Common Emergency Drugs & Dose Calculations

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DOPAMINE

About Drug
  • Dopamine is a prescription medicine used to treat the symptoms of low blood pressure, low cardiac output and improves blood flow to the kidneys. Dopamine may be used alone or with other medications.
  • Dopamine belongs to a class of drugs called Inotropic Agents.
Drug Usage
  • 1 ampoule= 200mg/5ml
  • Amount of drug needed per 50ml infusion solution :
  • Amount of drug to dilute = Body weight * 3
    • Example: 70 kg * 3 = 210 mg
  • Amount of drug = (210 mg * 5 ml)/200 mg = 5.25 ml
  • Preparation: 44.75 ml NSS + 5.25 ml drug = 50 ml 1 ml = (210 mg * 1000) / 50 ml = 4200 mcg
  • Rate of Infusion: (mcg * body weight * 60 min ) / drug concentration
    • Example: (5 mcg * 70 * 60 ) / 4200 mcg = 5 ml / hr

DORMICUM (MIDAZOLAM)
About Drug
  • Midazolam injection is used before medical procedures and surgery to cause drowsiness, relieve anxiety, and prevent any memory of the event. It is also sometimes given as part of the anesthesia during surgery to produce a loss of consciousness. It is also used to cause a state of decreased consciousness in seriously ill people in intensive care units (ICU) who are breathing with the help of a machine. It is in a class of medications called benzodiazepines. It works by slowing activity in the brain to allow relaxation and decreased consciousness.
Drug Usage
  • 1 ampoule= 15mg/3ml
  • Preparation: 45 mg ampoule (9 ml) + 36 ml NSS
    • Drug Concentration : 45 mg / 45 ml = 1 mg / 1 ml
  • Rate of Infusion:
  • (Desired Dose * Quantity ) / Drug Concentration
    • Example: (2 mg * 45 ml ) / 45 mg = 2 ml / hr

FENTANYL
About Drug
  • Fentanyl is used to treat breakthrough pain (sudden episodes of pain that occur despite round the clock treatment with pain medication) in cancer patients at least 18 years of age (or at least 16 years of age if using Actiq brand lozenges) who are taking regularly scheduled doses of another narcotic (opiate) pain medication, and who are tolerant (used to the effects of the medication) to narcotic pain medications. It is in a class of medications called narcotic (opiate) analgesics. It works by changing the way the brain and nervous system respond to pain.
Drug Usage
  • Infusion: 1 ampoule= 500 mcg/10 ml
  • Preparation: 10 ml Fentanyl + 40 ml NSS
    • Drug Concentration : 50 ml = 500 mcg
  • 1 ml = 10 mcg
  • Rate of Infusion:
  • (Desired Dose * Quantity ) / Drug Concentration
    • Example: (25 mcg * 50 ml ) = 2.5 ml 500 mcg

DOBUTAMINE
About Drug
  • Dobutamine is indicated for patients who require positive inotropic support in the treatment of cardiac decompensation due to depressed contractility resulting either from organic heart disease or from cardiac surgical procedures, especially when a low cardiac output is associated with raised pulmonary capillary pressure.
Drug Usage
  • 1 ampoule= 250mg/5ml
  • Amount of drug needed per 50ml solution :
    • Amount of drug to dilute = Body weight * 3
    • Example: 70 kg * 3 = 210 mg
      • Amount of drug = (210 mg * 5 ml)/250 mg = 4.2 ml
  • Preparation: 45.8 ml NSS + 4.2 ml drug = 50 ml
  • Rate of Infusion:
  • (mcg * body weight * 60 min ) / drug concentration
    • Example: (4 mcg * 70 * 60 ) / 4200 mcg = 4 ml / hr

