Emergency medications

2. Emergency medications Dr.Olfat El-Shafiey Assistant Professor Critical Care Assiut University

4. Drugs used during the management of a cardiac arrest • Oxygen:high concentration oxygen should be given to all patients in cardiac arrest • Oxygen in sufficient concentration to provided arterial oxygen saturation of >95% should be given to all patients and must be humidified because dry oxygen is not right for the patient

5. Drugs used during the management of a cardiac arrest • Oxygen pressure: modified oxygen pressure is very important • Oxygen pressure between (5-8ml of oxygen pressure)stimulate the respiratory center of the brain • Oxygen pressure between (10-15ml of oxygen pressure ) irritate the respiratory center of the brain • Oxygen pressure between(15-20ml of oxygen pressure) cause paralysis of the respiratory center of the brain • Oxygen pressure between (20-30ml of oxygen pressure cause damage for the respiratory center of the brain

7. Drugs used during the management of a cardiac arrest • Epinephrine(adrenaline) • Indications:is the first drug used in cardiac arrest of any etiology • Dose:during cardiac arrest ,the initial IV dose is I mg ,followed by 2-3mg ,diluted into a volume of 10ml of sterile water may be given via the tracheal tube

8. Drugs used during the management of a cardiac arrest • Action of epinephrine:is a directly-acting sympathomimetic amine that possess both alpha and beta adrenergic activity.epinephrine stimulates both a1 and a2 receptors to produce vasoconstriction.this increase systemic vascular resistance during CPR resulting in a relative increase in cerebral and coronary perfusion.

10. Drugs used during the management of a cardiac arrest • Action of epinephrine:in the beating heart effect of epinephrine mediated through the B1 receptors ,is to increase heart rate and force of contraction. • Epinephrine increases myocardial excitability • Use:available in two dilutions:1 in 10,000 (10ml of this solution contains 1mg of epinephrine) and 1 in 1,000 (1ml of a 1 in 10,000 is the more usual dilution used in cardiac arrest

11. Drugs used during the management of a cardiac arrest • Atropine • Indications: in systole • In Pulseless electrical activity with a rate<60b\min • In sinus ,atrial bradycardia • Dose: blocks the effect of the vagus nerve on both the (SA ) node and (AV)node conduction

13. Drugs used during the management of a cardiac arrest Aminodarone Indications:pulseless,ventricular fibrillation Dose:IV of 300mg aminodarone ,diluted in 5% dextrose to a volume of 20ml Side effects:bradycardia,hypotension

14. Drugs used during the management of a cardiac arrest Magnesium sulphate: shock in the presence of possible hypomagnesaemia Lidocaine: ventricular fibrillation\pulseless Dose:100mg and an addition of 50mg can be given if necessary

15. Drugs used during the management of a cardiac arrest Sodium bicarbonate: Indication:severe metabolic acidosis,hyperkalemia Dose:50 mmol given IV ,the dose can be repeated as necessary Actions: cardiac arrest results in combined respiratory and metabolic acidosis due to cessation of pulmonary gas exchange

16. Drugs used during the management of a cardiac arrest Vasopression: is a powerful vasoconstrictor that acts by stimulation of smooth muscle Fluids: normal saline or lactated ringer`s is the preferred crystalloid Calcium:pulseless electrical activity caused by:hyperkalemia,hypocalcemia,overdose of calcium channel blocking drugs

18. Drugs used during the management of a cardiac arrest Calcium: Actions: play a vital role in the cellular mechanisms underlying myocardial contraction

20. Digoxin • Antiarrhythmic • Cardiotonic • Brand names: digitoxin digoxin lanoxin digitaline

21. Digoxin-side effects • Adult:anxiety,blurred or yellow vision,confusion,dizziness,mental depression,headache,loss of appetite,visual –auditory hallusinations,diarrhea,lower stomach pain,nausea,palpitation

