1. INTRODUCTION TO EMERGENCY PHARMACOLOGY

Emergency medicine involves rapid diagnosis and immediate pharmacologic intervention to prevent morbidity and mortality. Drugs used in emergency settings must:

Act rapidly
Have predictable pharmacokinetics
Be titratable
Be safe under critical conditions
Be available in parenteral formulations

Emergency drugs are used in:

Cardiac arrest
Shock
Respiratory failure
Status epilepticus
Anaphylaxis
Acute coronary syndrome
Poisoning
Trauma
Hypertensive emergencies
Severe asthma
Sepsis

2. CLASSIFICATION OF DRUGS USED IN EMERGENCY

I. Cardiovascular Emergency Drugs

Vasopressors
Inotropes
Antiarrhythmics
Antihypertensives
Thrombolytics
Antiplatelets
Anticoagulants

II. Respiratory Emergency Drugs

Bronchodilators
Corticosteroids
Oxygen therapy drugs

III. CNS Emergency Drugs

Anticonvulsants
Sedatives
Rapid sequence intubation agents
Osmotic agents

IV. Anaphylaxis & Allergy Drugs

Epinephrine
Antihistamines
Steroids

V. Toxicology & Antidotes

Naloxone
Atropine
N-acetylcysteine
Activated charcoal

VI. Analgesics & Sedation

Opioids
NSAIDs
Ketamine
Propofol

3. DRUGS USED IN CARDIAC ARREST

Cardiac arrest management follows ACLS guidelines by the American Heart Association.

3.1 EPINEPHRINE

Class:

Sympathomimetic (Alpha & Beta adrenergic agonist)

Mechanism of Action:

Alpha-1 → Vasoconstriction → ↑ Coronary & cerebral perfusion
Beta-1 → ↑ Heart rate & contractility
Beta-2 → Bronchodilation

Dose in Cardiac Arrest:

1 mg IV/IO every 3–5 minutes

Indications:

Asystole
Pulseless Electrical Activity (PEA)
Ventricular fibrillation (after defibrillation)

Adverse Effects:

Tachyarrhythmias
Hypertension
Myocardial ischemia

Clinical Pearl:

Early administration improves ROSC but not necessarily neurological outcome.

3.2 AMIODARONE

Class:

Class III Antiarrhythmic

Mechanism:

Potassium channel blockade → prolongs action potential
Also blocks sodium & calcium channels

Dose:

300 mg IV bolus for refractory VF/pVT
Followed by 150 mg if needed

Indications:

Ventricular fibrillation
Pulseless ventricular tachycardia

Side Effects:

Hypotension
Bradycardia
QT prolongation

3.3 ATROPINE

Class:

Anticholinergic (Muscarinic antagonist)

Mechanism:

Blocks vagal influence → increases heart rate

Dose:

1 mg IV every 3–5 min
Max 3 mg

Indication:

Symptomatic bradycardia

4. DRUGS USED IN SHOCK

Shock is classified into:

Hypovolemic
Cardiogenic
Septic
Anaphylactic
Neurogenic

4.1 NOREPINEPHRINE

Class:

Potent alpha-1 agonist

Mechanism:

Vasoconstriction → ↑ systemic vascular resistance
Mild beta-1 stimulation

Dose:

0.05–1 mcg/kg/min IV infusion

First-line in:

Septic shock

Side Effects:

Peripheral ischemia
Arrhythmias

4.2 DOPAMINE

Dose-dependent effects:

Dose	Effect
Low	Renal vasodilation
Moderate	↑ Contractility
High	Vasoconstriction

Now used less due to arrhythmia risk.

5. DRUGS USED IN ANAPHYLAXIS

5.1 EPINEPHRINE (IM)

Dose:

0.3–0.5 mg IM (1:1000)

Life-saving effects:

Bronchodilation
Vasoconstriction
Decreases airway edema

5.2 ANTIHISTAMINES

Example:

Diphenhydramine

Dose:

25–50 mg IV

5.3 HYDROCORTISONE

Dose:

100–200 mg IV

Prevents biphasic reaction.

6. DRUGS USED IN STATUS EPILEPTICUS

6.1 LORAZEPAM

Class:

Benzodiazepine

Mechanism:

Enhances GABA-A receptor

Dose:

0.1 mg/kg IV

6.2 PHENYTOIN

Dose:

20 mg/kg IV loading

7. DRUGS USED IN ACUTE CORONARY SYNDROME

Guidelines by European Society of Cardiology.

MONA Protocol

Morphine
Oxygen
Nitroglycerin
Aspirin

7.1 ASPIRIN

Dose:

300 mg chewed

Mechanism:

COX inhibition → ↓ Thromboxane A2

8. RAPID SEQUENCE INTUBATION (RSI) DRUGS

Rapid Sequence Intubation is performed to secure the airway in:

Trauma
GCS ≤ 8
Respiratory failure
Status epilepticus
Severe shock

RSI involves:

Premedication
Induction agent
Neuromuscular blocker
Post-intubation sedation

8.1 INDUCTION AGENTS

8.1.1 ETOMIDATE

Class:

Non-barbiturate hypnotic

Mechanism:

Enhances GABA-A receptor activity

Dose:

0.3 mg/kg IV

Advantages:

Hemodynamically stable
Rapid onset (30–60 sec)
Short duration (3–5 min)

Disadvantage:

Adrenal suppression (11β-hydroxylase inhibition)

Preferred in:

Trauma
Hypotensive patients

8.1.2 PROPOFOL

Mechanism:

GABA potentiation

Dose:

1–2 mg/kg IV

Effects:

Hypotension
Respiratory depression
Anti-emetic property

Avoid in shock.

8.1.3 KETAMINE

Class:

NMDA receptor antagonist

Dose:

1–2 mg/kg IV

Advantages:

Preserves airway reflexes
Bronchodilator
Increases BP & HR

Preferred in:

Asthma
Hypotension

8.2 NEUROMUSCULAR BLOCKING AGENTS

8.2.1 SUCCINYLCHOLINE

Class:

Depolarizing NM blocker

Dose:

1–1.5 mg/kg IV

Onset:

45–60 sec

Contraindications:

Hyperkalemia
Burns >24h
Neuromuscular disease

8.2.2 ROCURONIUM

Class:

Non-depolarizing NM blocker

Dose:

1.2 mg/kg IV (RSI dose)

Longer duration than succinylcholine.

