Medicines

What are the 20 emergency drugs in life-threatening conditions?

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Posted By SUMIT SHARMA

Introduction

Today, we will discuss – what are the 20 emergency drugs used in life-threatening conditions?

Medical emergencies are the situation of life and death. Although all medical emergencies are not life-threatening. But some medical conditions may need immediate medical attention.

It may be a condition of heart attack, septic shock, trauma, stroke, burns, brain injury, etc. You might be in that situation.

In this article, we will know – what are the 20 emergency drugs used in life-threatening conditions.

I have made a quick guide to understand what are the 20 emergency drugs used in medical emergency conditions. Keep reading to find out why and how these drugs work in different medical emergencies.

 

What are emergency drugs?

Emergency drugs are those medicines that are used in critical or life-threatening conditions like cardiac arrest, septic shock, epilepsy, trauma, etc.

These drugs help to treat symptoms to save patient life. So, it is also called Life Saving drugs.

Emergency drugs are usually found in the emergency tray drug list, emergency trolley, ICU (Intensive Care Unit), O.T. (Operation Theatre), CCU (Critical care unit), emergency ward, and other areas of the hospital.

A well organised emergency tray or trolley helps to save time, immediate provide emergency drugs and reduce confusion in all chaotic situation.

The emergency physicians or specialists usually tackle the medical emergencies patients by using emergency drugs.

What are the 20 emergency drugs

 

What are the characteristics of emergency drugs?

The primary goal of using emergency drugs is to save patient life. So, doctors generally preferred those drugs

What are the 20 emergency drugs

a. Drugs that have a short half-life

If they use long-acting drug, then the drug may give long-term side effects. Due to this, the patient may die from the drug’s side effects too.

So, short-acting drugs are the preferred choice in emergency conditions. These short-acting drugs should have a half-life in seconds or minutes.

 

b. Drugs that have fast-acting

Emergency physicians are generally required those drugs that provide immediate effects. These drugs have a very short onset of action. They start to work within second or minutes.

 

c. Route of administration

The intravenous (i.v.) route is the preferred route of administration when the patient is in a life-threatening condition.

But sometimes, drugs are also used in other parenteral routes like intramuscular, subcutaneous, sublingual, etc., for different medical emergencies.

 

d. Highly effective drug

Doctors usually select the most active and powerful drug in an emergency condition.

 

What are the 20 emergency drugs in medical emergencies?

There are top 20 names of emergency drugs that are most commonly used in life-threatening conditions. Let’s discuss one by one – 

Click here to download, list of emergency drugs and their action PDF 

1. Adrenaline injection

Adrenaline injection should be the primary drug in the emergency tray drug list.

what are the 20 emergency drugs

Adrenaline belongs to the class of catecholamines or sympathomimetic agents. It is also known as epinephrine.

All catecholamines (such as adrenaline, noradrenaline, dopamine, and dobutamine) are highly potent drugs because they give a powerful effect even at low doses.

Adrenaline works on three primary receptors – Alpha-1 (present on blood vessels), Beta-1 (present on heart), and Beta-2 (present on lungs). But it has a higher affinity on the Beta-1 receptor.

Adrenaline injection is a drug of choice in cardiac arrest (pulseless) conditions. In this condition, your heart suddenly loses blood flow or electrical activity that lead to heart failure. Ischemic heart disease is the most common cause of cardiac arrest.

what are the 20 emergency drugs

When this drug injects into your vein, it goes to your bloodstream and directly binds with the beta-1 receptor.

As soon as adrenaline strongly binds with the beta-1 receptor, it gives potent cardiac stimulation or contraction by the S.A. (sinoatrial) node.

The dose of adrenaline injection in cardiac arrest is 1 mg I.V. route with a dilution of 1:10,000 (or 0.1 mg/ml).

The half-life of adrenaline is 2-3 mins. So, it should be repeated every 3-5 minutes in case of cardiac arrest.

Adrenaline is also a drug of choice in anaphylactic conditions. In this condition, histamine level start to increase that causes bronchoconstriction and vasodilation.

You may have suddenly developed severe allergic reactions, breathing difficulty, low blood pressure, etc.

If you have an anaphylactic reaction, you need an adrenaline injection as soon as possible. It increases your blood pressure (by the influence of alpha-1 receptor) and improves breathing problems (by the influence of beta-2 receptor).

