Adult and Pediatric Emergency Drugs Chapter 59 Adult and Pediatric Emergency Drugs Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Oxygen as an Emergency Drug May have beneficial and adverse effects Promote optimal oxygenation and ventilation before administering any pharmacologic agents Maintain oxygenation at least 95% Oxygen devices of choice For adults For children High oxygen concentration detrimental in COPD Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Emergency Drugs for Cardiac Disorders Aspirin: decreases platelet aggregation Nitroglycerin: dilates coronary arteries and improves blood flow to an ischemic myocardium Morphine sulfate: relieves pain, dilates venous vessels, and reduces the workload on the heart Atropine sulfate: treatment of hemodynamically significant bradycardia and some types of heart block Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Emergency Drugs for Cardiac Disorders (Cont.) Adenosine: first-line drug of choice to treat paroxysmal supraventricular tachycardia (PSVT) Diltiazem: second-line agent; IV bolus treats PSVT; slows ventricular response rate in atrial fibrillation or flutter Amiodarone, IV form: first-line agent in the advanced cardiac life support algorithms for treatment of life-threatening ventricular dysrhythmias and cardiac arrest Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Emergency Drugs for Cardiac Disorders (Cont.) Lidocaine: used to treat significant ventricular dysrhythmias Procainamide: antidysrhythmic agent prescribed for ventricular tachycardia, PVCs, and rapid supraventricular dysrhythmias unresponsive to adenosine Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Emergency Drugs for Cardiac Disorders (Cont.) Magnesium sulfate: refractory ventricular tachycardia, refractory ventricular fibrillation, cardiac arrest associated with hypomagnesemia, life-threatening ventricular dysrhythmias from digitalis toxicity and treatment of torsades de pointes Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Emergency Drugs for Cardiac Disorders (Cont.) Epinephrine: profound bradycardia and hypotension, asystole, pulseless ventricular tachycardia, and ventricular fibrillation Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Emergency Drugs for Cardiac Disorders (Cont.) Vasopressin: treatment of ventricular fibrillation that is refractory to defibrillation Sodium bicarbonate: metabolic acidosis that may accompany cardiac arrest and the hyperkalemia and acidotic states related to specific drug overdose situations Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Emergency Drugs for Neurosurgical Disorders Mannitol: osmotic diuretic used in emergency, trauma, critical care, and neurosurgical settings to treat cerebral edema and to reduce increased intracranial pressure Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Emergency Drugs for Poisoning Naloxone: reverses the effects of all opiate drugs by competitively binding to opiate receptor sites in the body Flumazenil: reversal agent for the respiratory depressant and sedative effects of benzodiazepine medications Activated charcoal: prevents absorption of toxins into the body if the ingested substance is known to be affected by charcoal in the gastrointestinal (GI) tract Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Emergency Drugs for Shock Dopamine: used to treat hypotension in shock states, increase heart rate in bradycardic rhythms Dobutamine: positive inotropic, positive chronotropic, and mild vasodilation Norepinephrine: alpha-adrenergic used in shock states when drugs such as dopamine and dobutamine have failed to produce adequate blood pressure Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Emergency Drugs for Shock (Cont.) Epinephrine: the drug of choice in the treatment of anaphylactic shock Albuterol: beta-adrenergic bronchodilator used to reverse bronchoconstriction in anaphylactic shock Diphenhydramine HCl: an antihistamine, often administered with epinephrine to treat anaphylactic shock Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Emergency Drugs for Shock (Cont.) Dextrose 50%: concentrated, high-carbohydrate solution given to treat insulin-induced hypoglycemia or insulin shock Glucagon: pancreas-produced hormone that elevates blood sugar by stimulating glycogenolysis Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Emergency Drugs for Hypertensive Crises and Pulmonary Edema Hypertensive crisis: diastolic blood pressure that exceeds 110 to 120 mm Hg, and pulmonary edema Labetalol: lowers heart rate, blood pressure, myocardial contractility, myocardial oxygen consumption, and reduces the vasoconstriction that results from sympathetic nervous system stimulation Nitroprusside sodium: immediate direct arterial and venous vasodilation Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Emergency Drugs for Hypertensive Crises and Pulmonary Edema (Cont.) Furosemide: promotes the renal excretion of water, sodium, chloride, magnesium, hydrogen, and calcium and depletes potassium. Also has peripheral and renal vasodilating effects that can lower blood pressure Morphine sulfate: produces venous vasodilation that decreases cardiac preload Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Practice Question #1 A patient presents to the emergency department with severe respiratory distress, hives, and edema after being stung on the face by a bee. Which are accurate nursing assessments of the situation? Hypotension and bronchospasm will progress rapidly if treatment is delayed. The patient is suffering from anaphylactic shock. Epinephrine and diphenhydramine are the drugs of choice as first-line agents. Prompt treatment with drug therapy will prevent this syndrome from occurring again. Answer: A, B, C Rationale: Treatment will not prevent anaphylaxis from occurring again. All other statements are true. Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Practice Question #2 Which finding indicates that administration of glucagon has been effective? The patient experiences an improvement in level of consciousness. an elevation in respiratory rate. suppression of heart rate. reduction in blood pressure. Answer: A Rationale: Glucagon is used for treatment of patients with severe hypoglycemia. An improved level of consciousness indicates elevation of blood sugar. A blood sugar analysis should also be obtained. Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Practice Question #3 A patient is experiencing both atrial and ventricular dysrhythmias. The nurse anticipates administration of which medication? Adenosine Amiodarone Atropine Epinephrine Answer: B Rationale: Amiodarone is used for the treatment of atrial and ventricular dysrhythmias. Adenosine is used for the treatment of PSVT. Atropine is used for the treatment of symptomatic bradycardia. Epinephrine is used for the treatment of cardiac arrest. Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.