9. SEDATION & ANALGESIA IN EMERGENCY

9.1 FENTANYL

Class:

Opioid analgesic

Dose:

1–2 mcg/kg IV

Advantages:

Rapid onset
Minimal histamine release

9.2 MIDAZOLAM

Dose:

0.05–0.1 mg/kg IV

Used for:

Procedural sedation
Seizures
Intubation

10. HYPERTENSIVE EMERGENCY DRUGS

Hypertensive emergency: BP >180/120 with target organ damage.

Guidelines by American College of Cardiology.

10.1 LABETALOL

Mechanism:

Alpha + Beta blocker

Dose:

20 mg IV bolus

Safe in:

Stroke
Pregnancy

10.2 NICARDIPINE

Class:

Calcium channel blocker

Dose:

5 mg/hr IV infusion

Preferred in:

Neuro emergencies

11. ACUTE SEVERE ASTHMA

11.1 SALBUTAMOL (ALBUTEROL)

Mechanism:

Beta-2 agonist → bronchodilation

Dose:

2.5–5 mg nebulized

11.2 IPATR0PIUM

Class:

Anticholinergic bronchodilator

11.3 MAGNESIUM SULFATE

Dose:

2 g IV over 20 min

Used in:

Severe refractory asthma

12. SEPSIS & SEPTIC SHOCK

Guidelines by Surviving Sepsis Campaign.

12.1 BROAD-SPECTRUM ANTIBIOTICS

Examples:

Piperacillin-tazobactam
Meropenem
Vancomycin

Administer within 1 hour.

12.2 VASOPRESSORS

First-line: Norepinephrine

Add: Vasopressin if refractory

13. POISONING & ANTIDOTES

13.1 NALOXONE

Mechanism:

Opioid receptor antagonist

Dose:

0.4–2 mg IV

Reverses:

Morphine
Heroin
Fentanyl overdose

13.2 ATROPINE (Organophosphate poisoning)

High-dose repeated administration.

13.3 N-ACETYLCYSTEINE

Used in: Paracetamol overdose

14. ADVANCED ANTIARRHYTHMIC DRUGS

Arrhythmias are managed according to ACLS algorithms by the American Heart Association.

14.1 ADENOSINE

Class:

Class V antiarrhythmic

Mechanism:

Activates A1 receptors in AV node
Transient AV nodal block
Interrupts re-entrant circuits

Dose:

6 mg rapid IV push
If no response → 12 mg

Indication:

Paroxysmal Supraventricular Tachycardia (PSVT)

Side Effects:

Flushing
Chest tightness
Transient asystole (seconds)

Clinical Pearl:

Must be given rapidly followed by saline flush.

14.2 LIDOCAINE

Class:

Class IB antiarrhythmic

Mechanism:

Sodium channel blockade

Dose:

1–1.5 mg/kg IV bolus

Use:

Alternative for ventricular arrhythmias.

15. THROMBOLYTIC DRUGS

Used in:

STEMI
Ischemic stroke
Massive pulmonary embolism

Guidelines by European Society of Cardiology.

15.1 ALTEPLASE (tPA)

Mechanism:

Converts plasminogen → plasmin → dissolves clot

Stroke Dose:

0.9 mg/kg IV (max 90 mg)

Time Window:

Within 4.5 hours of symptom onset

Major Risk:

Intracranial hemorrhage

16. ANTICOAGULANTS IN EMERGENCY

16.1 HEPARIN (Unfractionated)

Mechanism:

Activates antithrombin III

Indications:

Acute coronary syndrome
Pulmonary embolism
DVT

16.2 ENOXAPARIN

Low molecular weight heparin.

17. DIABETIC EMERGENCIES

17.1 DIABETIC KETOACIDOSIS (DKA)

Management principles:

Fluids
Insulin
Potassium correction

INSULIN (Regular)

Dose:

0.1 units/kg/hr IV infusion

Key Point:

Never start insulin if K⁺ < 3.3 mEq/L.

18. ELECTROLYTE EMERGENCIES

18.1 HYPERKALEMIA

Life-threatening due to arrhythmias.

Treatment Protocol:

Stabilize myocardium
Shift potassium intracellularly
Remove potassium

CALCIUM GLUCONATE

Dose: 10 mL of 10% IV over 5–10 min

Protects cardiac membrane.

INSULIN + DEXTROSE

Shifts potassium intracellularly.

SODIUM BICARBONATE

Used in:

Metabolic acidosis
Severe hyperkalemia

19. OBSTETRIC EMERGENCIES

19.1 ECLAMPSIA

First-line treatment:

MAGNESIUM SULFATE

Dose:

4 g IV loading + infusion

Prevents seizures.

19.2 POSTPARTUM HEMORRHAGE (PPH)

OXYTOCIN

Stimulates uterine contraction.

20. PEDIATRIC EMERGENCY DRUGS

Pediatric dosing is weight-based.

Guidelines by American Academy of Pediatrics.

Common Pediatric Emergency Drugs:

Drug	Dose
Epinephrine	0.01 mg/kg
Atropine	0.02 mg/kg
Adenosine	0.1 mg/kg
Lorazepam	0.1 mg/kg

21. EMERGENCY DRUG CALCULATIONS

Infusion Formula:


\text{Rate} = \frac{\text{Dose} \times \text{Weight} \times 60}{\text{Concentration}}

22. COMPLETE CRASH CART ESSENTIAL DRUGS

Cardiovascular:

Epinephrine
Amiodarone
Atropine
Adenosine

Airway:

Etomidate
Ketamine
Succinylcholine
Rocuronium

Shock:

Norepinephrine
Dopamine

CNS:

Lorazepam
Midazolam
Phenytoin

Others:

Magnesium sulfate
Calcium gluconate
Sodium bicarbonate
Naloxone

23. ADVANCED TOXICOLOGY IN EMERGENCY MEDICINE

Poisoning cases are common in emergency departments, especially in South Asia, including Pakistan, where organophosphate and pharmaceutical overdoses are frequently encountered.

Management principles:

Airway stabilization
Breathing support
Circulation stabilization
Decontamination
Antidote administration
Enhanced elimination

23.1 ORGANOPHOSPHATE POISONING

Common in agricultural exposure.

Mechanism:

Acetylcholinesterase inhibition
Excess acetylcholine accumulation

Clinical Features (SLUDGE):

Salivation
Lacrimation
Urination
Diarrhea
GI cramps
Emesis

ATROPINE (High Dose Protocol)

Mechanism:

Muscarinic receptor antagonist

Dose:

2–5 mg IV every 5 min until atropinization

End points:

Dry chest
HR > 80
Improved BP

PRALIDOXIME (2-PAM)

Mechanism:

Reactivates acetylcholinesterase

Most effective within first 24 hours.

