The equipment and use of first aid medicine are the basic requirements and skills that doctors must master when they go out to receive medical treatment or carry out related medical insurance. First aid drugs to achieve five definite, one is a definite quantity, a definite variety, including epinephrine, dopamine, lidocaine, cedelan, atropine, lobelin, coramine, hemostatic amine, Furosemide, nitroglycerin, alamin, diazepam, dexamethasone and other 13 kinds of rescue drugs, As well as conventional infusion solvents such as normal saline, 5% glucose, 10% glucose, 50% glucose, etc., the equipment includes blood pressure monitors, stethoscopes, tweezers, thermometers, dressers, scissors, infusion sets and syringes of various sizes, arteriovenous tourniquets, triangular towels, bandages, head compression dressing mesh sets, tape, alcohol cotton balls, iodophor cotton balls, hydrogen peroxide, etc. The second is fixed placement, first aid equipment generally must be placed in a fixed place; The third is the management of people, generally arrange special medical personnel to check regularly, if the number is lack, to supplement regularly, and must look at the warranty date, expiration to replace in time; Fourth, regular disinfection and sterilization, that is, regular disinfection and sterilization of medical devices.
The use of common emergency drugs shall be subject to the instruction manual. Relevant knowledge is summarized as follows:
1. Epinephrine, also known as pararenin, has an exciting effect on both α and β receptors, enhances myocardial contractile force, accelerates heart rate, increases myocardial oxygen consumption, constricts skin mucous membranes and internal small blood vessels, but dilates coronary and skeletal muscle blood vessels, relaxes bronchus and gastrointestinal smooth muscle; The indications are cardiac arrest, anaphylactic shock and rescue treatment of bronchial asthma. Note: hypertension, organic heart disease, coronary atherosclerosis, diabetes, hyperthyroidism, digitalis poisoning, trauma and hemorrhagic shock should be used with caution, and cardiac asthma should not be used. The adverse reactions were headache, palpitation, elevated blood pressure, convulsion, pallor, hyperhidrosis, tremor and urinary retention. Use for subcutaneous injection or intramuscular injection, to change the injection site to avoid causing tissue necrosis, injection must be withdrawn after no blood return, so as to avoid straying into the vein, closely observe the changes in blood pressure and pulse during injection, so as to avoid causing sudden rise in blood pressure and tachycardia, must be sufficient oxygen, pay attention to the occurrence of acidosis; The dosage was 0.25mg-1mg once, and the maximum dose was 1mg once subcutaneous injection.
2. Dopamine, also known as 3-hydroxytyramine, catecholamine, pharmacological dopamine receptor agonist, small doses can dilate mesentery, kidney, brain and coronary arteries, increase blood flow, increase renal blood flow and glomerular filtration rate, thereby increasing urine volume and sodium excretion, and prevent acute renal failure; Medium dose can increase myocardial contractility, increase cardiac output and accelerate heart rate. Large dose can increase peripheral resistance and blood pressure. Indications are various types of shock, congestive heart failure, acute renal failure; The commonly used preparation is injection, 2ml(20mg) per dose; Contraindicated in patients with eosinophilic cytoma; Large dose can cause respiratory acceleration and arrhythmia, and excessive dose can cause tachyarrhythmia. Blood volume should be replenished and acidosis corrected before use; Blood pressure, heart rate, urine volume and general condition should be observed during intravenous infusion. The changes of limb color and temperature should be closely observed in patients with peripheral vascular history to prevent severe ischemic necrosis of limbs. In adults, intravenous injection starts at 1-5μg/kg per minute and increases at 1-4μg/kg per minute within 10 minutes to achieve maximum efficacy; At the beginning of chronic intractable heart failure, intravenous drip gradually increases by 0.5-2μg/kg per minute according to body weight, and it can be effective in most patients by 1-3μg/kg per minute. In patients with occlusive vasculopathy, the initial infusion rate was 1μg/kg per minute, and gradually increased to 5-10μg/kg per minute until 20μg/kg per minute to achieve the most satisfactory effect; In adults, such as critical cases, the infusion is first given at 5µg/kg per minute, and then increased at 5-10μg/kg per minute to 20-50μg/kg to achieve satisfactory effect; Or 20mg of this product is added to 5% glucose injection 200-300ml, at the beginning of 75-100μg/ min drop, later according to the blood pressure, can accelerate the speed and increase the concentration, but the maximum dose does not exceed 500μg per minute.
