Common drugs used in the Emergency Room
By Henry Feldman, ?2001
(Edited by Lewis Nelson, MD)
Routes of administration
Intravenous administration is when the drug is given in liquid form directly into a vein. This is often
done by placing a venous catheter to allow easy administration.
Direct injection into the muscle. Often a painful mode of administration, and provides a slow route
of absorption.
By mouth (Per Orum). Typically intermediate between IM and IV in speed of absorption. (is this
Rectal administration (Per Rectum). The rectum is actually a very quick method of drug
administration as the rectum is highly vascular. This route is often used in children.
Certain drugs can be given down an endotracheal tube. The drugs are given at 2-2.5 times normal
IV dose. Drugs are followed with a saline bolus of ~10ml. The acronym for drugs that can go down
an ET tube is ALONE:
? A ? Atropine
? L ? Lidocaine
? O ? Oxygen
? N ? Naloxone (Narcan)
? E ? Epinephrine
Drug List
Lidocaine has 2 uses: It is a local anesthetic when injected subcutaneously (and it can be used
for a nerve block). It is also an antidysrhythmic drug when injected IV (used to treat cardiac
dysrhythmias). Anesthetic preparations come in 2 forms: with and without epinephrine. The
epinephrine is added to reduce absorption and prolong the effect. A classic question by the
resident/attending is: What is the toxic dose when used as a local anesthetic (Answer: 5mg/kg for
lidocaine without epi, and 7mg/kg with epi.)
Epinephrine is a natural substance produced by the adrenal gland (a.k.a. adrenaline).
Epinephrine is used in emergencies to stimulate the heart or to dilate the bronchial tree. Its use is
limited by cardiac side effects. It is also mixed with lidocaine to prolong lidocaine?s effect and to
control bleeding.
Furosemide (Lasix)
Lasix is a diuretic, which is given IV or PO, which causes the patient to produce more urine. This
is often given to reduce the fluid overload in patients with congestive heart failure (a.k.a. CHF) or
Diazepam (Valium)
Diazepam is a benzodiazepine that is used both as a powerful sedative and as an anticonvulsant
for patients with seizures. You will see it used for alcohol withdrawal, cocaine toxicity,
and status epilepticus (i.e. uncontrolled seizures). Diazepam may produce respiratory depression.
Midazolam (Versed)
Versed is a very powerful short acting benzodiazepine type of sedative and is used to sedate
patients for painful procedures. Excessive dosing may produce respiration depression (when
given i.v.) or coma.
Haloperidol (Haldol)
Haldol is a antipsychotic with powerful sedative properties. It is often used for patients who are
acting in a psychotic manner. It should not be used to treat alcohol withdrawal or cocaince toxicity.
In sufficient quantities it will render the patient unconscious.
Often called ?sux? (pronounced sucks), it is a paralytic, resulting in total muscular paralysis. It will
most often be used for ?rapid-sequence-intubation? to make tracheal intubation easier and to
allow the patient to be mechanically ventilated. It has no analgesic properities and paralyzed
patients see, hear and feel everything - like a zombie! - thus it is never used without sedation.
Atropine is used for several purposes, including inducing the heart to beat faster (i.e.
chronotropy) as well as an antidote for certain organophosphate poisonings. It is sometimes
used as a drug for patients with severe asthma. It can also be dripped into the eyes to produce
dilation of the pupil (although this is a different formulation). Can also be used to dry up respiratory
secretions during procedures.
Heparin is an anticoagulant used to prevent blood from clotting. It is used in patients suspected
of having a myocardial infarction and to prep the syringe for an arterial-blood-gas for the same
Valproic Acid
Valproic Acid is used as an anticonvulsant medication. It is not typically used in the emergency
treatment of seizures, but toxicity can often be seen with seizure patients who have taken too
Phenobarbital is a barbiturate which is used either as a sedative and/or anticonvulsant
Similar to phenobarbital but much faster acting and with a duration of effect. It is used as an
anticonvulsant medication and to treat severe alcohol withdrawal. Often used in a continuous
drip for patients who continue to seize.
Methylprednisolone (Solumedrol)
Solu-medrol is a long acting corticosteroid. It is often used to prevent the recurrence of
anaphylaxis after the epinephrine has worn off and for patients with asthma. It has a half-life of
around 6 hours.
Albuterol (Proventil)
Albuterol is a bronchodilator, used in a nebulizer for asthma patients. Typically a drop (0.5 mg)
of albuterol is suspended in saline and nebulized with oxygen. Often referred to as ?how many
nebs the patient got?.
Ampicillin/Sulbactam (Unasyn)
This is an antibiotic (ampicillin) with the second compound added to prevent bacterial ?lactamases
from working (which interfere with penicillins).