In an anaphylactic condition, the dose of adrenaline injection is 0.3-0.5 mg I.M. route with a dilution of 1:1000. If you don’t respond after three consecutive doses, it needs to give 0.05-0.1mg I.V.

You may be at higher risk if you are already taking drugs like tricyclic antidepressant (TCA) and monoamine oxidase (MAO) inhibitors. Because these drugs may cause severe high blood pressure with adrenaline. You or your attendant must tell your doctor about concomitant medication.

As far as the concern of side effects of adrenaline, it may cause

  • hypertension due to stimulation of alpha 1 receptor
  • arrhythmia due to stimulation of beta 1 receptor

 

Hypertension can be overcome by phentolamine injection, and arrhythmia can be treated by esmolol injection.

Doctors/nurses need to monitor your blood pressure, heart rate, pulse, ECG, and urine output during adrenaline therapy.

 

2. Noradrenaline injection

Suppose you have got severe blood loss or fluid during accident, burns, diarrhea, heavy bleeding in pregnancy, and sepsis.

In this condition, your heart suddenly stops pumping blood to various organs like the brain, liver, kidney, and other tissues. This medical emergency is called cardiogenic shock or vasodilatory shock, or hypotensive shock.

Inj. Noradrenaline is a drug of choice in cardiogenic shock. This drug is also belonging to the catecholamine class.

It has a higher affinity for the alpha-1 receptor (present on veins), providing a powerful vasoconstrictor effect. Due to this, noradrenaline increases your blood pressure.

It has also seen some effects on the beta-1 receptor (present in the heart). Due to this, it increases the contraction of your heart.

As far as the concern of dose of noradrenaline, it needs to deliver continuous I.V. infusion in the range of 0.025 to 0.4 mcg/kg/min.

What are the 20 emergency drugs

Noradrenaline injection is strictly contraindicated in intramuscular (i.m.) and subcutaneous (s.c.) because it has a higher chance of causing necrosis.

All catecholamines have similar side effects as adrenaline. So, doctors also require to monitor your blood pressure, ECG, pulse, heart rate, and urine output during noradrenaline therapy.

 

3. Dopamine and Dobutamine injection

These are another two essential emergency medicines of the catecholamine class.

Dopamine works on alpha-1 and beta-1 receptors.

A higher dose of dopamine (10 – 20 mcg/kg/min IV) increases your blood pressure due to the vasoconstriction effect. But at a lower dose of dopamine (5-10 mcg/kg/min IV), it stimulates your heart.

Whereas dobutamine only works on the beta-1 receptor.

Dobutamine (2-20 mcg/kg/min IV) is mainly used in acute (sudden) congestive heart failure because this drug help to increases your cardiac output.

 

4. Calcium gluconate injection

Calcium gluconate injection is used in emergency conditions like cardiac arrest and cardiotoxicity, which occurs due to hyperkalemia (high potassium level) or hypermagnesemia (high magnesium level).

It is given 10% solution, 15 to 30 ml IV over 2 to 5 mins.

Calcium gluconate is also used in hypocalcemia (low calcium level) conditions. If you have severe symptomatic hypocalcemia, it may lead to seizure, laryngospasm, and tetany.

In severe hypocalcemia conditions, the dose of calcium gluconate is 1-2 gm in 10 mins.

Calcium gluconate starts to work within 3 mins, and it is generally effective for 20 to 60 mins.

 

5. Atropine injection

Atropine is an antimuscarinic agent or parasympatholytic agent, or anticholinergic drug.

Since atropine is a non-selective antimuscarinic agent. So, it blocks the activity of muscarinic (M1, M2 & M3) and nicotinic (Nn & Nm) receptors.

  • M1 receptor present on CNS, gastric, and salivary gland
  • M2 receptor present on heart and lungs
  • M3 receptor present on smooth muscles

 

This drug is used in emergency conditions when your heart beats too slowly, like severe bradycardia.

It may also use when you don’t have a heartbeat (showing the flat line in ECG). This condition is called asystole (a severe form of cardiac arrest).

Atropine immediately starts to work within 1 minute, and it is generally effective for 30 to 60 mins.

It is also considered the best antidote in cholinergic poisonings like mushroom and organophosphorus compound toxicity.

The dose of atropine in asystole and bradycardia is 0.5 to 1.0 mg every 3-5 minutes by rapid IV push.

If atropine gives less than 0.5 mg, it causes bradycardia itself. So, it should not be less than 0.5 mg.

For mushroom poisoning = 1-2 mg rapid IV push and then as per need.

