EMERGENCY DRUGS

Oleh : Tiffany Chang

KEPANITERAAN KLINIK DEPARTEMEN
ANESTESI DAN REANIMASI
RSPAD GATOT SOEBROTO

Obat Emergency
Obat yg dibutuhkan untuk mengatasi keadaan

gawat darurat
Disiapkan dan disediakan ditempat yg mudah
dijangkau
Onset cepat
Harus 4 tepat : Dosis, Waktu, Cara, Dx.

Obat-obatan yang sering

digunakan
Adrenaline

Sulfas Atropine
Ephedrine
Lidocaine
Calcium Glukonas

Adrenaline
Indikasi :
o VF, Pulseless VT, PEA, Asystole
o Shock distributif
o bronchospasme

Sediaan :
o Ampul 1:1000(1mg/1ml); ampul 1:10.000(0,1mg/ml)
o Rute : IV flush, ET(2-3 Dose IV), infusiom

1mg/500ml D5%/NS(2ug/mL)
Dose :
o C.arrest : 1mg IV/IO q3-5 min. Or endotracheally 2-

2,5mg
o Anaphylaxis : 0,3-0,5ml (1:1000) IM

Sulfas Atropine
Antikolinergik

Indikasi :
o Asystole/PEA (2nd line setelah adrenalin)
o Bradikardia
o Keracunan kolinergik (organofosfat)

Sediaan : ampul 0,25mg/1mL

Dose:
o Bradikardia : First Dose 0,5mg bolus, repeat every

3-5 minutes, max. 3 mg

o Asystole/ PEA : 1 mg IV q3-5min PRN, up to
0,04mg/kg

Ephedrine
Moderate beta-1 and weak alpha adrenergic
Increase CO, BP, decrease renal perfusion and

variable PVR
Indication :
o Hypotension assc with spinal anesthesia
o PONV refractory to traditional antiemetics

Dose :
o Hypotension assc with spinal anesthesia : 25-5-mg

IM/SC, 1-2x or 5-25mgIV q5-10min PRN, max

150mg/day
o PONV refractory to traditional antiemetics : 0,5
mg/kg IM at the end of surgery

Lidocaine
Antidysrhythmics, Ib
Dec. Myocardial excitability and conduction

velocity
Indication :
o VT/ VF

Dose :
o VT/VF : 1-1,5mg/kg slow IV bolus over 2-3 min,

PRN 0,5-0,75 mg/kg in q5-10min Max.3mg/kg

Contraindication: alergy, AV block 2nd dan 3rd

degree, sinus arrest.

Ca Gluconate
Antidotes, calcium salts
Neurotransmission, muscle contraction and signal

transduction
Indication :
o Cardiac arrest (assc. Hyperkalemia, hypocalcemia

or hyperMg)
o Citrates toxicity
Dose :
o 1,5-3gr IV over 2-5 min
o Citrates toxicity :10 mL of a 10% solution of Ca

gluconate IV diluted in 100 mL D5W, given over 10

min

Trolly Emergency
RSPAD Gatot Soebroto

Aminophilin inj.
Aqua pro inj.
Aspilet 80 mg tab
ATP inj.
Atropin Sulfat inj.
Calsium Glukonas inj.
Cepezet inj.
Cetadop ( Dopamin ) inj.
Cordaron ( amiodaron) inj.
Dextrose 20% inj.
Dipenhidramin inj.
Doburan ( Dobutamin) inj.
Epineprin 0,1% inj.
Furosemid inj.
Inviclot/ Heparin inj.

Isosorbid dinitrat tab

Kalmethason inj.
Lidocain 2% inj.
MgSO4 20% inj.
Midazolam inj.
Nalokson inj.
Nitrogliserin ( Nitrocin) inj.
Novalgin inj.
Tranexid inj.
Valdimex/ diazepam inj.
Vascon / Norepinefrin inj.
Ventolin neb.
Vitamin k inj.
Xylocain jelly
Notrixum / atracurium inj.

Aminophyllin Aspilet 80
e inj.
mg tab

ATP inj.

Methylxanthine

Antiplatelet
agents

Antidysrhythmic
s, V

Mechanism Relaxes smooth

muscles of resp.
of Action

Inhibit synthesis
prostalglandin &
platelet
aggregation,
antipyretic,
analgesic

Slow conduction
AV node and
interrupts AV
reentry
pathways

Dosing and Acute

bronchospasm:
Uses

ACS : 160-325
mg PO or
300-600 PR

6 mg IVP (1-3
sec)
Flush with 20 ml
NS

N & V, rash, GI
pain

Flushing,
dyspnea

Class

Tract

L : 6-7 mg/kg IV
(20 min)
M : 0,4-0,6
mg/kg/hr IV

Side
Effects

Headache,
insomnia, N &V,
AMI

Atropin Sulfat inj. Calsium

Glukonas inj.

