Chapter 58: Adult & Pediatric Emergency Drug Therapy

Adult & Pediatric Emergency Drug Therapy begins by establishing oxygen as a fundamental emergency drug, essential for treating hypoxemia to prevent brain damage, which can commence within only six minutes of oxygen deprivation. The text details specific titration goals to maintain normoxemia—usually between 94% and 99%—while highlighting the risks of oxygen toxicity. For cardiac crises, the guide covers first-line agents like aspirin for its antiplatelet effects and nitroglycerin for coronary vasodilation, noting critical contraindications with certain medications. It further explores advanced life support drugs, including morphine for ischemic chest pain, atropine for treating hemodynamically significant bradycardia, and adenosine for the rapid conversion of paroxysmal supraventricular tachycardia. Potent antidysrhythmics such as amiodarone, lidocaine, and procainamide are analyzed for their roles in managing life-threatening heart rhythms, alongside magnesium sulfate for specific disturbances like torsades de pointes. The management of neurological emergencies focuses on the use of mannitol, an osmotic diuretic used to reduce intracranial pressure, which requires the use of a filter needle to prevent the injection of microscopic crystals. In cases of toxicology and overdose, the text outlines the administration of naloxone for opioid reversal, flumazenil for benzodiazepine sedation, and activated charcoal to minimize the absorption of ingested poisons. To address various forms of shock, the chapter describes the hemodynamic support provided by sympathomimetics like dopamine, dobutamine, and norepinephrine, while identifying epinephrine as the definitive treatment for both cardiac arrest and anaphylaxis. Finally, the discussion covers metabolic stabilization with concentrated dextrose or glucagon for severe hypoglycemia, and the management of hypertensive crises using labetalol, nitroprusside sodium—which must be protected from light—and the loop diuretic furosemide. This detailed overview prepares healthcare students for high-stakes clinical decision-making and precise emergency drug delivery.