ATRACURIUM

About Drug
  • Atracurium Besylate Injection is a skeletal muscle relaxant used in addition to general anesthesia, to facilitate endotracheal intubation and to provide skeletal muscle relaxation during surgery or mechanical ventilation. Atracurium besylate injection is available in generic form.
Drug Usage
  • 1 ampoule= 25 mg (2.5 ml)
  • Preparation: 4 ampoule (100 mg) + 40 ml NSS
  • Drug Concentration: 100 mg / 50 ml
  • Rate of Infusion: (Desired Dose * 50 ml) / Drug Concentration
    • Example: (5 mg * 50 ml ) / 100 mg = 5 ml / hr


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AMIODARONE

About Drug
  • Amiodarone is used to treat certain types of serious (possibly fatal) irregular heartbeat (such as persistent ventricular fibrillation/tachycardia). It is used to restore normal heart rhythm and maintain a regular, steady heartbeat.
  • Amiodarone is known as an anti-arrhythmic drug. It works by blocking certain electrical signals in the heart that can cause an irregular heartbeat.
Drug Usage
  • 1 ampoule= 150 mg (3 ml)
  • Loading Dose: 1 ampoule (150 mg / 3 ml) + 12 mlD5W
  • A.MAINTANENCE DOSE: 360 mg in 6 hours
    • ( 360 mg * 3 ml ) 150 mg = 7.2 ml
    • 7.2 ml ( amiodarone ) + 42.8 ml D5%W = 50 ml = 8.3 ml/hr
    • B. 540 mg in 18 hours
    • ( 540 mg * 3 ml ) / 150 mg = 10.8 ml
    • 10.8 ml ( amiodarone ) + 39.2 ml D5%W = 2.7 ml / hr


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ADRENALINE

About Drug
  • Adrenaline, also known as Epinephrine, is a medication and hormone. As a medication, it is used to treat a number of conditions, including anaphylaxis, cardiac arrest, asthma, and superficial bleeding. Inhaled epinephrine may be used to improve the symptoms of croup. It may also be used for asthma when other treatments are not effective. It is given intravenously, by injection into a muscle, by inhalation, or by injection just under the skin.
Drug Usage
  • 1 ampoule= 1 ml / 1mg
  • Preparation: 12 ml of Adrenaline + 38 ml D5W = 50 ml
  • Drug Concentration = 12 mg / 50 ml = 0.24 mg
    • 0.24 mg * 1000 = 240 mcg / ml
  • Rate of Infusion: ( Desired Dose * 60 ) / 240 mcg = ml / hr
    • Example (2mcg * 60 min) / 240 mcg = 0.5 ml / hr

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HEPARIN

About Drug
  • Heparin is used to prevent blood clots from forming in people who have certain medical conditions or who are undergoing certain medical procedures that increase the chance that clots will form. Heparin is also used to stop the growth of clots that have already formed in the blood vessels, but it cannot be used to decrease the size of clots that have already formed
Drug Usage
  • 1 ampoule= 25,000 IU / 5 ml
  • Preparation: 45 ml NSS + 25,000 ( 5 ml ) Heparin
  • Rate of Infusion: ( Desired Dose * Quantity ) / Drug Concentration
    • Example 100 units * 50 / 25,000 units = 0.2 ml / hr


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HYDRALAZINE
About Drug
  • Hydralazine is used to treat high blood pressure. Hydralazine is in a class of medications called vasodilators. It works by relaxing the blood vessels so that blood can flow more easily through the body
Drug Usage
  • 1 ampoule= 20 mg
  • Preparation: 20 mg dilute in 1 ml water of inj
  • Loading Dose: 10-20 mg over 3-5 minutes, further dilute with 10 ml NS over 3-5 mins, then repeat after 20-30 minutes
  • Infusion: Reconstitute 3 ampoules ( 60 mg ) Hydralazine with 1 ml water of injection each.
    • Make upto 60 ml with NSS
    • Drug Concentration: 1 ml : 1mg
  • Note: Give rate between 2 and 15 mg / hr depending on BP and Pulse