Cepezet inj.

Class

Cholinergic, toxicity
antidotes

Antidotes, calcium
salts

Antipsychotics,
phenothiazine

Mechanism of
Action

Inhibit Ach, anti

muscarinic agent

Bone mineral
componenet,
neurotransmission,
muscle contraction

Antagonis Dopamin
D2, depress RAS

Dosing and
Uses

Sinus Bradycardia
Cardiac arrest :
0,5-1 mg/ 0,04 mg/kg
1,5 3 gr IV over 2IV q5min (max.3 mg)
5 min
Asystole/ PEA :
1 mg IV q3-5min PRN,
up to 0,04mg/kg

Psychotic
disorders:
25 mg PRN, 2550mg after 1-4
hours

Side Effects

Midriasis, hypertermia, Bradycardia,

dry mouth, palpitation hypotension,
headache

Akathisia, dystonis,
parkinsonism,
tardive dyskinesia

Cetadop
( Dopamin )inj.

Cordaron
(amiodaron)
inj.

Dextrose 20%
inj.

Class

Inotropic agents

Antidysrhythmics ,
III

Glucose elevating
agents

Mechanism
of Action

Low Dose : renal and

mesenteric vasodilatation
Med. Dose : cardiac
stimulation, renal
vasodilatation
High Dose :stimulates
alpha-adrenergic recp.

Prolongs action
potential and
repolarization,
decrease AV
conduction and
sinus node function

Energy

Dosing and
Uses

Low Dose : 15mcg/kg/min

Med- Dose : 515mcg/kg/min
High Dose : 2050mcg/kg/min

Pulseless Vfib/ VT
:
300mg IV/IO, may
follow initial Dose
150mg IV q3-5min

Hypoglycemia :
10-25gr

Side Effects

Dyspnea, N&V, azotemia,

inc. IOP

Photosensitivity,
dizziness,
involuntary
movement

Hyperosmolarity,
hypervolemia,
phlebitis

Dipenhidramin
inj.

Doburan
( Dobutamin) inj.

Epineprin 0,1% inj.

Class

Antihistamines(1st
), antiemetic

Inotropic agents

Alpha/beta adrenergic
agonists

Mechanism
of Action

Moderate to high
anticholinergic and
antiemetic

Inc. CO, BP, and

Alpha : inc. CO and HR,
HR; dec. Peripheral dec. Renal perfusion and
vasc. resistance
PVR, systemic
vasoconstriction and inc
vasc. Permeability,
Beta : bronchial smooth
muscle relaxation

Dosing and
Uses

Allergic reaction
:10-50mg (no >
100mg) IV/IM q 4-6hr
Max.400mg/day

Low CO :
2-20mcg/kg/min IV

Cardiac arrest :
0,5-1 mg IV q3-5min, up
to 0,1mg/kg
Astma/ anaphylaxis:
0,1-0,25IV at rate 14mcg/min over 5 min

Side Effects

Sedation, confusion,
dry nasal mucosa

Tachyarrhytmia,
hypertension,
angina

Angina, anxiety, dyspnea

Furosemid inj.

Inviclot/ Heparin inj.

Isosorbid
dinitrat tab

Class

Loop diuretics

Anticoagulants

Nitrates,
angina

Mechanism
of Action

Inhibits reabsorption
of sodium and
chloride ions at
proximal and distal
renal tubules and
loop of henle

Low Dose L : ina. F. Xa and

conversion prothrombin to thrombin
High : ina. F.IX,X,XI, XII, and
thrombin, inh. Fibrinogen to fibrin

Vasodilating
agent

Dosing and
Uses

Hyperkalemia :
40-80 mg IV
Acute pulmonary
edema/
hypertensive crisis,
inc.ICP :
0,5-1 mg/kg (or
40mg) IV over 12min

DVT and PE :
5000u/kg IV bolus, cont. 1300 u/hr
STEMI (on fibr.)
60 u/kg max.4000u, cont.12-15u/kg/hr,
max.1000u/hr
Unstable angina /NSTEMI
60-70u/kg max.5000u, cont. 12-15
u/kg/hr, max.1000u/hr
APTT: 50-70 sec.

Angina
pectoris :
2,5-5 mg q510min; not >
3 Doses in
15-30 min.

Side Effects

Hyperuricemia,
hypokalemia

HI-thrombocytopenia, hematoma

Rebound
hypertension,
dizziness,
nausea

Kalmethaso Lidocain
n inj.
2% inj.

MgSO4 20% inj.