For organophosphate poisoning = 1-6 mg rapid IV push every 3-5 minutes.

Doctors/nurses may need to monitor your urine output and heart rate during atropine therapy. Because atropine may cause urine retention and increase heart rate (tachycardia).

 

6. Amiodarone injection

Amiodarone is a class III antiarrhythmic drug. It is a potassium channel blocker that helps to prolongation of the repolarisation (phase-3).

It also has the property to block sodium channels, calcium channels, and beta-receptor of your heart.

If you feel a fast heartbeat, palpitation, dizziness, low blood pressure, and chest pain. Then it may indicate a dangerous type of arrhythmia.

If an arrhythmia is occurring in your myocardia cells (or ventricle area), it will call ventricular tachycardia (125 to 250 bpm) and ventricular fibrillation (over 300 bpm).

This type of arrhythmia may cause cardiac arrest with loss of consciousness and death.

According to published literature in the European review for medical and pharmacological sciences, 2005 suggested that amiodarone is considered a drug of choice in pulse-less ventricular tachycardia (V.T.) and ventricular fibrillation (V.F.).

Amiodarone is the only antiarrhythmic drug that reduces sudden cardiac death.

The dose of amiodarone in pulseless VF/VT is 300mg IV rapid push followed by 150mg IV rapid push.

The major side effects of amiodarone are hypotension and bradycardia.

The risk of bradycardia can increase if you are already taking beta-blocker drugs (propranolol, atenolol, etc.) and calcium channel blockers (verapamil, amlodipine, nifedipine, etc.).

Some enzyme inhibitors (like ketoconazole and erythromycin) inhibit the metabolism of amiodarone. Due to this, it may increase amiodarone toxicity.

So, you (or your attendant) must talk about concomitant medication to your doctor before taking an amiodarone shot.

 

7. Lidocaine (Lignocaine) injection

If the amiodarone injection is not available or contraindicated for the patient with ventricular tachycardia (V.T.) and ventricular fibrillation (V.F.).

In that case, lidocaine injection (1.0 to 1.5 mg/kg slow IV push) is a perfect choice for treating V.T. and V.F.

Although lidocaine is a local anesthetic drug. But it also acts as a class-I antiarrhythmic effect by blocking the sodium channel.

Lidocaine is a drug of choice in –

  • acute myocardial infarction,
  • ventricular tachycardia due to digitalis toxicity
  • heart surgery

What are the 20 emergency drugs

But it is ineffective in atrial arrhythmia.

You may have developed seizures after the administration of lidocaine. In that case, the doctor may give you a diazepam injection to overcome this side effect.

 

8. Adenosine injection

Suppose your ECG report showing arrhythmia above the ventricles (in the atrium area) is called supraventricular tachycardia (SVT).

SVT has four main types –

 

Adenosine is the drug of choice in PSVT. It is also effective in other types of SVT.

Adenosine acts as an antiarrhythmic agent. It slows the conduction of your heart by blocks the A.V. (atrioventricular) node.

Adenosine is contraindicated or not affected if it is given a slow IV push. Because adenosine has a very short half-life (around 0.6 to10 sec.). So, it should be administered rapid IV push.

The dose of adenosine is 6 mg rapid IV push. If you don’t respond to this dose, then it may require a 12 mg rapid IV push.

Adenosine may cause bronchoconstriction and hypotension. So, doctors/nurses may monitor your blood pressure during adenosine therapy.

 

9. Esmolol injection

Esmolol injection is an alternative option for the treatment of atrial flutter, atrial fibrillation, and PSVT.

Esmolol is an ultra-short-acting drug (half-life is about 9 minutes), and it starts to work within 60 seconds.

This drug decreases the heart rate and contraction of your heart by blocking the beta-1 receptor.

The dose of esmolol injection is 500 mcg/kg loading dose IV bolus, then continuous infusion of 50-300 mcg/kg/min.

During the esmolol therapy, you may have developed bradycardia and asystole. Doctors/nurses may monitor your heart rate and pulse.

The esmolol concentration may increase in your blood if you are already on verapamil drug.

 

10. Magnesium sulfate injection

This drug should be available in every emergency area of the hospital.

As per a study, intravenous magnesium sulfate injection is a drug of choice in torsade de points.

Torsade de points is a type of ventricular arrhythmia that can lead to sudden cardiac death.

In this condition, your heart may have excessive lengthening of Q.T. interval. It may be due to the imbalance of electrolytes, especially low potassium levels (hypokalemia ) and low magnesium level (hypomagnesemia).