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INSULIN
About Drug
  • Human insulin is used to control blood sugar in people who have type 1 diabetes (condition in which the body does not make insulin and therefore cannot control the amount of sugar in the blood) or in people who have type 2 diabetes (condition in which the blood sugar is too high because the body does not produce or use insulin normally) that cannot be controlled with oral medications alone
Drug Usage
  • Preparation: 49.5 ml NSS + 50 units (0.5 ml R.I)
  • Rate of Infusion: (Desired Dose * Quantity) / 50 units
    • Example: (3 Units * 50 ml ) / 50 units = 3 ml / hr

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LABETALOL
About Drug
  • Labetalol belongs to a group of medicines called beta blockers. It’s used to treat high blood pressure, including high blood pressure in pregnancy. It can also be used to prevent chest pain caused by angina
Drug Usage
  • 1 ampule ( 20 ml ) = 100 mg
  • Preparation: 20 ml Labetalol + 30 ml NSS
  • Drug Concentration: 1 ml = 2 mg
  • Rate of Infusion: (Desired Dose * Quantity) / Drug Concentration
    • Example: (5 mg * 50 ) / 100 mg = 2.5 ml / hr

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LASIX
About Drug
  • Lasix is used to reduce extra fluid in the body (edema) caused by conditions such as heart failure, liver disease, and kidney disease. This can lessen symptoms such as shortness of breath and swelling in your arms, legs, and abdomen. This drug is also used to treat high blood pressure
Drug Usage
  • 1 ampule = 20 mg ( 2ml )
  • Drug Concentration: 10 ampule = 200 mg (20 ml)
  • Preparation: 20 ml Lasix + 20 ml NSS
    • 40 ml = 200 mg
    • 1 ml = 5 mg
  • Rate of Infusion: (Desired Dose * Quantity) / Drug Concentration
    • Example: (10 mg/hr * 40 ml ) / 200 mg = 2 ml / hr

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LEVOPHED
About Drug
  • Levophed (norepinephrine bitartrate) is a vasoconstrictor, similar to adrenaline, used to treat life-threatening low blood pressure (hypotension) that can occur with certain medical conditions or surgical procedures. Levophed is often used during or after CPR (cardio-pulmonary resuscitation)
Drug Usage
  • 1 ampule = 3 mg / 3 ml
  • Drug Concentration: 3 mg / 50 ml = 0.06 mg /1 ml
    • 0.06 mg * 1000 mcg = 60 mcg / ml
  • Preparation: 3 mg + 47 ml D5W = 50 ml
  • Rate of Infusion: (Desired Dose * 60 min) / 60 mcg
    • Example: ( 2 mcg * 60 min ) / 60 mcg = 2 ml / hr

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NITROGLYCERINE
About Drug
  • Nitroglycerin sublingual tablets are used to treat episodes of angina (chest pain) in people who have coronary artery disease (narrowing of the blood vessels that supply blood to the heart). It is also used just before activities that may cause episodes of angina in order to prevent the angina from occurring
Drug Usage
  • 1 ampule = 50 mg ( 10 ml )
  • Drug Concentration: 50 mg / 50 ml = 1 mg /1 ml
    • 1 mg * 1000 mcg = 1000 mcg / ml
  • Preparation: 40 ml NSS + 10 ml NTG
  • Rate of Infusion: (Desired Dose * 60 min) / Drug Concentration
    • Example: ( 5 mcg * 60 min ) / 1000 mcg = 0.3 ml / hr

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OMEPRAZOLE
About Drug
  • Omeprazole reduces the amount of acid your stomach makes. It’s a widely used treatment for indigestion and heartburn and acid reflux. It’s also taken to prevent and treat stomach ulcers.
  • Sometimes omeprazole is taken for a rare illness caused by a tumour in the pancreas or gut called Zollinger-Ellison syndrome.
Drug Usage
  • 1 vial = 40 mg
  • Preparation: 5 vial (200 mg) Omeprazole + 50 ml NS
    • 50 ml = 200 mg
    • 1 ml = 4 mg
  • Rate of Infusion: (Desired Dose * Quantity) / Drug Concentration
    • Example: ( 8 mg * 50 ml ) / 200 mcg = 2 ml / hr