23.2 OPIOID OVERDOSE

Primary drug: Naloxone (covered earlier)

Monitor for:

Re-sedation
Withdrawal symptoms

23.3 BENZODIAZEPINE OVERDOSE

FLUMAZENIL

Mechanism:

GABA-A antagonist

Caution:

May precipitate seizures.

Avoid in chronic BZD users.

23.4 CARBON MONOXIDE POISONING

Treatment:

100% oxygen
Hyperbaric oxygen (if severe)

24. SNAKE BITE MANAGEMENT

Common in rural regions.

ANTI-SNAKE VENOM (ASV)

Indications:

Neurotoxicity
Coagulopathy
Progressive swelling

Administer slowly IV with monitoring.

25. TRAUMA PHARMACOLOGY

25.1 TRANEXAMIC ACID (TXA)

Mechanism:

Inhibits fibrinolysis

Dose:

1 g IV over 10 min
Followed by 1 g over 8 hours

Must be given within 3 hours of trauma.

25.2 MASSIVE TRANSFUSION PROTOCOL

Ratio: 1:1:1

Packed RBC
Plasma
Platelets

26. BLOOD PRODUCTS IN EMERGENCY

26.1 PACKED RED BLOOD CELLS

Indication: Hb < 7 g/dL (or shock)

26.2 FRESH FROZEN PLASMA (FFP)

Used in:

Coagulopathy
Liver failure

26.3 PLATELETS

Indicated if: Platelets < 10,000 or active bleeding.

27. ICU SEDATION STRATEGIES

Guidelines from Society of Critical Care Medicine.

Goals:

RASS score 0 to -2
Daily sedation interruption

27.1 DEXMEDETOMIDINE

Mechanism:

Alpha-2 agonist

Advantages:

Minimal respiratory depression
Cooperative sedation

28. BURNS MANAGEMENT DRUGS

28.1 FLUID RESUSCITATION

Parkland Formula: 4 mL × kg × %TBSA

Use: Ringer’s Lactate

28.2 SILVER SULFADIAZINE

Topical antimicrobial.

29. RENAL EMERGENCIES

29.1 ACUTE PULMONARY EDEMA

FUROSEMIDE

Dose:

20–40 mg IV

30. ADVANCED PHARMACOKINETICS IN CRITICAL ILLNESS

Critical illness alters:

Volume of distribution
Protein binding
Hepatic metabolism
Renal clearance

Example: Hypoalbuminemia → ↑ free drug fraction

Sepsis → augmented renal clearance

31. COMPARATIVE EMERGENCY DRUG TABLE (SUMMARY)

Emergency	First-Line Drug	Alternative
Cardiac arrest	Epinephrine	Vasopressin
SVT	Adenosine	Verapamil
Anaphylaxis	Epinephrine IM	—
DKA	Insulin	—
Hyperkalemia	Calcium gluconate	Calcium chloride
Septic shock	Norepinephrine	Dopamine

32. NEUROCRITICAL CARE DRUGS

Neurological emergencies require rapid pharmacologic intervention to prevent secondary brain injury. Key goals:

Maintain cerebral perfusion pressure (CPP)
Reduce intracranial pressure (ICP)
Prevent seizures
Control blood pressure appropriately

Guidance from the American Association of Neurological Surgeons and international neurocritical care bodies informs practice.

32.1 RAISED INTRACRANIAL PRESSURE (ICP)

A. MANNITOL

Class: Osmotic diuretic
Dose: 0.25–1 g/kg IV bolus
Mechanism:

Increases plasma osmolality
Draws water from brain parenchyma

Monitoring:

Serum osmolality (<320 mOsm/kg)
Renal function

B. HYPERTONIC SALINE (3% / 7.5%)

Mechanism:

Osmotic gradient reduces cerebral edema

Preferred in:

Hypotensive patients (does not cause diuresis like mannitol)

32.2 STATUS EPILEPTICUS (REFRACTORY)

If benzodiazepines fail:

Levetiracetam
Valproate
Phenobarbital

LEVETIRACETAM

Dose: 60 mg/kg IV (max 4500 mg)

33. STROKE BLOOD PRESSURE MANAGEMENT

Guidelines from the European Stroke Organisation.

Ischemic Stroke (no tPA):

Treat only if BP > 220/120.

If thrombolysis planned:

Maintain BP < 185/110.

Preferred agents:

Labetalol
Nicardipine

34. MECHANICAL VENTILATION DRUGS

Sedation goals:

Patient comfort
Ventilator synchrony
Avoid oversedation

34.1 ANALGESIA-FIRST STRATEGY

FENTANYL INFUSION

1–2 mcg/kg/hr

34.2 SEDATION

PROPOFOL INFUSION

5–50 mcg/kg/min

Risk:

Propofol infusion syndrome (PRIS)

34.3 PARALYSIS (IF REQUIRED)

CISATRACURIUM

Used in:

ARDS
Severe ventilator dyssynchrony

35. PEDIATRIC RESUSCITATION ADVANCED PRINCIPLES

Guidelines by American Academy of Pediatrics.

Key differences from adults:

Higher respiratory causes of arrest
Weight-based dosing mandatory
Broselow tape recommended

Example: Epinephrine dose = 0.01 mg/kg IV (1:10,000)

36. GERIATRIC EMERGENCY PHARMACOLOGY

Elderly patients have:

Reduced renal clearance
Increased drug sensitivity
Polypharmacy interactions

High-risk drugs:

Benzodiazepines
Anticholinergics
Opioids

Use lower starting doses.

37. DRUG INTERACTIONS IN EMERGENCY

Examples:

Combination	Risk
Amiodarone + QT drugs	Torsades
ACE inhibitors + K⁺	Hyperkalemia
Opioids + Benzodiazepines	Respiratory depression

38. EMERGENCY DRUG STORAGE & CRASH CART DESIGN

Standards recommended by the World Health Organization.

Crash cart organization:

Drawer 1 – Airway drugs
Drawer 2 – Cardiac drugs
Drawer 3 – IV access supplies
Drawer 4 – Pediatric drugs

Temperature control: 15–25°C

Monthly inventory checks required.

39. WHO ESSENTIAL EMERGENCY MEDICINES

Key emergency drugs listed:

Epinephrine
Atropine
Diazepam
Morphine
Magnesium sulfate
Oxytocin
Naloxone
Insulin

These are especially critical in low-resource settings.