This drug helps to increase magnesium and potassium levels by blocking the calcium channel.

Magnesium sulfate is also used in eclampsia conditions (hypertension + proteinuria + seizure during pregnancy) and severe acute (or sudden) asthma attacks.

Doses: –

  • For torsade points = 2 gm slow IV push
  • Eclampsia = 2-4 gm IV over 5 mins.
  • Severe acute asthma = 2 gm over 15 mins.

 

11. Mannitol injection

Mannitol is a highly effective osmotic diuretic. It powerfully increases the urine output and excretes almost all the electrolytes like sodium, potassium, calcium, magnesium, chloride, bicarbonate, and phosphate ions.

Mannitol is the preferred drug in emergency situations like acute congestive glaucoma, shock, head injury, cerebral edema, and stroke.

It reduces the intracranial pressure of your brain and intraocular pressure of your eye.

Mannitol is also used in acute kidney failure. It is contraindicated in pulmonary edema, severe heart failure, and anuria (kidney stop producing urine).

Nurses may monitor your electrolyte serum during mannitol therapy because this drug may cause electrolyte imbalances.

The usual dose of mannitol is 1.5 to 2g/kg infused over 30 to 60 min.

 

12. Furosemide injection

If you have developed edema (or fluid retention in your body) due to congestive heart failure, kidney disease, and liver disease. In that condition, furosemide injection can be used.

Furosemide is a powerful loop diuretic agent. It inhibits the reabsorption of the following electrolytes – sodium, potassium, and chloride ions.

It is used in emergency situations like –

  • pulmonary edema condition
  • edema, which is caused by liver disease, cardiac disease, and kidney disease.

what are the 20 emergency drugs

Furosemide starts to work within 15 mins. after intravenous administration, the half-life of furosemide is 1 to 1.5 hrs.

The recommended initial dose of furosemide is 20- 40 mg IV administration.

 

13. Sodium bicarbonate injection

Sodium bicarbonate is an alkalizing agent, and it is a drug of choice in metabolic acidosis conditions.

In metabolic acidosis, your body produced too much acid by the imbalance of electrolytes.

It may be due to kidney disease, gastrointestinal bicarbonate loss, drug-induced hyperkalemia, and administration of acid.

Intravenous sodium bicarbonate is also used in hyperkalemia, TCA (tricyclic antidepressant agents) toxicity, and aspirin poisoning.

This drug increase serum bicarbonate level in your body. It is administered 5% Sodium Bicarbonate in 300 to 500 mL fluid rapid IV push in your body.

 

14. Fosphenytoin injection

Fosphenytoin is an antiepileptic drug. It is a prodrug of phenytoin and is used in the treatment of status epilepticus.

If you have developed seizures of more than 5 minutes or have more than 1 seizure in 5 minutes is considered status epilepticus.

This type of seizure is a medical emergency that can lead to brain damage and death.

Intravenous fosphenytoin injection controls your seizure by block the sodium channel.

It is recommended 15-20 mg/kg slow IV push followed by continuous infusion 150 mg/min.

If it is given rapid IV push, it may cause asystole (serious cardiac arrest).

So, your heart rate and pulse may be monitor during fosphenytoin therapy.

 

15. Nitroglycerin

It is also known as GTN (Glyceryl Trinitrate). Nitroglycerin injection is primarily used to treat your high blood pressure during surgery.

Since it is an antianginal drug. So, it is also used in unstable angina pectoris, coronary artery spasm, and myocardial infarction conditions.

GTN is a short-acting nitrate, and its half-life is around 2-3 min.

The recommended dose of GTN is 0.5 to 2.0 mg/min.

You may use GTN as a sublingual to terminate the angina pectoris attack. The sublingual dose is 0.3 – 0.4 mg, and it starts to work within 1-2 mins.

 

16. 25% or 50% dextrose infusion

It can’t be avoided from the emergency drug list. It helps to overcome fluid loss from your body.

If you have developed hypovolemia conditions due to severe diarrhea, accidents, burns, etc. Doctors may administer 25% or 50% dextrose infusion in your body.

It also treats hypoglycemia conditions.

 

17. Snake antivenom

Snake antivenom is an emergency treatment of snake bites. The snake bite may cause severe paralysis, breathing problem, bleeding, and local tissue damages.

According to a study, snake antivenom is the only effective antidote in the treatment of snakebite. It reverses the effect of snake venom, and this antivenom is prepared by poisonous snake venom and horse serum.

