Emergency Medicines & Injections — सम्पूर्ण क्लिनिकल रिफरेंस (Dose, Route, Protocols)

Emergency Medicines & Injections — सम्पूर्ण Clinical Reference

Contents — Quick jumps

Overview & Principles Routes & Access Medicine Tables (by emergency category) Life-saving Injections — administration notes Stepwise Protocols Compatibility, Dilution & IV Push Rules Monitoring, Adverse effects & Antidotes Pediatric & Pregnancy considerations Storage, labelling & safety Nutrition in critically ill patients FAQ References

Overview & Basic Principles

Emergency medicines में समय, सही dose, और सही route का तेज़ असर रोगी की outcome बदल सकता है। हमेशा 5Rs (Right patient, Right drug, Right dose, Right route, Right time) फॉलो करें, allergy history लें और dose को weight-based pediatric tables के अनुरूप verify करें।

Routes of administration & vascular access

Intravenous (IV)

सबसे तेज़ systemic delivery — resuscitation, infusions और IV push के लिये preferred।

Intramuscular (IM) / Subcutaneous (SC)

IM epinephrine (1:1000) is the cornerstone for anaphylaxis when IV access absent. SC for insulin/LMWH.

Intraosseous (IO) & Intranasal (IN)

IO when IV fails in arrest/shock. IN route (naloxone, midazolam) is useful prehospital or when IV/IM not available.

Medicine Tables — emergency categories

1) Anaphylaxis & Severe Allergic Reactions

Medicine	Adult dose	Route	Key cautions
Epinephrine (Adrenaline)	0.3–0.5 mg IM (1:1000) thigh; repeat q5–15 min PRN. Arrest: 1 mg IV (1:10,000) q3–5 min.	IM / IV	Tachycardia, ischemia in CAD
Hydrocortisone	200 mg IV bolus (then 50–100 mg q6–8h)	IV	Hyperglycemia, infection risk
Chlorpheniramine	10 mg IV slow	IV	Sedation, anticholinergic effects
Famotidine / Ranitidine	Famotidine 20 mg IV or Ranitidine 50 mg IV	IV	Renal dose adjust for famotidine

2) Cardiac Arrest & Dysrhythmias (ACLS)

Medicine	Dose	Route	Notes
Epinephrine	1 mg IV (1:10,000) q3–5 min	IV/IO	Standard ACLS
Amiodarone	300 mg IV bolus (then 150 mg if required)	IV	QT prolongation, hepatotoxicity (monitor)
Lidocaine	1–1.5 mg/kg IV bolus	IV	Neurotoxicity at high doses
Magnesium sulfate	2 g IV over 2–5 min (torsades)	IV	Hypotension if rapid bolus

3) Status Epilepticus & Seizure Emergencies

Medicine	Dose	Route	Notes
Lorazepam	4 mg IV slow; may repeat once	IV	Respiratory depression risk
Midazolam	IM 10 mg adult or IN 0.2 mg/kg (max 10 mg)	IM/IN/IV	Useful when IV unavailable
Fosphenytoin	20 mg PE/kg IV loading	IV	Cardiac/respiratory monitoring during infusion
Phenobarbital	15–20 mg/kg IV if refractory	IV	Prolonged sedation

4) Severe Asthma / COPD Exacerbation

Medicine	Dose	Route	Notes
Salbutamol (Albuterol)	Neb 2.5–5 mg q20 min ×3 or continuous 10–15 mg/hr	Neb/MDI	Tachycardia common
Ipratropium bromide	500 µg neb q20 min ×3 (with salbutamol)	Neb	For severe exacerbation
Magnesium sulfate	2 g IV over 20 min	IV	Life-threatening asthma adjunct
Hydrocortisone / Methylprednisolone	Hydrocortisone 100–200 mg IV or Methylpred 125 mg IV	IV	Then oral steroid course

5) Sepsis & Septic Shock — initial interventions

Intervention / Drug	Dose / Action	Route	Notes
Crystalloid bolus (NS / Ringer's)	30 mL/kg initial bolus	IV	Assess fluid responsiveness
Norepinephrine	Start 0.05–0.1 µg/kg/min titrate	IV infusion (central preferred)	Vasopressor of choice
Vasopressin	0.03 units/min infusion	IV	Add-on agent
Hydrocortisone	200 mg IV/day (refractory shock)	IV	Consider if vasopressor-refractory

6) Hypoglycaemia

Medicine	Dose	Route	Notes
Dextrose 50% (D50)	25 g IV (50 mL of 50%)	IV	Check glucose, repeat PRN
Glucagon	1 mg IM/SC (adult) if no IV	IM/SC	Causes nausea

7) Opioid Overdose

Medicine	Dose	Route	Notes
Naloxone	0.4–2 mg IV/IM/IN; repeat q2–3 min up to 10 mg	IV/IM/IN	Titrate to restore respiration

8) Massive Hemorrhage & Trauma

Medicine / Intervention	Dose	Route	Notes
Tranexamic acid (TXA)	1 g IV over 10 min, then 1 g over 8 hr	IV	Give within 3 hr of bleeding
Massive transfusion protocol	PRBC:FFP:Platelets ≈ 1:1:1	IV	Follow local MTP

9) Hyperkalaemia (life-threatening)

Action	Dose	Route	Notes
Calcium gluconate	10 mL of 10% = 1 g IV over 2–5 min	IV	Stabilizes myocardium
Insulin + glucose	Insulin 10 U IV + 25 g D50	IV	Monitor glucose closely
Dialysis	Definitive removal in renal failure	—	Arrange urgent RRT

Life-Saving Injections — administration & dilution notes

Epinephrine (IM vs IV)

IM epinephrine (1:1000) is first-line for anaphylaxis. IV epinephrine (1:10,000) reserved for cardiac arrest/monitored hypotension. Infusions require pump and preferably central access.