40. ALGORITHM-BASED DRUG FLOWCHARTS

Cardiac Arrest (VF/pVT)

Defibrillate
CPR
Epinephrine
Amiodarone

Anaphylaxis

IM Epinephrine
Oxygen
IV fluids
Antihistamines
Steroids

DKA

IV Fluids
Potassium check
Insulin infusion
Monitor anion gap

41. HIGH-YIELD EXAM TABLE (MBBS / FCPS / USMLE)

Emergency	First Drug	Dose	Key Point
Asystole	Epinephrine	1 mg	Every 3–5 min
SVT	Adenosine	6 mg	Rapid IV push
Anaphylaxis	Epinephrine IM	0.5 mg	Lateral thigh
Eclampsia	MgSO₄	4 g IV	Seizure prevention
Hyperkalemia	Ca Gluconate	10 mL	Cardiac protection
Opioid OD	Naloxone	0.4–2 mg	Repeat dosing

42. FUTURE DIRECTIONS IN EMERGENCY PHARMACOLOGY

Point-of-care pharmacogenomics
Ultrasound-guided drug titration
AI-driven dosing calculators
Target-controlled infusions

43. ADVANCED HEMODYNAMIC SUPPORT PHARMACOLOGY

In critically ill patients, drug selection must be individualized based on:

Cardiac output
Systemic vascular resistance
Lactate levels
Echocardiographic findings
Invasive monitoring

Modern management integrates bedside ultrasound and arterial waveform analysis.

43.1 VASOPRESSIN

Class: Non-adrenergic vasopressor
Mechanism: V1 receptor stimulation → intense vasoconstriction

Dose: 0.03 units/min (fixed dose)

Use:

Septic shock refractory to norepinephrine
Adjunct in cardiac arrest

Clinical Insight:
Unlike catecholamines, vasopressin works in acidotic states where adrenergic receptors are less responsive.

43.2 DOBUTAMINE

Class: Beta-1 agonist (Inotrope)
Dose: 2–20 mcg/kg/min

Indications:

Cardiogenic shock
Low cardiac output state
Septic shock with myocardial depression

Risk: Hypotension due to vasodilation

44. ACUTE RESPIRATORY DISTRESS SYNDROME (ARDS) PHARMACOLOGY

Guidelines influenced by the Society of Critical Care Medicine.

Key Pharmacologic Strategies:

Lung-protective ventilation (non-drug but essential)
Conservative fluid management
Neuromuscular blockade (early severe ARDS)
Corticosteroids (selected cases)

44.1 METHYLPREDNISOLONE

Dose varies (e.g., 1–2 mg/kg/day)

Reduces inflammatory lung injury in selected ARDS cases.

45. ACID–BASE EMERGENCIES

45.1 SEVERE METABOLIC ACIDOSIS

Drug: Sodium bicarbonate (already discussed)

Indications:

pH < 7.1
Severe hyperkalemia
TCA overdose

Caution:

Excess bicarbonate → paradoxical intracellular acidosis.

46. HYPONATREMIA MANAGEMENT

46.1 SEVERE SYMPTOMATIC HYPONATREMIA

Drug: Hypertonic saline (3%)

Dose:

100 mL bolus over 10 minutes

Correction Limit:

≤ 8–10 mEq/L in 24 hours
(To prevent osmotic demyelination)

47. ENDOCRINE EMERGENCIES

47.1 THYROID STORM

Treatment Protocol:

Beta-blocker (Propranolol)
Antithyroid drug
Iodine
Steroids

PROPRANOLOL

Dose: 1 mg IV slowly

Reduces peripheral T4 → T3 conversion.

47.2 MYXEDEMA COMA

Drugs:

IV Levothyroxine
Hydrocortisone

48. HEMATOLOGICAL EMERGENCIES

48.1 THROMBOTIC THROMBOCYTOPENIC PURPURA (TTP)

Treatment:

Plasma exchange
Steroids

Drug: Rituximab (in refractory cases)

49. MALIGNANT HYPERTHERMIA

Triggered by:

Succinylcholine
Volatile anesthetics

DANTROLENE

Mechanism: Blocks calcium release from sarcoplasmic reticulum.

Dose: 2.5 mg/kg IV repeated as needed.

50. DISASTER & MASS CASUALTY PHARMACOLOGY

In disasters:

Triage-based drug allocation
Emphasis on life-saving drugs
Simplified dosing

Essential emergency kit includes:

Epinephrine
Naloxone
Antibiotics
Analgesics
IV fluids
TXA

WHO emergency medical kits recommended by World Health Organization.

51. ETHICAL CONSIDERATIONS IN EMERGENCY DRUG USE

Consent often implied
Life-saving drugs prioritized
Off-label drug use common
Resource limitation triage

52. PHARMACOGENOMICS IN EMERGENCY

Emerging concept:

CYP450 variations affect drug metabolism
Clopidogrel resistance
Opioid metabolism differences

Future emergency care may include bedside genetic testing.

53. DRUG DOSING IN SPECIAL SITUATIONS

53.1 OBESITY

Lipophilic drugs → dose by total body weight
Hydrophilic drugs → adjusted body weight

53.2 RENAL FAILURE

Avoid accumulation:

Morphine metabolites
LMWH

53.3 LIVER FAILURE

Reduced metabolism:

Benzodiazepines
Sedatives

54. POINT-OF-CARE ULTRASOUND GUIDED PHARMACOLOGY

Example:

Fluid responsiveness assessment before vasopressors
Cardiac output monitoring for inotrope titration

Integration of pharmacology with bedside imaging improves outcomes.

55. ADVANCED COMPARATIVE TABLE (ULTRA-HIGH YIELD)

Condition	Drug of Choice	Mechanism	Key Danger
Septic Shock	Norepinephrine	α1 agonist	Peripheral ischemia
Cardiogenic Shock	Dobutamine	β1 agonist	Hypotension
ARDS	Cisatracurium	NM blockade	Prolonged weakness
Thyroid Storm	Propranolol	β-blocker	Bradycardia
Hyperkalemia	Ca Gluconate	Membrane stabilization	Tissue necrosis (extravasation)
Malignant Hyperthermia	Dantrolene	↓ Ca release	Hepatotoxicity

56. MASTER REVISION SUMMARY

Emergency pharmacology revolves around:

Rapid onset
Parenteral routes
Titration
Reversibility
Monitoring

Core Life-Saving Drugs:

Epinephrine
Norepinephrine
Atropine
Adenosine
Amiodarone
Magnesium sulfate
Calcium gluconate
Naloxone
Insulin
TXA
Oxytocin

57. EXTRACORPOREAL LIFE SUPPORT (ECLS) & PHARMACOLOGY

Extracorporeal Membrane Oxygenation (ECMO) is increasingly used in refractory cardiac arrest and severe respiratory failure.