 

18. Naloxone injection

This drug is mainly used in emergency conditions when you are exposed to opioids (like morphine, heroin, etc.) poisoning.

The overdose of opioids may cause cardiac arrest, respiratory depression, and mental depression.

Naloxone injection starts to give effect within 2 minutes when given intravenously.

 

19. Flumazenil injection

Flumazenil injection reverses the sedative effects of the benzodiazepine.

If you have mistakenly overdosed on benzodiazepines drugs (like diazepam, alprazolam, clonazepam, clobazam, etc.). Then, you may have developed severe mental depression, ataxia (unable to make balance), and slurred speech (unable to speak).

In that case, Flumazenil injection is the best antidote.

 

20. Other antidotes in poisoning

  • antidote for alcohol, methanol, ethylene glycol, and diethylene glycol poisoning – fomepizole
  • antidote for rat poisoning (rodenticides) –vitamin K1
  • antidote for arsenic, gold, lead, and inorganic mercury poisoning – dimercaprol (BAL) and sodium calcium edetate (sodium-calcium EDTA)
  • antidote for datura poisoning – physostigmine
  • antidote for cyanide poisoning – hydroxocobalamin and sodium thiosulfate

 

What are the 10 emergency drugs for cardiac diseases?

The life-threatening conditions are more likely in severe heart conditions such as cardiac arrest, cardiogenic shock, sudden cardiac death, severe arrhythmia, etc.

Therefore, hospitals should always have the following 10 emergency drugs on hand in case of cardiac emergencies. It includes –

what are the 20 emergency drugs

1. Adrenaline injection for cardiac arrest

2. Noradrenaline injection for cardiogenic shock

3. Dopamine injection for cardiac arrest

4. Dobutamine injection for acute congestive heart failure

5. Calcium gluconate injection for cardiac arrest and cardiotoxicity due to hyperkalaemia or hypermagnesemia.

6. Atropine injection for severe bradycardia and asystole (a severe form of cardiac arrest).

7. Amiodarone injection for arrhythmia, especially ventricular tachycardia and ventricular fibrillation.

8. Lidocaine injection for arrhythmia, especially ventricular tachycardia and ventricular fibrillation.

9. Magnesium sulphate injection for torsade de points (long QT prolongation)

10. Adenosine and esmolol injection for paroxysmal supraventricular tachycardia, atrial fibrillation, atrial flutter and WPWS (Wolff Parkinson White syndrome).

 

Takeaway

Now, you have got a clear picture – what are the 20 emergency drugs used in life-threatening conditions. These drugs should be available in every emergency area of the hospital.

This post has covered the main emergency drugs with action, doses, uses, and side effects.

This information is only for knowledge purposes. Do not try any drug of this list yourself.

If you found this post (what are the 20 emergency drugs) informative, please share it on social media.

Drop your query in the comment box related to this post (what are the 20 emergency drugs).

 

FAQ

Q 1. What are the five essential emergency drugs in life threatening conditions?

There are five essential emergency drugs that should be available in every hospital emergency department, emergency medical services and ICU (Intensive care unit) –

  1. Adrenaline
  2. Atropine
  3. Amiodarone
  4. Dopamine
  5. Magnesium sulphate

 

Q 2. What are the first line emergency drugs for cardiac arrest?

Among the list of emergency medications, adrenaline is often regarded as the first line emergency drug in cardiac arrest condition.  

 

Q 3. What are the common emergency drugs for pain relief?

Some common emergency painkillers should be present in every emergency department –

  • Paracetamol – Pain reliever and fever reducer.
  • Diclofenac – It is a nonsteroidal anti-inflammatory drug (NSAID) that is used to treat mild to moderate body pain.
  • Drotaverine – It is an antispasmodic medication that is used to treat abdominal pain and stomach discomfort.
  • Tramadol – It is a narcotic analgesic that is used to treat moderate to severe body pain.

 

References –

1. K.D. Tripathi. Essentials of medical pharmacology, 7th edition. JP Brothers Medical Publisher, 2013; Chapter – 8,9,38,39,40, and 41b.

2. Lippincott’s illustrated reviews. Pharmacology 5th edition. Wolters kluwer health, 2012. Chapter – 5,6,7,17,18, and 19.

 

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One thought on “What are the 20 emergency drugs in life-threatening conditions?
  1. Raja. Anthony

    Thank you so much sir …for this life saving medicine’s

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