22. Digoxin-side effects • Children: stomach upset,loss of appetite • Rare side effects:skin rash,bleeding gums

23. Digoxin overdose • Visual and auditory hallucinations • Tinning of the ear • Disturbances of vision • Yellowish coloration surrounded by witch coloration

25. Medical problems may affect the use of digitalis • Electrolyte disturbances • Lung disease • Kidney disease • Liver disease • Overactive thyroid

26. The following medication should not be used at all with Digoxin • Amphetamine • Appetite suppressant • Medication for asthma • Medication for cold,sinus problems • Calcium channel blocking (adalet,isoptin) • Beta-adrenergic blocking gents • diuretics

28. Precautions before receiving digoxin • Count radial pulse if it was below 60beats\min stop receiving medicine and report • Instruct your patient in the morning when get up to concentrate his vision on a source of light when he watch yellowish coloration surrounded by whitch coloration,tinning or roaring of the ear ,low of concentration ,headache must call his doctor (digitalis toxicity)

29. Precautions before receiving digoxin • Every 4 months patient must test the concentration of the drug in his blood to avoid digitalis toxicity and to change the dose • Avoid diarrhea • Avoid constipation • Avoid abdominal cramps • Avoid coughing • Receive fruits and vegetables rich in potassium

31. Nitroglycerin and anginal pain • Nitrates : brand name:isordil

32. Nitroglycerin and anginal pain • Are used to treat the symptoms of angina (chest pain) • Are used to treat angina in three ways: 1-to relieve an attack2-to prevent attacks from occurring by using the medication just before an attack is expected to occur 3-to reduce the number of attack that occur by using the medicine regularly on a long term basis

33. Nitroglycerin and anginal pain • Nitrates work by relaxing blood vessels and increasing the supply of blood and oxygen to the heart while reducing its workload

35. Certain medications should not be used with nitroglycerin at all • antihypertensive

36. Nitroglycin should not be used with certain Medical problems • Anemia • Glaucoma • Head injury

38. Corticosteroids • Brand names : hydrocortisone,betamethasone, cortisone,dexamethasone,prednisolone, predispose • Category:anti-inflammatory,antiemetic in cancer chemotherapy ,

39. Corticosteroids • Description: are used to provide relief for inflamed areas of the body, lessen swelling,redness,itching,and allergic reactions,asthma.

40. Corticosteroids • Before using this medicine:follow a low –salt diet,a potassium –rich diet,add extra protein to diet • Pregnancy:birth defects with corticosteroids • Breast-feeding:corticosteroids pass into breast milk and may cause problems with growth

41. Corticosteroids • Older adults:develop high blood pressure ,osteoporosis

44. Medications should not be used with corticosteroids • Antacids • Barbiturates • Tegretol • Dilantin • Depakine • Antidiabetic agents(corticosteroids may increase blood glucose level) • Cyclosporine (cause seizures)

46. Medications should not be used with corticosteroids • Digitalis glycosides (corticosteroids decrease the amount of potassium in the blood),digitalis can increase the risk of having an irregular heartbeat or other problem if the amount of potassium in the blood gets too low • Diuretics(using corticosteroids with diuretics may cause the diuretic to be less effective)Alsocorticosteroids may increase the risk of low blood potassium

47. Medications should not be used with corticosteroids • Diuretics(potassium supplements or a different type of diuretic is used in treating high blood pressure in those people who have problems keeping their blood potassium at a normal level. • Immunization –while patient are being treated with this medicine and even after stop taking it,do not have any immunization without doctor`s approval.

48. Medications should not be used with corticosteroids • Immunization –Also other people living in the patient`s home should not receive the oral polio vaccine,since there is a chance they could pass the polio virus on to patient • In addition,patient should avoid close contact with other people at school or work who have recently taken the oral polio vaccine.

50. Medications should not be used with corticosteroids • Skin test injections—corticosteroids may cause false results in skin tests.