Guidance frameworks align with principles from the Extracorporeal Life Support Organization.

57.1 ANTICOAGULATION DURING ECMO

UNFRACTIONATED HEPARIN

Goal: Prevent circuit thrombosis
Monitoring: aPTT or anti-Xa
Risk: Heparin-induced thrombocytopenia (HIT)

57.2 SEDATION IN ECMO

High drug sequestration occurs in ECMO circuits.

Drugs commonly used:

Propofol
Midazolam
Fentanyl

Dose adjustments are often required due to increased volume of distribution.

58. ECPR (EXTRACORPOREAL CPR)

Used in refractory cardiac arrest.

Pharmacologic considerations:

Continue epinephrine
Correct acidosis
Avoid excessive vasoconstrictor doses once ECMO flow established

59. ADVANCED CARDIOGENIC SHOCK PROTOCOL

Modern cardiogenic shock management integrates:

Inotropes
Vasopressors
Mechanical support

59.1 MILRINONE

Class: PDE-3 inhibitor
Effect: ↑ cAMP → ↑ contractility + vasodilation

Preferred in:

Right ventricular failure
Pulmonary hypertension

Risk:

Hypotension

60. PULMONARY EMBOLISM – ADVANCED PHARMACOLOGY

High-risk (massive) PE requires:

Thrombolysis
Vasopressor support
Consider ECMO

TENECTEPLASE

Single IV bolus dosing.
Higher fibrin specificity than alteplase.

61. CYTOKINE STORM & IMMUNOLOGIC EMERGENCIES

Seen in:

Severe sepsis
Autoimmune crises
Certain viral infections

TOCILIZUMAB

Class: IL-6 receptor antagonist
Used in selected inflammatory crises.

62. ACUTE HEART FAILURE PHARMACOLOGY

62.1 NITROGLYCERIN

Mechanism: Venodilation → ↓ preload
High doses → arterial dilation

Used in:

Pulmonary edema
Hypertensive emergency with heart failure

63. ADVANCED TOXICOLOGY – CARDIOTOXIC DRUGS

63.1 TRICYCLIC ANTIDEPRESSANT (TCA) OVERDOSE

Treatment: Sodium bicarbonate bolus

Mechanism:

Narrows QRS
Corrects acidosis

63.2 BETA-BLOCKER OVERDOSE

Treatment:

Glucagon
High-dose insulin euglycemic therapy

GLUCAGON

Bypasses beta receptors → increases heart rate.

64. HIGH-DOSE INSULIN EUGLYCEMIC THERAPY (HIET)

Used in:

Calcium channel blocker overdose
Beta blocker overdose

Mechanism: Improves myocardial carbohydrate utilization.

Requires:

Continuous glucose monitoring
Potassium monitoring

65. SEVERE HYPOTHERMIA

Drug considerations:

Avoid aggressive epinephrine until warmed
Reduced metabolism of sedatives

Rewarming is primary treatment.

66. HYPERTHERMIA & HEAT STROKE

Treatment:

Rapid cooling
IV fluids

Avoid:

Antipyretics (ineffective)

67. EMERGENCY ANTIBIOTIC STRATEGY (SEPSIS EXPANSION)

Broad spectrum coverage:

Gram positive
Gram negative
Anaerobes

Examples:

Meropenem
Vancomycin
Piperacillin-tazobactam

De-escalation after culture results.

68. POINT-OF-CARE REVERSAL AGENTS

68.1 ANDexanet Alfa

Reversal of factor Xa inhibitors.

68.2 IDARUCIZUMAB

Reversal of dabigatran.

69. EMERGENCY DRUG ERRORS & SAFETY

Common causes:

Similar ampoule appearance
Calculation errors
Pediatric misdosing

Prevention:

Double-check protocol
Pre-printed dosing charts
Color-coded syringes

70. RESEARCH FRONTIERS IN EMERGENCY PHARMACOLOGY

Emerging developments:

Selective vasopressin analogues
Novel synthetic oxygen carriers
AI-driven titration pumps
Targeted nanomedicine delivery

MASTER ULTRA-ADVANCED SUMMARY TABLE

System	Critical Drug	Advanced Consideration
Shock	Norepinephrine	Add vasopressin if refractory
Cardiogenic	Dobutamine	Consider mechanical support
PE	Tenecteplase	Monitor bleeding risk
TCA OD	Sodium bicarbonate	Monitor QRS duration
BB overdose	Glucagon + HIET	ICU monitoring required
ECMO	Heparin	Anti-Xa guided dosing

71. TOXIC ALCOHOL POISONING

Common agents:

Methanol
Ethylene glycol

Metabolized by alcohol dehydrogenase → toxic metabolites.

71.1 FOMEPIZOLE

Mechanism: Alcohol dehydrogenase inhibitor
Dose: 15 mg/kg IV loading

Prevents formation of:

Formic acid (methanol)
Glycolic/oxalic acid (ethylene glycol)

Alternative:

Ethanol infusion (competitive substrate).

72. ADVANCED HEMOSTATIC PHARMACOLOGY

Used in:

Trauma
Surgical bleeding
Anticoagulant reversal

72.1 PROTHROMBIN COMPLEX CONCENTRATE (PCC)

Contains:

Factors II, VII, IX, X

Used for:

Warfarin reversal
Life-threatening bleeding

Acts faster than FFP.

73. MYASTHENIC CRISIS

Autoimmune neuromuscular emergency.

Treatment:

Airway protection
IVIG
Plasmapheresis

73.1 NEOSTIGMINE (Diagnostic Use)

Mechanism: Inhibits acetylcholinesterase → ↑ acetylcholine.

Used cautiously.

74. CHOLINERGIC VS MYASTHENIC CRISIS DIFFERENTIATION

Cholinergic crisis:

Excess secretions
Bradycardia
Diarrhea

Treatment: Atropine.

75. BIOLOGICAL & CHEMICAL EXPOSURE EMERGENCIES

Preparedness recommendations align with the World Health Organization.

75.1 CYANIDE POISONING

Occurs in:

Smoke inhalation
Industrial exposure

HYDROXOCOBALAMIN

Mechanism: Binds cyanide → forms cyanocobalamin (excreted)

Preferred over older nitrite-thiosulfate kits.