Amiodarone

300 mg IV bolus for refractory VF/VT. Dilute per hospital pharmacy; bolus may cause hypotension.

Magnesium sulfate

2 g IV over 10–20 min for torsades or life-threatening asthma. Monitor BP and respirations.

Tranexamic acid (TXA)

1 g IV bolus then 1 g infusion — use in trauma/bleeding within 3 hours.

Calcium gluconate vs calcium chloride

Calcium gluconate (less irritant) is preferred peripherally; calcium chloride has more elemental calcium and is more irritant — use central access where possible.

Label every prepared syringe clearly with drug name, concentration and time. Keep emergency trolley checked daily.

Key stepwise emergency protocols

Anaphylaxis

Call for help; IM epinephrine 0.3–0.5 mg into mid-anterolateral thigh.
High-flow oxygen; IV access; crystalloids 1–2 L.
Adjuncts: chlorpheniramine, famotidine, hydrocortisone.
Observe 6–24 hr for biphasic reaction.

Cardiac arrest (ACLS essentials)

High-quality CPR; early defib for VF/VT.
Epinephrine 1 mg IV q3–5 min.
Amiodarone 300 mg IV for refractory VF/VT.
Address reversible causes (H’s & T’s).

Status epilepticus

Airway, oxygen, IV access, glucose check.
Lorazepam 4 mg IV (repeat once) or IM/IN midazolam if no IV.
Load fosphenytoin 20 mg PE/kg if seizures persist.

Septic shock (first hour)

Obtain cultures, broad-spectrum antibiotics within 1 hour.
Crystalloid 30 mL/kg initial bolus.
If hypotension persists → norepinephrine infusion to MAP ≥65 mmHg.

Drug compatibility, dilution & IV push rules

Use infusion pumps for vasopressors; central line preferred.
Check Y-site compatibility charts before co-administering drugs (do not assume compatibility).
Flush line between incompatible drugs with 10–20 mL NS.

Monitoring, Adverse Effects & Antidotes

Monitoring essentials

Continuous ECG when using antiarrhythmics/vasopressors.
Frequent vitals and urine output in resuscitation.
Capillary/venous glucose during insulin/glucose therapy.

Adverse effects & reversal

Medicine	Major adverse effect	Reversal / management
Epinephrine	Arrhythmia, hypertension, myocardial ischemia	Reduce/stop; treat arrhythmia per ACLS
Amiodarone	Hypotension, QT prolongation, long-term pulmonary toxicity	Supportive; magnesium for torsades; monitor LFTs
Naloxone	Acute withdrawal in dependent patients	Titrate dose; consider infusion
Insulin (with glucose)	Hypoglycaemia	Treat with IV dextrose; monitor glucose

Pediatric & Pregnancy considerations

बच्चों में weight-based dosing अनिवार्य है — use Broselow or pediatric dosing tools. Examples:

Epinephrine (anaphylaxis): IM 0.01 mg/kg of 1:1000 (max 0.3–0.5 mg).
Epinephrine (arrest): IV 0.01 mg/kg of 1:10,000.
Lorazepam: 0.05–0.1 mg/kg IV (max 4 mg).

Pregnant patients require obstetric modifications (left uterine displacement during CPR) and early obstetric/ICU involvement.

Storage, labelling, medication safety & waste disposal

Expiry check and stock rotation monthly.
Label syringes after preparation (drug, conc., time, initials).
Sharps into puncture-resistant containers; biomedical waste policy follow करें।

Nutrition in critically ill / emergency patients

Stabilize ABCs first. Once stable, prioritize early enteral nutrition when safe; high-protein support for catabolic states; correct electrolytes and micronutrient deficiencies guided by labs.

FAQ

Q: क्या IM epinephrine में delay होता है?

A: नहीं — IM epinephrine (thigh) anaphylaxis में rapid absorption देता है और शरूआती दवा है।

Q: Vasopressors peripheral line से दें तो क्या ध्यान रखें?

A: Dilute करें, short duration रखें, frequent site checks; central access arrange करें।

References & Clinical Notes

ACLS / PALS Guidelines — American Heart Association
Surviving Sepsis Campaign Guidelines
Local hospital pharmacy dilution & compatibility manuals
Emergency medicine textbooks and peer-reviewed clinical guidance

यह शैक्षिक सामग्री है — किसी भी रोगी पर दवा लागू करने से पहले स्थानीय protocols और treating specialist की पुष्टि आवश्यक है।

Emergency Medicines: Injectable Drugs, Standard Doses & Usage Protocols