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Discussion

Medications in the Modern ED

It is by no means exhaustive. On the contrary, I have made effort to remove medications that although may be textbook standards of care, I have not encountered in practice, or medications that may be falling out of favor, but still part of some medical teams' treatment plans. For example, Lidocaine is not included, rather only Amiodarone.

Add to the list by commenting below!

Some medicines may be more common in EMS, Intensive Care, or post admission hospitalist care. But as more patients are boarded within the walls of the ED, understanding of these medications (primarily drips) is very necessary.

The medications are listed first by pharmacological category and subsequently by order of importance (I.e. which one should I learn first).

Airway Management

  • Albuterol
  • Ipratropium

Antibiotics

  • Azithromycin - macrolide
  • Vancomycin - glycopeptide
  • Piperacillin/Tazobactam (Zosyn) - beta-lactamase inhibitor
  • Ampicillin/Sulbactam (Unasyn) - beta-lactamase inhibitor
  • Metronidazole (Flagyl) - bacterial & Amebicidal
  • Ciprofloxacin- fluoroquinolones
  • Ceftriaxone (Rocephin) - 3rd cephalosporin
  • Cefazolin - 1st cephalosporin
  • Clindamycin - Lincomycin derivative
  • Doxycycline - tetracycline
  • Amoxicillin and Clavulanate - beta-lactamase inhibitor
  • Bacitracin

Seizure / Neurological

Phenytoin

Psychiatric

  • Lorazepam
  • Midazolam (Versed)
  • Haloperidol

Antiarrhythmics / Electric Manipulators

  • Amiodarone
  • Procainamide
  • Adenosine

Myocardial Management

  • Diltiazem
  • Digoxin
  • Dobutamine
  • Esmolol
  • Magnesium

Blood Pressor Management / Fluid Management

  • Lebetalol
  • Metoprolol
  • Norepinephrine
  • Epinephrine
  • Dopamine
  • Nitroglycerine
  • Furosemide
  • Mannitol
  • Phenylephrine

Anticoagulants / Thrombolytics

Antiemetics / Antacids

  • Ondansetron
  • Metoclopramide
  • Meclizine
  • Famotidine (Pepcid)
  • Esomeprazole (Nexium)
  • Pantoprazole (Protonix)
  • Milk of Magnesia

Sedation / Induction / Paralysis

  • Rocuronium
  • Succinylcholine
  • Etomidate
  • Ketamine
  • Propofol

Dermatology

Silver Sulfadiazine

Inflammation

  • Dexamethasone
  • Prednisone/Prednisolone
  • Methylprednisolone (Solu-Medrol)
  • Diphenhydramine

Pain

  • Hydromorphone
  • Morphine
  • Tramadol
  • Fentanyl
  • Ibuprofen
  • Acetaminophen
  • Ketorolac
  • Oxycodone
  • Hydrocodone
  • Percocet (oxycodone/aceta)
  • Norco (hydrocodone/aceta)
  • Vicodin (hydrocodone/aceta)

Glucose Management

  • Insulin Aspart (Novolog)
  • Regular Insulin (Humulin)
  • Dextrose 50

Antidotes

  • Naloxone
  • Flumazenil
  • Protamine Sulfate
  • Phentolamine
  • N-acetylcysteine
  • Activated Charcoal
  • Methylene Blue
  • Cyanide Kit

Contrast Dyes

  • Gastrographin
  • IV Constrast

The following medications are generally not mainstays of classic emergency treatment. But do play a role in the right patient. In addition they are are commonly taken by our patients on a regular basis, or we will need to provide teaching for patients being prescribed these medications.

Outpatient / Inpatient Meds

  • Clopidogrel
  • Rivaroxaban
  • Verapamil
  • Atorvastatin

The following medications will be contained in any crash cart. However these medications have many uses outside of the realm of rapid decompensation and cardiopulmonary events.

Crash Cart Medications

  • Atropine
  • Calcium Chloride 10%
  • Calcium Gluconate
  • Sodium Bicarbonate
  • Vasopressin

Dangerous Not To Know

These medicines are for high acuity patients. You may not need them often, but when you do, you may not have time to check your reference. A mistake could cause serious M&M, or might be result in a terrible experience for the patient.

  • Epinephrine
  • Rocuronium
  • Succinylcholine
  • Etomidate
  • Ketamine
  • Propofol
  • rtPA
  • Nitroglycerine
  • Norepinephrine
  • Diltiazem
  • Lebetalol
  • Metoprolol

Like The Back Of Your Hand

  • Insulin
  • Morphine
  • Fentanyl
  • Heparin

Meat And Potatoes, Learn Them Well

  • Albuterol
  • Ipratropium
  • Lorazepam
  • Famotidine (Pepcid)
  • Dexamethasone
  • Ondansetron
  • Metoclopramide
  • Meclizine
  • All antibiotics

Pearls

Know which class of antibiotic a particular antibiotic falls into. When a patient tells you about a penicillin allergy, it's in everyone's best interest that you do not administer any beta-lactams.

**Please add to what I have forgotten! Or any pearls about these meds**

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    • Featured Replies

    Unless I missed it, Nicardipine is not on that list. Easily titratable, and wonderful for htn management especially in stroke/head injured patients.

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    Glucagon could also be listed as an antidote.

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    Thank you for this! I am a new nurse and really trying to learn my "common ER meds" like the back of my hand. I have encountered many of these.

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    I would add that drugs used for intubation, including RSI, as well as drugs/drips used for maintenance should be included in drugs that you know like the back of your hand. Until you've done a bunch of them, they can be stressful situations. It helps so much to understand what the goal of each drug is, when it will take effect (and how to tell that it has), and how long it will last. Also, it is very important to know what the plan is for maintenance sedation (and paralysis if needed) ahead of time if possible- too many times the MD doesn't know his plan, so asking helps them remember to address that, preferably before hand so drips are mixed and ready to go.

    Otherwise, I'd say knowing everything listed pretty well is a good start.

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    Could you please list the specific medications used for: 1)Intubation

    2) RSI

    3) Drugs/Drips used for maintenance

    Also, could you give an example of a plan for maintenance sedation (and paralysis if needed)?

    Any other specific common ED medications you recommend to know that may not be on this list?

    Thank you!

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    Octreoride/protonix iv for lower GI bleeds too

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    Oh this is awesome. Thank you to the contributors!

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