76. RADIATION EMERGENCIES

POTASSIUM IODIDE

Mechanism: Blocks radioactive iodine uptake by thyroid.

Time-sensitive administration.

77. TRANSPLANT-RELATED EMERGENCIES

Acute rejection or infection.

Emergency drugs:

High-dose corticosteroids
Tacrolimus adjustments

78. ADVANCED ELECTROLYTE MANAGEMENT

78.1 SEVERE HYPOCALCEMIA

CALCIUM CHLORIDE

More potent than calcium gluconate.

Used in:

Cardiac arrest
Severe hypocalcemia

79. PRECISION RESUSCITATION & TARGETED PHARMACOLOGY

Modern ICU integrates:

Lactate-guided vasopressor titration
Echocardiography-based inotrope selection
Goal-directed therapy

80. SEPSIS – IMMUNOMODULATION FRONTIER

Emerging therapies:

Cytokine adsorption filters
Immunoglobulin therapy
Precision antibiotics

81. GENE-BASED THERAPIES (FUTURE)

Potential emergency use in:

Inherited metabolic crises
Rapid enzyme replacement

Still experimental.

82. DRUG STABILITY & STORAGE IN EXTREME ENVIRONMENTS

Important for:

Military medicine
Disaster zones
Rural Pakistan & remote settings

Key principles:

Temperature-controlled storage
Protection from light
Avoid freezing biologics

83. COMPREHENSIVE SYSTEM-BASED FINAL MASTER TABLE

System	Emergency	Drug	Key Action
CNS	Raised ICP	Mannitol	Osmotic shift
CVS	Shock	Norepinephrine	Vasoconstriction
Respiratory	Asthma	Salbutamol	Bronchodilation
Endocrine	DKA	Insulin	Stops ketogenesis
Toxicology	Opioid OD	Naloxone	Receptor blockade
Hematology	Warfarin bleed	PCC	Factor replacement
Chemical	Cyanide	Hydroxocobalamin	Binds cyanide
Electrolyte	Hyperkalemia	Calcium	Stabilizes myocardium

85. CARDIO-OBSTETRIC EMERGENCIES

Pregnancy alters pharmacokinetics:

↑ Plasma volume
↓ Albumin
↑ Renal clearance
Altered drug distribution

Management principles align with global maternal emergency recommendations from the World Health Organization.

85.1 PERIPARTUM CARDIOMYOPATHY

Acute heart failure in late pregnancy/postpartum.

Pharmacologic Strategy:

Diuretics (Furosemide)
Vasodilators (Hydralazine)
Beta-blockers
Anticoagulation (if EF severely reduced)

ACE inhibitors contraindicated during pregnancy but allowed postpartum.

85.2 AMNIOTIC FLUID EMBOLISM (AFE)

Rare but catastrophic.

Treatment:

Vasopressors
Massive transfusion
Oxygenation

Drug support:

Norepinephrine
Epinephrine (if arrest)

86. NEUROVASCULAR CATASTROPHES

86.1 SUBARACHNOID HEMORRHAGE (SAH)

Prevention of vasospasm:

NIMODIPINE

Class: Dihydropyridine calcium channel blocker
Dose: 60 mg orally every 4 hours

Reduces delayed cerebral ischemia.

86.2 INTRACEREBRAL HEMORRHAGE (ICH)

BP control critical:

Labetalol
Nicardipine

Reversal if anticoagulated:

PCC
Vitamin K

87. MASSIVE TRANSFUSION – ADVANCED CONCEPTS

Guidance aligns with trauma care standards from the American College of Surgeons.

87.1 CALCIUM REPLACEMENT DURING TRANSFUSION

Citrate in blood products chelates calcium.

Drug:

Calcium chloride (preferred in severe shock).

87.2 FIBRINOGEN REPLACEMENT

Cryoprecipitate indicated when fibrinogen <150 mg/dL.

88. METABOLIC COLLAPSE SYNDROMES

88.1 REFEDING SYNDROME

Occurs in malnourished patients.

Electrolyte shifts:

Hypophosphatemia
Hypokalemia
Hypomagnesemia

Treatment: Gradual feeding + electrolyte correction.

88.2 LACTIC ACIDOSIS (SEVERE)

Treat underlying cause:

Sepsis → antibiotics
Shock → vasopressors

Bicarbonate reserved for extreme acidosis.

89. HYPERGLYCEMIC HYPEROSMOLAR STATE (HHS)

Similar to DKA but:

No significant ketosis
Profound dehydration

Treatment:

IV fluids
Insulin infusion
Electrolyte monitoring

90. EMERGENCY ANTIMICROBIAL STRATEGY

Broad-spectrum initiation is common, but stewardship is critical.

Principles:

Early empiric therapy
Source control
Culture-guided de-escalation
Avoid unnecessary prolonged therapy

Common ER combinations:

Piperacillin-tazobactam + Vancomycin
Meropenem (if resistant risk)

91. ANTIFUNGAL EMERGENCIES

91.1 INVASIVE CANDIDIASIS

CASPOFUNGIN

Echinocandin class.

Preferred in unstable ICU patients.

92. ANTIVIRAL EMERGENCIES

92.1 HERPES ENCEPHALITIS

Drug: Acyclovir IV

Early treatment reduces mortality.

93. SIMULATION-BASED EMERGENCY PHARMACOLOGY

Modern training uses:

High-fidelity mannequins
Drug calculation drills
Code blue simulations

Enhances:

Dosing accuracy
Team coordination
Error reduction

94. CLINICAL PHARMACODYNAMICS UNDER STRESS STATES

Shock alters:

Receptor responsiveness
Drug absorption (IM unreliable in shock)
Hepatic metabolism

Example: Epinephrine less effective in severe acidosis.

95. DRUG DELIVERY ROUTES IN EMERGENCY

Route	Indication
IV	Most common
IO	Cardiac arrest
IM	Anaphylaxis
Endotracheal	Limited drugs (NAVEL: Naloxone, Atropine, Vasopressin, Epinephrine, Lidocaine)

96. SPECIAL POPULATION – IMMUNOCOMPROMISED PATIENT

High suspicion for:

Fungal infections
Atypical organisms

Empiric therapy broadened accordingly.

