occurs within 6 minutes O 2 saturation is measured using pulse oximeter in emergency condition, O 2 is required for severe physiological stress Shock Traumatic injury Acute myocardial infarction Cardiac arrest

6. Emergency Drugs Oxygen O 2 is delivered using nasal mask or cannula delivered through nasal cannula at the rate of 1-4 litre / min through face mask the rate is 5-10 L/min is titrated according to SPO 2 (when below 90 %)

7. Emergency Drugs Details of some common drugs:

8. Emergency Drugs Classification: antiarrythmic local anesthetic

9. Xylocard Mechanism of action: decreases the automaticity, and excitability of the ventricles during the diastolic phase by a direct action on the tissues, especially the Purkinje network produces local anesthesia by reducing sodium permeability of sensory nerves, which blocks impulse generation and conduction Uses: ventricular arrythmias resulting from MI, digitalis, toxicity, cardiac surgery or cardiac catheterization or GA in susceptible patients

10. Xylocard Doses : Arrythmia treatment for ventricular arrythmias begins with an intravenous injection followed by an intravenous infusion Bolus : initially, 50-100 mg iv bolus given at rate of 25-50 mg/min if desired response doesn’t occur, give repeat dose at 25-50 mg/min; max dose is 300 mg given over hour

11. Xylocard Infusion : a drip rate of 2-4mg/min is recommended Infusion duration is normally 2 or more days (at least 24 hours after the last signs of ventricular arrhythmia is evident) Serum Lidocaine levels should be monitored frequently during prolonged use. therapeutic serum lidocaine levels range from 1.5 to 5 mcg/ml if signs of overdose occur, stop the infusion immediately and monitor the patient closely

12. Xylocard Side effects: • CNS: light headedness, euphoria, confusion, dizziness, drowsiness, tinnitus, blurred vision, vomiting, tremors, twitching • Cardiovascular: bradycardia, hypotension, cardiovascular collapse which may lead to cardiac arrest

13. Contraindication : hypersensitivity severe degree of sino -atrial, atrio-ventricular or intra-ventricular block Precaution: pregnancy, breastfeeding Xylocard

14. Emergency Drugs Atropine

15. Emergency Drugs Atropine an anticholinergic drug Indications: used as a first-line drug for treating acute severe bradycardia also used in organophosphate-carbamate toxicity acts as an antispasmodic agent

16. Atropine Mechanism of action: inhibits action of VAGUS nerve, anti cholinergic Dose: 0.5-1mg q 3-5 min to a max of 3 mg

17. Side effects dry mouth blurred vision sensitivity to light dizziness nausea loss of balance hypersensitivity reactions tachycardia Contraindications CAD glaucoma, acute angle-closure pyloric stenosis obstructive uropathy paralytic ileus toxic megacolon chronic lung diseases myasthenia gravis high environmental temperature Atropine

18. Emergency Drugs Mephentermine

19. Mephentermine Synthetic, non catecholamine Mechanism of Action evokes the release of nor adrenaline from post ganglionic sympathetic neurons has a positive inotropic effect on myocardium

20. Mephentermine onset : 5 to–15 mins with IM dosing, and immediate with IV dosing Uses : hypotension Dose: 3-6 mg IV bolus to a max of 30 mg

21. Mephentermine Contraindicatons patients on MAO inhibitors patients taking anti arrhythmic drugs as procainamide and quinidine

22. Emergency Drugs Phenylephrine

23. Emergency Drugs Phenylephrine synthetic selective α 1 -adrenergic receptor agonist with minimal to no beta-adrenergic activity causes constriction of both arteries and veins used to increase  blood pressure  (given intravenously in cases of  hypotension ,  septic shock  and anaesthesia) also used as a nasal  decongestant , to  dilate the pupil

24. Phenylephrine Dose infusion: 0.1-2mcg/kg/min bolus: 50-200 mcg every 2-5 minutes

25. Phenylephrine side effects nausea vomiting headache anxiety slow heart rate intestinal ischemia chest pain tissue death at the site of injection

26. Emergency Drugs Adrenaline

27. Adrenaline also known as Epinephrine a hormone released from adrenal gland and by a small number of neurons in the medulla oblongata functions to prepare body for fight or flight by increasing blood flow to muscles, cardiac output by acting on the SA node, pupil dilation response, and blood sugar level

28. Adrenaline

29. Emergency Drugs Adrenaline Dose: 1mg IV every 3-5 mins of CPR 2-3mg diluted to 10ml with sterile water via tracheal tube 2-10 mcg/min infusion for atropine resistant bradycardia and hypotensive patients 0.5 ml 1:1,000 IM; 3-5ml (1:10,000) IV- for anaphylaxis, depending upon severity