3. Lidocaine, local anesthetics and antiarrhythmic agents, can reduce myocardial excitability, slow down conduction velocity, raise ventricular fibrillation threshold and inhibit the automaticity of ectopic rhythm points; The indications are tachycardia caused by various reasons, frequent ventricular premature, ventricular fibrillation, digitalis poisoning, myocardial infarction, etc. Commonly used preparations were 5ml(0.1mg), 10ml(0.2mg), 20ml(0.4mg) per pill; Precautions are prohibited for allergic patients, severe atrioventricular block, indoor block; Adverse reactions include nausea, vomiting, dizziness, lethargy, euphoria, dysphagia, restlessness, etc. Large doses can cause convulsion, respiratory depression, cardiac arrest; Blood pressure and electrocardiogram should be closely observed to prevent excessive poisoning. The choice should distinguish between lidocaine for arrhythmia and injection for local anesthesia. Lidocaine for adult surface anesthesia is 2% ~ 4% solution, no more than 100mg at a time, and the amount of injection does not exceed 4.5mg/kg(without epinephrine) or every 7mg/kg(with 1:200,000 concentration of epinephrine). The usual dosage for children varies with the individual. The total amount of one dose shall not exceed 4.0 ~ 4.5mg/kg, 0.25% ~ 0.5% solution is commonly used, and 1.0% solution is only used in special cases; Antiarrhythmic lidocaine is injected intravenously with 1 to 1.5mg/kg body weight (generally 50 to 100mg) for the first loading for 2 to 3 minutes, and the intravenous injection is repeated once or twice every 5 minutes if necessary, but the total amount within 1 hour should not exceed 300mg; Intravenous infusion is generally 1 to 4mg/ml of medicine with 5% glucose injection or with an infusion pump, which can continue to be maintained at 1 to 4mg per minute after using the load, or at 0.015 to 0.03mg/kg body weight per minute. The elderly, heart failure, cardiogenic shock, decreased liver blood flow, liver or kidney dysfunction should reduce the dosage, at 0.5 ~ 1mg per minute, you can use 0.1% solution intravenous drip, no more than 100mg per hour; The maximum load within 1 hour of intravenous injection is 4.5mg/kg body weight (or 300mg), and the maximum maintenance is 4mg per minute.
4. Cedilan, alias deacetyllanoside, deacetyllanoside C, positive inotropic drugs, enhance myocardial contractility, slow down heart rate, inhibit conduction; The indications were acute and chronic heart failure, atrial fibrillation and paroxysmal supraventricular tachycardia, with injections of 1ml(0.2mg) and 2ml(0.4mg) each. It should be used with caution in patients with severe myocardial damage and renal insufficiency. Adverse reactions include nausea, vomiting, loss of appetite, headache, bradycardia, and atrioventricular block. It is forbidden to use calcium injection in combination with intravenous injection for more than 5 minutes after dilution. The usual dosage for adults is diluted with 5% glucose injection and injected slowly, the first dose is 0.4 ~ 0.6mg (1 ~ 1.5 PCS), then every 2 ~ 4 hours can be given 0.2 ~ 0.4mg (0.5 ~ 1 PCS), the total amount is 1 ~ 1.6mg (2.5 ~ 4 PCS); The usual dosage for children is given 2-3 times at 3-4 hour intervals according to the following doses, premature infants and full-term newborns or children with renal function decline and myocarditis, intramuscular or intravenous injection according to weight 0.022mg/kg, 2 weeks to 3 years old, according to weight 0.025mg/kg, after intravenous injection is satisfactory, the usual maintenance dose of digoxin can be used to maintain the efficacy.