97. ADVANCED REVISION TABLE – SYSTEM FAILURE APPROACH

Failure	Primary Drug	Adjunct
Cardiac arrest	Epinephrine	Amiodarone
Septic shock	Norepinephrine	Vasopressin
Raised ICP	Mannitol	Hypertonic saline
SAH	Nimodipine	BP control
Massive bleed	TXA	PCC
BB overdose	Glucagon	HIET

98. GLOBAL EMERGENCY MEDICINE PERSPECTIVE

Low-resource settings require:

Essential drug prioritization
Cost-effective alternatives
Simplified dosing charts
Stable storage conditions

Critical in regions with limited ICU access.

99. ETHICAL TRIAGE & DRUG ALLOCATION

In mass casualty events:

Prioritize survivable cases
Use limited high-cost drugs judiciously
Maintain transparency in allocation

101. PHARMACOLOGY IN PATIENTS WITH CARDIAC DEVICES

Increasing numbers of emergency patients have:

Permanent pacemakers
Implantable cardioverter defibrillators (ICDs)
Left ventricular assist devices (LVADs)

Management principles align with contemporary cardiac device guidance from the American College of Cardiology.

101.1 ICD STORM (Electrical Storm)

Defined as ≥3 episodes of ventricular tachycardia/fibrillation in 24 hours.

Pharmacologic Strategy:

Amiodarone IV
Beta-blockers (e.g., esmolol infusion)
Magnesium sulfate (if torsades suspected)

ESMOLOL

Class: Ultra-short acting beta-1 blocker
Use: Rapid titration in arrhythmic storms
Advantage: Very short half-life (~9 minutes)

102. LVAD PATIENT EMERGENCY PHARMACOLOGY

Key principles:

Patients may not have palpable pulse
Doppler BP measurement required
Anticoagulation typically ongoing (warfarin)

Drug Considerations:

Avoid hypotension (maintain MAP 70–90 mmHg)
Rapid reversal of anticoagulation if bleeding (PCC + Vitamin K)

103. ACUTE ADRENAL CRISIS

Life-threatening endocrine emergency.

Triggers:

Infection
Stress
Sudden steroid withdrawal

HYDROCORTISONE (High Dose)

Dose: 100 mg IV bolus, then 200 mg/day infusion

Correct:

Hypotension
Hypoglycemia
Electrolyte imbalance

104. ACUTE PORPHYRIA ATTACK

Rare but serious metabolic crisis.

Treatment: Hemin infusion

Precipitated by:

Certain drugs (barbiturates, sulfonamides)

105. RARE BUT CRITICAL TOXICOLOGICAL EMERGENCIES

105.1 METHEMOGLOBINEMIA

Caused by:

Nitrates
Certain medications

Symptoms:

Cyanosis unresponsive to oxygen
Chocolate-colored blood

METHYLENE BLUE

Dose: 1–2 mg/kg IV

Mechanism: Reduces Fe³⁺ to Fe²⁺ in hemoglobin.

106. PROCEDURAL EMERGENCY PHARMACOLOGY

106.1 CHEST TUBE INSERTION ANALGESIA

Options:

Ketamine
Fentanyl
Local anesthetic (lidocaine)

LIDOCAINE (Local)

Dose depends on body weight.
Max dose without epinephrine: 4.5 mg/kg.

107. SEDATION FOR ELECTRICAL CARDIOVERSION

Preferred drugs:

Propofol
Etomidate

Short duration required.

108. MILITARY & TACTICAL EMERGENCY PHARMACOLOGY

Common scenarios:

Blast injuries
Chemical exposure
Massive hemorrhage

Essential drugs in combat kits:

TXA
Morphine or fentanyl
Epinephrine auto-injector
Atropine + Pralidoxime kits

Guided by battlefield trauma principles consistent with international defense medical protocols.

109. ALTITUDE & ENVIRONMENTAL EMERGENCIES

109.1 HIGH-ALTITUDE CEREBRAL EDEMA (HACE)

Drug: Dexamethasone

DEXAMETHASONE

Reduces cerebral edema in altitude sickness.

110. SYSTEMS-BASED EMERGENCY DRUG DEPLOYMENT

Hospital emergency systems require:

Standardized drug trays
Color-coded labeling
Barcode medication verification
Automated dispensing systems

111. HUMAN FACTORS & PHARMACOLOGY

Major causes of medication error:

Fatigue
Cognitive overload
Similar packaging
Stress during resuscitation

Solutions:

Pre-filled syringes
Checklists
Closed-loop communication

112. EMERGENCY PHARMACOECONOMICS

In low-resource settings:

Cost-effective alternatives preferred
Generic drugs prioritized
Essential drug lists implemented

Balancing cost with survival benefit is critical.

113. RESEARCH EVOLUTION IN RESUSCITATION SCIENCE

Current investigations include:

Epinephrine timing optimization
Vasopressin-steroid combinations
Neuroprotective agents post-ROSC
Oxygen titration to avoid hyperoxia

114. ARTIFICIAL INTELLIGENCE IN DRUG TITRATION

Future emergency systems may use:

AI-based vasopressor titration
Automated insulin algorithms
Closed-loop sedation systems

115. COMPLETE ULTRA-ADVANCED MASTER TABLE

Emergency	First Drug	Advanced Option	Monitoring
Adrenal Crisis	Hydrocortisone	Vasopressors	BP, glucose
ICD Storm	Amiodarone	Esmolol	Continuous ECG
Methemoglobinemia	Methylene blue	Exchange transfusion	SpO₂, ABG
SAH	Nimodipine	Endovascular therapy	Neuro status
Porphyria	Hemin	Glucose loading	Pain control
HACE	Dexamethasone	Descent	ICP symptoms

DRUGS USED IN EMERGENCY MEDICINE

Comprehensive Academic Review – Part 11

(Ultra-Advanced Resuscitation Science, Special Crisis Pharmacology, Peri-Arrest Optimization, Biomarker-Guided Therapy, Nanomedicine & Translational Emergency Pharmacology)

116. PERI-ARREST PHARMACOLOGY

Peri-arrest state refers to patients who are critically unstable and at imminent risk of cardiac arrest.

Clinical markers:

Severe hypotension
Rising lactate
Altered mentation
Progressive hypoxia

Guideline principles align with advanced resuscitation frameworks from the American Heart Association.

116.1 PRE-EMPTIVE VASOPRESSOR STRATEGY

Instead of waiting for arrest:

Early norepinephrine infusion
Low-dose vasopressin adjunct
Avoid excessive fluid overload

Goal: Maintain MAP ≥ 65 mmHg (individualized in chronic hypertensives).

