Emergency drug doses – PBS doctor’s bag items

Aust Prescr 2012;35:25-7

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 0.25–0.5 mL
>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: 0.5–1mg 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 1mL injection)
Severe bradycardia, asystole Adults: 1mg 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 1mg
Benztropine
(2 mg in 2 mL injection)
Acute dystonic reactions Adults: 1–2mg IM or IV

Children >3 years: 20microgram/kg IM or IV (maximum 1mg). 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 <1 year: 300 mg IV or IM
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: 0.15mg/kg IV
Diazepam
(10 mg in 2mL injection)
Severely disturbed patients Adults: 5–10mg IV over 1–2 minutes (halve dose in elderly) in a large vein. Repeat if necessary every 5–10minutes (maximum 30mg).
Seizures Adults: 10mg IV slowly in a large vein. Repeat once if necessary.
10–20 mg rectally if IV access not possible. Repeat once if necessary.

Children: 0.2–0.3mg/kg IV slowly in a large vein (maximum 10mg). Repeat once if necessary.
0.3–0.5mg/kg rectally (maximum 10mg). 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 <5 years: 0.5 mg SC, IM or IV
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
(100mg or 250mg with
2 mL solvent for injection)
Acute severe asthma Adults: 100mg IV
Children: 4mg/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
(100mg 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: 1mg/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
<39 years 7.5–12.5 mg
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 <50 kg: 0.05–0.1 mg/kg SC or IM
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 mg in 3.4 mL injection)
This should read
(1.5 g in 3.4 mL injection)
Corrected May 2013
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: 2.5–5mg by nebuliser as required

Children <2 years: 0.1 mg/kg up to 2.5 mg by nebuliser as required

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 intravenousSC subcutaneous
A guide to paediatric weights10 kg at 1–2 years15 kg at 2–3 years20 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
(20 mg in 1 mL injection)

Noisy breathing and secretions

Adults: 10–20 mg subcutaneously

PBS* Pharmaceutical Benefits Scheme

References

  1. Anaphylaxis: emergency management for health professionals [wall chart]. Aust Prescr 2011;34:124.
  2. National Asthma Council Australia. Asthma Management Handbook 2006. www.nationalasthma.org.au/handbook

>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.



First published online: February - 2012