5. Atropine is an M-choline receptor blocker, which can relieve spasm of smooth muscle, inhibit glandular secretion, relieve inhibition of vagus nerve on heart, increase heart rate, dilate mydriasis and intraocular pressure, stimulate respiratory center, relax visceral smooth muscle and dilate mydriasis; The indications were visceral colic, organophosphorus pesticide poisoning, mydriasis, Ars-syndrome, septic shock, and preanesthetic administration. The adverse reactions include dry mouth, vertigo, dilated eyes, skin flushing, rapid heart rate, excitement, irritability, and convulsion. The intravenous injection should be slow to observe whether there is excess or poisoning. For the elderly, constipation and urine volume should be observed, and the inner canthus should be compressed during eye drops to avoid flowing into the nose. Subcutaneous, intramuscular or intravenous injection, the usual dosage for adults is 0.3 ~ 0.5mg each time, 0.5 ~ 3mg a day; The maximum dose was 2mg once, and children were injected subcutaneously 0.01 ~ 0.02mg/kg each time, 2 ~ 3 times a day; Intravenous injection is used for the treatment of AZ syndrome, 0.03-0.05 mg/kg each time, if necessary, repeat once 15 minutes until flushed face, circulation improves, blood pressure rises, extend the interval time until blood pressure is stable; Antiarrhythmic adult intravenous injection 0.5 ~ 1mg, once every 1 ~ 2 hours as needed, the maximum dose is 2mg; Detoxification for antimony induced AS syndrome, intravenous injection of 1 ~ 2mg, 15 ~ 30 minutes after the injection of 1mg, if the patient does not have an attack, as needed every 3 ~ 4 hours subcutaneous or intramuscular injection of 1mg; For organophosphorus poisoning, intramuscular or intravenous injection of 1 to 2 mg (severe organophosphorus poisoning can be increased by 5 to 10 times), repeated every 10 to 20 minutes, until the cyanosis disappears, continue to use the drug until the disease is stable, and then use the maintenance amount, sometimes for 2 to 3 days; Adults are generally 0.02 ~ 0.05mg/kg body weight, diluted with 50% glucose injection or diluted with glucose water. For adults, 0.5mg was intramuscularly injected 0.5 to 1 hour before surgery. For children, the subcutaneous injection dosage was 0.1mg for those weighing less than 3kg, 0.2mg for 7 to 9kg, 0.3mg for 12 to 16kg, 0.4mg for 20 to 27kg, and 0.5mg for those weighing more than 32kg.
6. Lobeline, also known as lobeline, excites the carotid sinus and the chemoreceptor of the aortic body to reflectively excite the respiratory center, and then inhibits the autonomic nerve; The indications are neonatal asphyxia, respiratory failure caused by carbon monoxide, inhaled anesthetic and other central depressant drug poisoning, pneumonia, diphtheria and other infectious diseases; It was an injection, 1ml(3mg) per dose; Adverse reactions include nausea, vomiting, cough, headache, palpitation, etc. Large doses can cause bradycardia, conduction block, respiratory depression, and even convulsion. Observe whether there is sweating, tachycardia, hypotension, etc., and the drip rate should be slow. Intravenous injection of 3mg once for adults, maximum dose of 6mg once, 20mg a day; Children 0.3 ~ 3mg once, if necessary, can be reused every 30 minutes; 3mg can be injected into umbilical vein for neonatal asphyxia. Subcutaneous or intramuscular injection for adults 10mg once, maximum dose 20mg once, 50mg daily; Children 1 ~ 3mg at a time.
7. Colamine, also known as Nicosamine, selectively stimulates the medulla respiratory center, and can also act on the carotid sinus and the aortic body of the chemical receptor reflex excitation respiratory center, so that the respiration deepens and accelerates; The indications were central respiratory insufficiency, respiratory failure caused by pulmonary heart disease, and opioid poisoning. Each injection was 1.5ml(0.375g),2ml(0.5g); Large doses can cause increased blood pressure, palpitation, sweating, vomiting, tremor and muscle rigidity. In case of convulsion, intravenous benzodiazepines should be injected in time. The usual administration routes are subcutaneous injection, intramuscular injection and intravenous injection. Adults 0.25 ~ 0.5g(about 1) at a time, repeat the drug 1 ~ 2 hours if necessary, the maximum amount of 1.25g(about 3.3) at a time; Children under 6 months of age 75mg once (1/5), 1 year old once 0.125g(1/3), 4 to 7 years old once 0.175g(about 0.5).