Class

Corticosteroid,
anti-inflammatory
agents

Antidysrhythmic
s, Ib

Antidysrhythmics, V
Electrolytes

Mechanism
of Action

Dec.
Inflammation,
improves
pulmonary
microcirculation

Dec. Myocardial
excitability and
conduction
velocity

Depresses CNS, anticonvulsant

effects, prolongs conduction time

Dosing and
Uses

Shock :
1-6mg/kg IV obce
or 40 mg IV q26hr PRN
Allergic :
Day 1 : 4-8mg IM

VT/ VF :
1-1,5mg/kg slow
IV bolus over 23 min, PRN 0,50,75 mg/kg in 510min
Max.3mg/kg

HypoMg :
Mild 1gIM q6he for 4Doses
Severe 5 g IV over 3 hr
TDP :
Pulse : 1-2gr slow IV (dil 50100ml D5W) 5-60min, then 0,51g/hr IV
Cardiac arrest :
1-2gr slow IV (dil 10ml D5W) 520min

Side Effects

Bradycardia
Cardiac arrest

Hypotension,
edema, N&V,
confusion

Circulatory collapse,
resp.paralysisi, hypothermia

Midazolam inj.

Nalokson inj.

Nitrogliserin
(Nitrocin) inj.

Class

Antianxiety agents

Opioid antagonists

Nitrates, angins

Mechanism
of Action

Enhances the
inhibitory effects of
GABA

Competitive opioid
antagonists

Systemic
venodilatation, dec.
preload

Dosing and
Uses

Premedication :
0,5-1mg IV over 2
min
Refractory st.
Epilepticus :
150-300mcg/kg IV
110-15 min PRN

Reversal
0,4-4 mg IV/IM/SC
q2-3min PRN,
max.10mg
OverDose :
0,4 mg IM/SC
anterolateral thigh

Angina :
5mcg.min,
increase 5mcg/min
q3-5min up to 20
mcg..min

Side Effects

Dec.RR, apnea,
drowsiness

Cardiac arrest,
Vfib, dyspnea

Headache,
hypotension,
tachycardia

Class

Novalgin inj.

Tranexid inj.

Valdimex/
diazepam inj.

ampyrone sulfonate

Antifibrinolytics
agents

Anticonvulsant,
skeletal muscle
relaxant, antiaxiety

Displacing
plasminogen from
fibrin

Modulates
postsynaptic
effects of GABA-A
transmission

Mechanism of ampyrone sulfonate

analgesic,
Action
antispasmodic and
antipyretic

Dosing and
Uses

Oral- 500mg to 1g
every 3 to 4 times
Intramuscular - 2ml
every 2 to 3 times.
Intravenous -1 to 5
ml daily by slow i.v

250mg/ml

Sedation ICU :
5-10mg IV 102 hrs
before surgery;
0,03-0,1mg/kg
q30min to 6hr

Side Effects

hypersensitivity
reactions,
agranulocytosis,
aplastic anemia

Hypotension, N&V

Diarrhea, euphoria

Vascon /
Norepinefrin inj.

Ventolin neb.

Vitamin k inj.

Class

Alpha/beta
adrenergic agonists

Beta 2 agonists

Hemostatics,
vitamins

Mechanism
of Action

Inc. CO and HR,

dec. Renal
perfusion and PVR
and variable BP
effects

Relaxes bronchial smooth

muscle with little effect on HR

Promotes hepatic
synthesis of
clotting factors II,
VII, IX, X

Dosing and
Uses

Cardiac arrest :
Initial 8-12mcg/min
Maintanance 24mcg/min

Acute :
0,5ml of 0,5% solutin (2,5mg)
over 5-15 min q4-8hr PRN,
max 10mg/d
Severe :
0,5ml of 0,5% solutin (2,5mg)
q20min PRN or cont. 1015mg/hr

Hypoprothrombin
emia :
2,5-10mg
PO/IV/IM/SC PRN,
may inc. To
25mg/50mg,
repeat in 12-48hrs

Side Effects

Bradycardia,
hypertension,
arrhytmias

Tremor, insomnia

Anaphylaxis,
cyanosis

Xylocain jelly

Notrixum /
atracurium
inj.

Class

Anesthetics topical

Neuromuscular
blockers,
nondepolarizing

Mechanism
of Action

Inhibitin ionic fluxes

Dosing and
Uses

Lubricant
Not exceed
600mg/12hr

0,4-0,5 mg/kg IVP

over 60sec then
0,08-0,1 mg/kg
20-45 min after

Side Effects

Cardiovascular
collapse,
hypotension,
twitching

Skin flush,
erythema,
wheezing

TERIMAKASIH