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PHENYLEPHRINE
About Drug
  • Phenylephrine is used to relieve nasal discomfort caused by colds, allergies, and hay fever. It is also used to relieve sinus congestion and pressure. Phenylephrine will relieve symptoms but will not treat the cause of the symptoms or speed recovery. Phenylephrine is in a class of medications called nasal decongestants. It works by reducing swelling of the blood vessels in the nasal passages
Drug Usage
  • 1 ampoule: 10 mg / 1 ml
  • Preparation: 10 mg in 250 ml NS
    • 1 ml = 40 mcg/min
  • Rate of Infusion: (Desired Dose * 60) / 40 mcg/ml
    • Example: ( 1 mcg/min * 60 ) / 40 mcg/ml = 40 mcg / min

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PHENYTOIN

About Drug
  • Phenytoin is used to control certain type of seizures, and to treat and prevent seizures that may begin during or after surgery to the brain or nervous system. Phenytoin is in a class of medications called anticonvulsants. It works by decreasing abnormal electrical activity in the brain
Drug Usage
  • 1 ampoule: 250 mg / 5 ml
  • Loading Dose: 15 mg/kg at a rate not greater than 50 mg/min for 20-30 mins.
  • Maintenance Dose: Followed by 100 mg every 6-8 hours
  • Prophylaxis: 200-600 mg/day PO/IV
  • Antiarrythmic: 10 mg IV every 15 minutes until arrhythmia stops

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PROPOFOL
About Drug
  • Propofol is an intravenous (IV) sedative-hypnotic agent that can be used for initiation and maintenance of Monitored Anesthesia Care (MAC) sedation, combined sedation and regional anesthesia, induction of general anesthesia, maintenance of general anesthesia, and intensive care unit (ICU) sedation of intubated, mechanically ventilated patients
Drug Usage
  • Infusion: 1 ampoule: 200 mg = 20 ml
  • Preparation: 500 mg = 50 ml without dilution
  • Drug Concentration: 1 ml = 10 mg
  • Rate of Infusion: ( Desired Dose * Quantity ) / Drug Concentration
    • Example: (10 mg * 50 ml ) / 500 mg = 1 ml / hr

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SANDOSTATIN
About Drug
  • Sandostatin LAR Depot (octreotide acetate) is an octapeptide used to treat acromegaly. Sandostatin LAR Depot is also used to reduce flushing episodes and watery diarrhea caused by cancerous tumors (carcinoid syndrome) or tumors called vasoactive intestinal peptide tumors (VIP adenomas)
Drug Usage
  • 1 ampoule: 100 mcg / ml
  • 3 ampoules (300 mcg / 3 ml) + 27 ml NSS = 30 ml
  • Drug Concentration: 30 ml = 300 mcg
    • 1ml = 10 mcg
  • Note: 25 mcg bolus followed by 25-50 mcg / hr

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VASOPRESSIN
About Drug
  • Vasopressin is used to manage anti-diuretic hormone deficiency. It has off-label uses and is used in the treatment of gastrointestinal bleeding, ventricular tachycardia and ventricular defibrillation. Vasopressin is used to treat diabetes insipidus related to low levels of antidiuretic hormone
Drug Usage
  • 1 ampoule: 20 units / 1ml
  • Usual Dose: 0.01 to 0.03 units/minutes
  • Preparation: 20 units in 50 ml NSS
  • Drug Concentration: 20 units / 50 ml = 0.4 units / ml
  • Rate of Infusion: ( Desired Dose * 60 ) / Drug Concentration
    • Example: (0.01 units/min * 60 ) / 0.4 units / ml = 1.5 ml/hr
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