Feature
Emergency drug doses – PBS doctor’s bag items
- Aust Prescr 2012;35:25-7
- 1 February 2012
- DOI: 10.18773/austprescr.2012.011
ISSUE 1 FEBRUARY
Corrected May 2013.
This is the corrected version of the article.
Up-to-date emergency drugs and their doses can be viewed on the Doctor's Bag app.
| DRUG | INDICATION | DOSE |
| Adrenaline (1000 microgram in 1 mL injection equivalent to 1:1000) 1000 microgram = 1 mg |
Anaphylaxis1 | 5–10 microgram/kg IM approximates to: Adults: >50 kg 0.5 mL Children: 10 kg (1–2 years) 0.1 mL 15 kg (2–3 years) 0.15 mL 20 kg (4–6 years) 0.2 mL 30 kg (7–10 years) 0.3 mL Repeat dose every 5 minutes if no response |
| Cardiac arrest | Adults: 0.5–1 mg IV Flush with normal saline to aid entry into the circulation Children: 10 microgram/kg slow IV (Dilute 1 mL adrenaline injection 1:1000 with 9 mL sodium chloride (0.9%) and give 0.1 mL/kg) |
|
| Atropine (0.6 mg in 1 mL injection) |
Severe bradycardia, asystole | Adults: 1 mg IV, repeat every 3–5 minutes until desired heart rate is reached or to a maximum of 3 mg Children: 20 microgram/kg IV (maximum dose 0.5 mg), repeat every 5 minutes until desired heart rate is reached or to a total maximum of 1 mg |
| Benztropine (2 mg in 2 mL injection) |
Acute dystonic reactions | Adults: 1–2 mg IM or IV Children >3 years: 20 microgram/kg IM or IV (maximum 1 mg). Repeat after 15 minutes if needed. |
| Benzylpenicillin (600 mg or 3 g powder, dissolve in water for injections) |
Severe infections, including suspected meningococcal disease | Adults and children ≥10 years: 1.2 g IV or IM Children aged 1–9 years: 600 mg IV or IM Children |
| Chlorpromazine (50 mg in 2 mL injection) |
Acute psychosis, severe behavioural disturbance | Avoid parenteral use – injections cause pain and skin irritation. Use haloperidol instead. Adults: If there is no alternative, chlorpromazine 25–50 mg (12.5–25 mg in the elderly) can be given by deep IM injection (buttock or deltoid) |
| Dexamethasone sodium phosphate (4 mg in 1 mL injection) |
Acute severe asthma2 | Adults: 4–12 mg IV slowly |
| Severe croup | Children: 0.15 mg/kg IM if oral route is not possible | |
| Bacterial meningitis | Start before or at the same time as antibiotic Adults: 10 mg IV Children aged >3 months: 0.15 mg/kg IV |
|
| Diazepam (10 mg in 2 mL injection) |
Severely disturbed patients | Adults: 5–10 mg IV over 1–2 minutes (halve dose in elderly) in a large vein. Repeat if necessary every 5–10 minutes (maximum 30 mg). |
| Seizures | Adults: 10 mg IV slowly in a large vein. Repeat once if necessary. 10–20 mg rectally if IV access not possible. Repeat once if necessary. Children: 0.2–0.3 mg/kg IV slowly in a large vein (maximum 10 mg). Repeat once if necessary. 0.3–0.5 mg/kg rectally (maximum 10 mg). Repeat once if necessary. |
|
| Dihydroergotamine (1 mg in 1 mL injection) |
Severe migraine | Adults: 0.5–1 mg SC or IM. Repeat every hour if needed (maximum 3 mg daily). |
| Diphtheria and tetanus booster vaccine (0.5 mL pre-filled syringe) |
Tetanus prophylaxis | Adults and children >8 years: 0.5 mL IM |
| Frusemide (20 mg in 2 mL injection) |
Left ventricular failure, acute pulmonary oedema | Adults: 20–40 mg IV slowly or IM |
| Glucagon (injection kit containing 1 mg glucagon and 1 mL solvent in syringe) |
Severe hypoglycaemia | Adults and children >5 years: 1 mg SC, IM or IV Children |
| Glyceryl trinitrate (400 microgram per dose, 200 doses as sublingual spray) |
Acute angina, acute left ventricular failure | Adults: 1–2 sprays under the tongue. Repeat after 5 minutes if needed (maximum 3 sprays). |
| Haloperidol (5 mg in 1 mL injection) |
Acute psychosis, severe behavioural disturbance | Adults: 2–10 mg IM (0.5–2 mg in the elderly) |
| Hydrocortisone sodium succinate (100 mg or 250 mg with 2 mL solvent for injection) |
Acute severe asthma | Adults: 100 mg IV Children: 4 mg/kg IV |
| Anaphylaxis | Adults: 100 mg IV or IM Children: 2–4 mg/kg IV |
