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Medications in the Modern ED

Emergency   (6,673 Views | 8 Replies)
by jep395 jep395 (New) New

jep395 has 1 years experience and specializes in emergency and intensive nursing.

1,008 Profile Views; 6 Posts

The is a collection of the most common medications encountered in emergency treatment (in my own experience). It is by no means exaustive. 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.

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

SIEZURE/NEUROLOGICAL

Phenytoin

PSYCHIATRIC

Lorazepam

Midazolam (Versed)

Haloperidol

ANTIARHYTHMICS/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

Aspirin

tPA

Heparin

Enoxaparin

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 patents 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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RNCEN has 5 years experience and specializes in ER.

234 Posts; 4,752 Profile Views

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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heather in ohio has 11 years experience and specializes in ICU.

40 Posts; 2,202 Profile Views

Glucagon could also be listed as an antidote.

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NurseIndependa specializes in Emergency Department.

113 Posts; 3,256 Profile Views

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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wyosamRN has 6 years experience and specializes in ED, OR, Oncology.

108 Posts; 4,432 Profile Views

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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KBabiesRN has <1 years experience.

7 Posts; 910 Profile Views

On 10/6/2015 at 5:16 PM, wyosamRN said:

Hi wyosamRN:

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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Banana nut has 2 years experience as a BSN, RN, EMT-B.

1 Follower; 316 Posts; 6,786 Profile Views

Octreoride/protonix iv for lower GI bleeds too 

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Sehnsucht specializes in New Grad Dec 2019.

22 Posts; 184 Profile Views

Oh this is awesome. Thank you to the contributors!

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