8. Styptin, also known as styptin and phenylethylamine, can increase the number of platelets in the blood, enhance their aggregation and adhesion, promote the release of thrombocoagulant active substances by platelets, shorten the clotting time, accelerate clot contraction, and enhance capillary resistance; Indications for the prevention and hemostasis of bleeding before and after surgery, bleeding caused by various vascular factors; Each tablet was 0.25mg, each injection was 2ml(0.25g),2ml(0.5g),5ml(1g); Adverse reactions include nausea, headache and rash, which should not be combined with alkaline drugs. Polymer blood blade extender should be used after the use of this drug. Intramuscular or intravenous injection, 0.25 ~ 0.5g once, 0.5 ~ 1.5g daily; Intravenous infusion 0.25 ~ 0.75g once, 2 ~ 3 times a day, after dilution; For the prevention of postoperative bleeding, intravenous drip or intramuscular injection of 0.25-0.5g 15 to 30 minutes before surgery, and then injection of 0.25g 2 hours later if necessary.
9. Furosemide, also known as furosemide, is a fast-acting and potent diuretic drug, which mainly acts on the medullary part of the ascending branch of the medullary loop, has the effect of water and electrolyte excretion, dilates renal vessels, reduces the resistance of renal vessels, increases the renal blood flow, expands the volumetric vein of the lung, reduces the permeability of pulmonary capillaries, and reduces the return blood volume. Clinically used to treat cardiac edema, renal edema, cirrhosis of ascites, dysfunction or vascular disorders caused by peripheral edema, and can promote the discharge of upper urethral stones; Tablets, 20mg each, injection, 2ml (20mg) each; It is prohibited for hypokalemia, hepatic coma, pregnant women and people allergic to sulfonamides. Adverse reactions include water and electrolyte disorders, hyperuricemia, postural hypotension, shock, hypokalemia, hyponatremia, hypocalcemia, increased cardioside toxicity, bone marrow suppression, headache and hearing impairment. Intravenous injection should be slow and should not be mixed with other drugs. The large dose of intravenous injection should not exceed 4mg/ min, and the change of blood pressure and heart rate should be monitored. At the beginning of oral administration ~ 40mg per day, it can be increased to ~ 120mg per day according to needs, when the daily dose exceeds 40mg, it can be divided every 4 hours; The oral dose of children starts at 1 ~ 2mg/kg, and then increases according to the situation.
10. Nitroglycerin directly relaxes vascular smooth muscle, reduces myocardial oxygen consumption, and increases blood oxygen supply to myocardial ischemic area. It is mainly used for various types of angina pectoris, acute myocardial infarction, and chronic cardiac insufficiency. The adverse reactions were pulsating headache, accelerated heart pain, postural hypotension, increased intracranial pressure, angina pectoris, tolerance, and should not be stopped suddenly. Each dose is 5mg; Large doses can cause methemoglobinemia, and severe cases can cause dyspnea, cyanosis, coma and even death.
11. Alamin, also known as meT-hydroxylamine bitartrate, mainly activates the a receptor, has a strong and long-lasting vasoconstriction effect, and has a mild strengthening effect on the heart; The blood pressure increases gradually after injection, which can be used for prevention and treatment of hypotension, spinal anesthesia, surgical bleeding and cardiogenic shock. 10mg/1ml each; Usual dosage: intramuscular injection of 10-20mg; Intravenous infusion 10-40mg once; Maximum dosage: 100mg at a time (0.2-0.4mg per minute)
12. Dexamethasone, also known as Flamethasone, is a synthetic long-term glucocorticoid drug; It has strong anti-inflammatory and anti-allergic effects, but it has slight effects on water and sodium retention and promoting potassium discharge, antitoxin effect, anti-shock effect, relieving arteriole spasm, enhancing cardiac contractile force, and improving microcirculation. The indications are various severe bacterial infectious diseases, bronchial asthma, allergic diseases, severe skin diseases, eye inflammation caused by various causes, aplastic anemia, leukemia, shock; Commonly used preparations are tablets, 0.75mg each, injections, 0.5ml (2.5mg), 1ml (5mg) each.