|
| Acute adrenal insufficiency | Adults: 100 mg IV or IM Children 1–12 years: 50 mg IV or IM Children 1–12 months: 25 mg IV or IM |
|
| Lignocaine (100 mg in 5 mL injection) |
Sustained ventricular tachycardia | Lignocaine has serious adverse effects including the potential to worsen arrhythmia and cardiac failure. Do not use outside of hospital. Adults and children: 1 mg/kg IV over 1–2 minutes. Repeat after 5 minutes if needed. |
| Metoclopramide (10 mg in 2 mL injection) |
Nausea and vomiting | Adults: IV or IM >60 kg 10 mg starting dose 30–59 kg 5 mg starting dose (maximum 0.5 mg/kg daily) Not generally recommended in children as there is a risk of extrapyramidal adverse effects |
| Methoxyflurane (3 mL plus inhaler) |
Pain after acute trauma | Adults and children (who are able to use the device, usually ≥ 5 years): 6–8 breaths at a time (maximum 6 mL/day) |
| Morphine sulfate (15 mg or 30 mg in 1 mL injection) |
Severe pain | Adults: SC or IM starting at lower dose 40–59 years 5–10 mg 60–69 years 2.5–7.5 mg 70–85 years 2.5–5 mg >85 years 2–3 mg Can also be given as IV increments of 0.5–2 mg titrated to effect Children >1 year and |
| Naloxone (2 mg in 5 mL injection) |
Opioid overdose | Adults and children: 0.4–0.8 mg IV, IM or SC repeated as necessary Neonates born with low APGAR scores to mothers taking opioids: 0.1 mg/kg IV, IM or SC. Repeat if needed. |
| Procaine penicillin (1.5 g in 3.4 mL injection) |
Severe infections (only suitable for infections where prolonged low concentrations are appropriate) | Adults: 1–1.5 g by deep IM injection Children: 50 mg/kg by deep IM injection |
| Prochlorperazine (12.5 mg in 1 mL injection) |
Nausea and vomiting, vertigo | Adults: 12.5 mg IM or IV |
| Promethazine hydrochloride (50 mg in 2 mL injection) |
Allergic reactions | Adults and children >12 years: 25–50 mg IM Children >2 years: 0.125 mg/kg IM |
| Nausea and vomiting | Adults and children >12 years: 12.5–25 mg IM | |
| Salbutamol inhaler (100 microgram per dose, 200 doses) |
Acute asthma, bronchospasm | Adults and children: 4 puffs (400 microgram) via spacer. Repeat after 4 minutes if needed. If still no improvement, continue giving 4 puffs every 4 minutes until ambulance arrives. |
| Salbutamol nebuliser solution (2.5 mg or 5 mg in 2.5 mL per dose, 30 doses) |
Acute asthma, bronchospasm | Adults and children >2 years: 2.5–5 mg by nebuliser as required Children For anaphylaxis give 5 mg by nebuliser to adults and children, repeat if required |
| Terbutaline (500 microgram in 1 mL injection) |
Acute asthma | Adults: 250 microgram SC Children: 5 microgram/kg SC |
| Tramadol (100 mg in 2 mL injection) |
Pain | Adults: 50–100 mg IV over 2–3 minutes or IM |
| Verapamil (5 mg in 2 mL injection) |
Paroxysmal supraventricular tachycardia in patients who are not: - taking beta blockers - having an infarction - in second or third degree atrioventricular block |
Do not use outside of hospital Adults: 5 mg IV slowly (over at least 3 minutes), repeat after 5–10 minutes if no response Children: 0.1–0.3 mg/kg IV, repeat after 30 minutes if no response (maximum 5 mg) |
|
* Pharmaceutical Benefits Scheme IM intramuscular IV intravenous SC subcutaneous |
||
| A guide to paediatric weights 10 kg at 1–2 years 15 kg at 2–3 years 20 kg at 4–6 years 30 kg at 7–10 years | ||
| PBS* doctor's bag items for palliative care patients | ||
| These drugs should only be used after consultation with a palliative care specialist | ||
| DRUG | INDICATION | DOSE |
| Clonazepam (oral liquid containing 25 mg in 10 mL) |
Preventing seizures, hiccups | Adults: 0.25–1 mg orally or sublingually |
|
Hyoscine butylbromide |
Noisy breathing and secretions |
Adults: 10–20 mg subcutaneously |
|
PBS* Pharmaceutical Benefits Scheme |
||
Further reading
Holmes JL. Time to restock the doctor's bag. Aust Prescr 2012;35:7–9.
Baird A. Drugs for the doctor's bag. Aust Prescr 2007;30:143-6.