30. Adrenaline Contraindications heart disease hypertension hyperthyroidism during GA with halothane or cyclopropane because they increase the sensitivity of the myocardium to arrhythmia with LA at the sites of end arteries

31. Emergency Drugs Amiodarone

32. Amiodarone functional class: antiarrhythmic chemical class: iodinated benzofuran derivative mechanism of action: works on cardiac cell membranes relaxes the smooth muscles, also improves myocardial blood flow

33. Amiodarone Uses : hemodynamically unstable ventricular tachycardia ventricular fibrillation supraventricular tachycardia artial flutter cardiac arrest, cardiac surgery CPR heart failure

34. Amiodarone Doses: oral Loading dose- 800 to 1,600 mg for 1-3 weeks maintenance dosage- 600 to 800 mg/day I.V. Infusion: 150 mg loading dose must be given with 10 minutes slowly for maintenance dose, a 540 mg amiodarone over 18 hours.

35. Amiodarone SIDE EFFECTS: CNS: headache, dizziness, tremors, peripheral neuropathy, ataxia, malaise CVS: hypotension, bradycardia, CHF, SA node dysfunction, AV block Eye : blurred vision, photophobia, dry eyes Endocrine: hypo/hyperthyroidism GI: nausea, vomiting, diarrhea, abdominal pain, anorexia, hepatotoxicity SKIN : rash, photosensitivity, blue-gray skin discoloration, alopecia, phlebitis Respi : pulmonary fibrosis/toxicity, pulmonary inflammation, ARDS MS: weakness, pain in extremities

36. Amiodarone Contraindications hypersensitivity pregnancy and breastfeeding neonates, infants severe sinus node dysfunction cardiogenic shock bradycardia, 2nd and 3rd degree AV block

37. Emergency Drugs Streptokinase

38. Streptokinase Classification: Therapeutic: thrombolytics Pharmacologic: plasminogen activator MECHANISM OF ACTION: Combines with plasminogen to form activator complexes, then converts plasminogen to plasmin, which is then able to degrade clot bound fibrin

39. Streptokinase USES: acute myocardial infarction (MI) pulmonary embolism (PE) deep vein thrombosis(DVT) acute peripheral arterial thrombosis occluded arterio-venous cannula

40. Streptokinase DOSES: 1) Myocardial Infarction: IV (Adults): 1.5 million IU given as a continuous infusion over 60 minutes. Intracoronary (Adults): 20,000 IU bolus followed by 2000 IU/min infusion for 60 min.

41. Streptokinase DOSES: 2) DVT, Pulmonary Emboli, Arterial Emboli, or Other Thrombosis: IV (Adults): 250,000 IU loading dose, followed by 100,000 IU/ hr for 24 hr for pulmonary emboli, 72 hr for recurrent pulmonary emboli or deep vein thrombosis. 3) Occluded Arterio-venous Cannula: IV (Adults): 250,000 IU/2 mL instilled into occluded catheter

42. Streptokinase SIDE EFFECTS: CNS: intracranial hemorrhage. ENT: epistaxis, gingival bleeding. RESP: bronchospasm, hemoptysis. CV: reperfusion arrhythmias, hypotension, GI: GI bleeding, hepatotoxicity, nausea, retroperitonial bleeding, vomiting.

43. Streptokinase Contraindication active internal bleeding history of cerebrovascular accident recent (within 2 months) intracranial or intra-spinal injury/trauma Intracranial neoplasm severe uncontrolled hypertension known bleeding tendencies hypersensitivity.

44. Emergency Drugs Nitroglycerine

45. Nitroglycerine Mechanism of action Venodilator ; acts by releasing NO leading to smooth muscle relaxation Uses Angina Pectoris Myocardial Infarction Hypertensive Emergencies and Urgencies

46. Nitroglycerine Doses Sublingual – 0.3-0.4 mg to be repeated after 5 min (max: 3 doses) IV infusion 5mcg/kg/min to 20mcg/kg/min

47. Nitroglycerine Common side effects: headache weakness dizziness lightheadedness nausea flushing  hypotension

48. Other Emergency Drugs Propofol/Ketamine/Thiopentone Succinylcholine/Rocuronium/Vecuronium Noradrenaline/Dopamine/Dobutamine Calcium Gluconate/Magnesium Sulfate/ Sodium Bicarbonate Adenosine Esmolol/ Labetolol Hydrocortisone/Dexamethasone/ Pheniramine Maleate Naloxone/Flumazenil/ Vitamine K/Protamine