117. POST-RESUSCITATION PHARMACOLOGY

After Return of Spontaneous Circulation (ROSC):

Goals:

Prevent secondary brain injury
Stabilize hemodynamics
Prevent arrhythmias
Avoid hyperoxia & hyperglycemia

117.1 TARGETED TEMPERATURE MANAGEMENT (TTM)

Pharmacologic considerations:

Increased sedation needs
Shivering control

Drugs used:

Propofol
Fentanyl
Magnesium sulfate
Neuromuscular blockers

118. SHIVERING CONTROL PROTOCOL

118.1 MEPPERIDINE

Suppresses shivering reflex.

Caution: Neurotoxicity in renal failure.

119. BIOMARKER-GUIDED DRUG TITRATION

Modern emergency care increasingly uses biomarkers:

Biomarker	Guides
Lactate	Vasopressor titration
Procalcitonin	Antibiotic duration
Troponin	Cardiac injury severity
BNP	Heart failure therapy

Precision dosing reduces overtreatment.

120. SEPSIS – STEROID AUGMENTATION

In refractory septic shock:

Low-dose corticosteroids recommended by the Surviving Sepsis Campaign.

HYDROCORTISONE (Septic Shock)

200 mg/day IV infusion

Reduces vasopressor requirements.

121. ACUTE PANCREATITIS – EMERGENCY PHARMACOLOGY

Primarily supportive:

Aggressive IV fluids
Analgesia (opioids)
Antiemetics

Antibiotics only if infected necrosis suspected.

122. HEPATIC FAILURE & ENCEPHALOPATHY

LACTULOSE

Mechanism: Reduces ammonia absorption.

Dose titrated to 2–3 soft stools/day.

123. RARE ELECTROPHYSIOLOGIC EMERGENCIES

123.1 TORSADES DE POINTES

Drug of choice: Magnesium sulfate IV bolus.

If unstable: Defibrillation.

124. ADVANCED PHARMACOLOGY IN ACUTE STROKE INTERVENTION

Bridging therapy:

IV thrombolysis
Mechanical thrombectomy

BP tightly controlled during reperfusion.

125. DRUG DOSING IN EXTREME OBESITY

Challenges:

Altered distribution
Lipophilic drug accumulation

Example: Propofol loading dose may require total body weight; maintenance adjusted.

126. PEDIATRIC SHOCK – ADVANCED

Fluid responsiveness cautious in:

Dengue shock
Malnutrition

Inotropes often started earlier.

127. NANOMEDICINE & FUTURE EMERGENCY THERAPIES

Emerging areas:

Nanoparticle-delivered thrombolytics
Targeted anti-inflammatory agents
Artificial oxygen carriers

Potential to revolutionize trauma care.

128. TRANSLATIONAL RESEARCH IN RESUSCITATION

Investigational agents:

Selective beta-2 agonists for cardiac arrest
Neuroprotective peptides
Mitochondrial stabilizers

Still experimental.

129. EMERGENCY DRUG SCORING SYSTEMS

Tools to predict severity:

SOFA score
APACHE II
qSOFA

These influence drug intensity and ICU decisions.

130. ULTRA-HIGH-YIELD SYSTEM FAILURE MATRIX

System Failure	Core Drug	Backup	Monitoring
Cardiogenic Shock	Dobutamine	Milrinone	Echo, MAP
Septic Shock	Norepinephrine	Vasopressin	Lactate
Raised ICP	Hypertonic saline	Mannitol	Osmolality
Anaphylaxis	IM Epinephrine	IV infusion	Airway
BB Overdose	Glucagon	HIET	Glucose
Methemoglobinemia	Methylene blue	Exchange transfusion	ABG

131. COMPLETE INTEGRATED EMERGENCY PHARMACOLOGY FRAMEWORK

Emergency drug management revolves around:

Rapid recognition
Immediate stabilization
Targeted pharmacologic intervention
Continuous reassessment
Prevention of secondary injury

The pharmacology must always integrate with:

Airway management
Hemodynamic monitoring
Laboratory evaluation
Imaging
Definitive procedural care

GRAND MASTER CONSOLIDATION

This multi-part academic compendium has now covered:

Foundational emergency drugs
Advanced ICU pharmacology
Toxicology & antidotes
Obstetric & pediatric crises
ECMO & ECPR integration
Disaster & chemical exposure
Transfusion medicine
Neurovascular emergencies
Rare metabolic & endocrine crises
Military & environmental pharmacology
AI & future precision resuscitation
Translational research & nanomedicine

DRUGS USED IN EMERGENCY MEDICINE (Comprehensive Academic Review

1. INTRODUCTION TO EMERGENCY PHARMACOLOGY

2. CLASSIFICATION OF DRUGS USED IN EMERGENCY

I. Cardiovascular Emergency Drugs

II. Respiratory Emergency Drugs

III. CNS Emergency Drugs

IV. Anaphylaxis & Allergy Drugs

V. Toxicology & Antidotes

VI. Analgesics & Sedation

3. DRUGS USED IN CARDIAC ARREST

3.1 EPINEPHRINE

Class:

Mechanism of Action:

Dose in Cardiac Arrest:

Indications:

Adverse Effects:

Clinical Pearl:

3.2 AMIODARONE

Class:

Mechanism:

Dose:

Indications:

Side Effects:

3.3 ATROPINE

Class:

Mechanism:

Dose:

Indication:

4. DRUGS USED IN SHOCK

4.1 NOREPINEPHRINE

Class:

Mechanism:

Dose:

First-line in:

Side Effects:

4.2 DOPAMINE

Dose-dependent effects:

5. DRUGS USED IN ANAPHYLAXIS

5.1 EPINEPHRINE (IM)

Dose:

Life-saving effects:

5.2 ANTIHISTAMINES

Dose:

5.3 HYDROCORTISONE

Dose:

6. DRUGS USED IN STATUS EPILEPTICUS

6.1 LORAZEPAM

Class:

Mechanism:

Dose:

6.2 PHENYTOIN

Dose:

7. DRUGS USED IN ACUTE CORONARY SYNDROME

MONA Protocol

7.1 ASPIRIN

Dose:

Mechanism:

8. RAPID SEQUENCE INTUBATION (RSI) DRUGS

8.1 INDUCTION AGENTS

8.1.1 ETOMIDATE

Class:

Mechanism:

Dose:

Advantages:

Disadvantage:

Preferred in:

8.1.2 PROPOFOL

Mechanism:

Dose:

Effects:

8.1.3 KETAMINE

Class:

Dose:

Advantages:

8.2 NEUROMUSCULAR BLOCKING AGENTS

8.2.1 SUCCINYLCHOLINE

Class:

Dose:

Onset:

Contraindications: