Emergency Management of Key Medical Conditions

All serious medical conditions

Don’t forget:

• secure IV line

• oxygen (where indicated)

Acute pulmonary oedema (left ventricular failure)

• frusemide 40-80 mg IV (or twice usual dose)

• glyceryl trinitrate 1 dose (spray) or tablet

• consider (esp. if chest pain)—morphine 2.5–5 mg IV

• CPAP for unresponsive cases (usu. ambulance)

Acute anaphylaxis

• adrenaline 0.3–0.5 mg (1:1000) IM, repeat every 5 mins as nec.

If no rapid improvement:

• salbutamol inhalation

• IV fluids

• adrenaline infusion

• hydrocortisone/glucagon/antihistamines

Angio-oedema + acute urticaria

• promethazine 25 mg IM or prednisolone 25–50 mg (o) as single dose

Asthma (severe)

• salbutamol 6 (<6 yrs) – 12 (adults) puffs by spacer (4 × 4 × 4 rule)

• hydrocortisone 200–250 mg IV or IM

If severe (hospital):

• adrenaline 0.3–0.5 mg 1:1000 IM or SC or infusion in N saline

Croup (severe)

• dexamethasone 0.15 mg/kg IM or prednisolone 1 mg/kg (o)

Epilepsy (seizure)

• midazolam 0.2 mg/kg IM or IV or bucally or diazepam 5–20 mg IV (rate ≤2 mg/min)

Opiate respiratory depression

• naloxone HCl 0.2–0.4 mg IV + 0.4 mg IM

Myocardial infarction

• aspirin 300 mg soluble tab

• glyceryl trinitrate spray or tabs (max. 3)

• morphine sulphate 2.5–5 mg IV (if pain)

Hypoglycaemia

• glucagon 1 mg/mL SC, IM or IV, then sweet drink or 20–30 mL 50% glucose IV

Migraine (severe)

• prochlorperazine 12.5 mg IV or

• metoclopramide 10 mg IV or

• haloperidol 5 mg IM or IV

Cluster headache

• 100% oxygen 6L/min for 15 mins

• metoclopramide 10 mg IV

Movement disorders (from antipsychotic medication)

• benztropine 1–2 mg IV or IM

Meningococcaemia

• benzylpenicillin 60 mg/kg IV or ceftriaxone ( 91)

Uretic colic

• morphine 10–15 mg IM or IV ± metoclopramide

• indomethacin suppository

Vertigo (acute)

• prochlorperazine 12.5–25 mg IM or promethazine 25 mg IM

Vomiting

• prochlorperazine 12.5mg IM or IV or metoclopramide 10 mg or ondansetron 4 mg (o)