Emergency drugs in general practice

Headnote

This review article discusses available drugs for the initial management of medical emergencies in general practice.

General practitioners need the knowledge, skills, drugs and equipment for managing medical emergencies. Clinics need treatment rooms and doctor's bags that enable emergencies to be managed onsite and offerte respectively. Rural medical generalists may provide more advanced emergency management in their local hospitals. In managing emergencies, GPs may be working with paramedics, therefore it helps to be familiar with their skills and with the drugs they carry. General principles that apply in managing medical emergencies are described in Table 1. Relevant contraindications should be checked before administering any of the drugs described below (Table2).

Life threatening medical emergencies

Cardiac arrest

Current guidelines1 emphasise the importance of cardiac compressions, and prompt defibrillation for ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT). Adrenaline is given every 3 minutes intravenously (IV) until return of spontaneous circulation (ROSC):

* adult dosage: 1 mg with a saline flush (10-20 mL)

* paediatric dosage: 0.01 mg/kg (10 pg/kg) (Table 5) with a saline flush (up to 5 mL).

During cardiopulmonary resuscitation, the following drugs may be considered:

* VF or VT: lignocaine 1 mg/kg

* asystole or severe bradycardia: atropine 1.2-3.0 mg (adult); 20 µg/kg (child)

In the hospital setting amiodarone is the first line drug for treating ventricular arrhythmias. Following ROSC, blood pressure (BP) and adequate perfusion should be maintained. This may require IV adrenaline ( Table 4).

Anaphylaxis2

* Adrenaline is given every 5 minutes intramuscularly (IM) (anterolateral thigh) until clinical features have improved. Up to 10 doses may be given:

-adult dosage: 0.5 mg

- paediatric dosage: 0.01 mg/kg ( 10 µg/kg) ( Table 3)

-in adults, if there is a poor response, consider glucagon 1-2 mg IV over 5 minutes

- consider IV adrenaline if shock persists after two IM doses; use with extreme caution ( Table 4)

* Oxygen (8 L/min)

* Normal saline (20 mL/kg) is given for hypotension

* Hydrocortisone 250 mg (or 4 mg/kg), single dose IV.

Potentially life threatening emergencies

Asthma and bronchospasm3

Critical or severe (any of: talking in words, unable to talk, SpO^sub 2^ <90%, agitated, confused, drowsy, maximal accessory muscle use and recession).

Adult

* oxygen, at least 8 L/min to maintain...