Preparing the Emergency Drugs
Summary
This is a summary that discusses how to prepare emergency drugs in theatre.
Basics
Preparing your emergency drugs is one of the most important steps in anaestheisa. In the morning, you should request your medications and head to theatre to do two things:
- Request your medications for the theatre.
- Prepare your emergency medications.
- Perform the machine checks.
- Ensure that are your instruments are present and working correctly.
Emergency drugs needed
Below we will provide short basic summaries of each drug and how to prepare them.
Note
You will sometimes see doctors writing 5:1, 10:1 or other numbers outside of the syringes or vaculiters. This means that each ml of the solution containts 5 units of the drug, 10 units of the drug and so on.
Adrenaline
- Ampule usually comes as 1:1000, meaning that each ampule has 1000mcg (1mg) of Adrenaline.
- Indication: Hypotensive patient, usually with a severe bradycardia which is not responding to ephedrine.
- Mechanism of Action: alpha agonist
- Preparation:
- Put 1 ampule (1000mcg) into 200ml of Normal Saline to make a solution with a concentration of 5mcg/ml (5:1). [Divide 1000mcg by 200ml] OR
- Put 1 ampule (1000mcg) into a 10ml syringe with Normal Saline to make a solution with a concentration of 100mcg/ml (100:1). Take 1ml from this syringe and dilute it into ANOTHER 10ml syringe with Normal Saline in order to further dilute it to 10:1. [Divide 1000mg by 10, then by 10 again]
- Give as: 5-10mcg IV boluses.
Phenylephrine (PEP)
- Usually comes as a 10 000mcg (10mg) in 1ml ampule. This ampule is kept in the refrigerator.
- Indication: Patient with hypotension and a heart rate > 80bpm. It is an alpha-1 agonist, causing vasoconstriction without affecting the heart. This effect may result in a reflex bradycardia.
- Preparation:
- Put the ampule of 10 000mcg into a 200ml vaculiter of Normal Saline to make the concentration 50mcg/ml (50:1) OR
- Put the ampule of 10 000mcg into a 10mly syrine of Normal Saline to make the concentration 1000mcg/ml (1000:1). Repeat this by taking 1000mcg (1 ml) from this syringe and diluting into another 10ml syringe of Normal Saline to get a concentration of 100mcg/ml (100:1).
- Given as: 50-100mcg IV boluses.
Ephedrine
- Ampule usually comes as a 50mg ampule of 1ml. Not stored in the fridge.
- This drug is a vasoconstrictor with positive ionotropic and positive chronotropic properties.
- Indication: Patient with hypotension and a heart rate < 80bpm.
- It is nice to remember this medication as being “similar” to adrenaline. This means that it will result in an elevated blood pressure and an elevated heart rate as well. Not very useful in repeated doses because of tachyphylaxis.
- Preparation:
- Put the 50mg ampule into a 10ml syringe with Normal Saline. This results in a concentration of 5mg/ml (5:1).
- Give as: 5-10mg IV boluses
Suxamethonium
- Ampule usually comes as a 100mg in 2ml ampule that needs to be kept in the fridge or in your cooler box.
- Rapid acting, depolarizing muscle relaxant. Required for intubation, especially in an Rapid Sequence Induction/Intubation.
- Preparation:
- Put the 100mg ampule into a 2ml syringe. Therefore the concentration becomes 50mg/ml (50:1). It is kept undiluted.
- Give us: 1-1.5mg/kg, then you wait around 45-60 seconds (usually after the fasciculations). Duration of action is around 4 – 6 minutes.
Note
All drugs need to be labelled correctly and clearly.
Atropine
- Usually comes in a 0.5mg in a 1ml ampule. Does not require refrigeration.
- Indication: Used to treat bradycardia
- Give us: 10mcg/kg IV to treat bradycardia
References and Further Reading
Link
Made with ❤️ by QuickBeat
We are a small education agency that aims to provide medical education.
EXPLORE
SERVICES
CONTACT
- Pretoria North, Gauteng
- contact@quickbeat.co.za