given undiluted with syringe pump. Glyceryl trinitrate
5 mg/ml to be diluted before use.lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug. Forms available from special-order
manufacturers include: ointment
Solution for infusion
EXCIPIENTS:May contain Ethanol, propylene glycol
▶Glyceryl trinitrate (Non-proprietary)
Glyceryl trinitrate 1 mg per 1 mlGlyceryl trinitrate 50 mg/ 50 ml
solution for infusion vials| 1 vialP£ 15. 90
Glyceryl trinitrate 5 mg per 1 mlGlyceryl trinitrate 50 mg/ 10 ml
solution for infusion ampoules| 5 ampouleP£ 64. 90 (Hospital
only)
Glyceryl trinitrate 25 mg/ 5 ml solution for infusion ampoules|
5 ampouleP£ 32. 45 (Hospital only)
▶Nitrocine(Aspire Pharma Ltd)
Glyceryl trinitrate 1 mg per 1 mlNitrocine 10 mg/ 10 ml solution for
infusion ampoules| 10 ampouleP£ 58. 75 (Hospital only)
▶Nitronal(Intrapharm Laboratories Ltd)
Glyceryl trinitrate 1 mg per 1 mlNitronal 5 mg/ 5 ml solution for
infusion ampoules| 10 ampouleP£ 18. 04
Nitronal 50 mg/ 50 ml solution for infusion vials| 1 vialP£ 14. 767.1 Cardiac arrest
Cardiopulmonary resuscitation
Overview
The algorithms for cardiopulmonary resuscitation (Life
support algorithm (image) p. 1107 )reflect the
recommendations of the Resuscitation Council (UK); they
cover paediatric basic life support, paediatric advanced life
support, and newborn life support. The guidelines are
available atwww.resus.org.uk.Paediatric advanced life support
Cardiopulmonary (cardiac) arrest in children is rare and
frequently represents the terminal event of progressive
shock or respiratory failure.
During cardiopulmonary arrest in children without
intravenous access, the intraosseous route is chosen because
it provides rapid and effective response; if circulatory access
cannot be gained, the endotracheal tube can be used. When
the endotracheal route is used ten times the intravenous
dose should be used; the drug should be injected quickly
down a narrow bore suction catheter beyond the tracheal
end of the tube and thenflushed in with 1 or 2 mL of sodium
chloride 0. 9 %. The endotracheal route is useful for lipid-
soluble drugs, including lidocaine hydrochloride p. 826 ,
adrenaline/epinephrine below, atropine sulfate p. 810 , and
naloxone hydrochloride p. 842. Drugs that are not lipid-
soluble (e.g. sodium bicarbonate p. 586 and calcium chloride
p. 593 ) shouldnotbe administered by this route because
they will injure the airways.
For the management of acute anaphylaxis, see allergic
emergencies under Antihistamines, allergen immunotherapy
and allergic emergencies p. 171.SYMPATHOMIMETICS›VASOCONSTRICTOR
Adrenaline/epinephrine 27-Sep-2017
lDRUG ACTIONActs on both alpha and beta receptors and
increases both heart rate and contractility (beta 1 effects); it
can cause peripheral vasodilation (a beta 2 effect) or
vasoconstriction (an alpha effect).lINDICATIONS AND DOSE
Acute hypotension
▶BY CONTINUOUS INTRAVENOUS INFUSION
▶Neonate:Initially 100 nanograms/kg/minute, adjusted
according to response, higher doses up to
1. 5 micrograms/kg/minute have been used in acute
hypotension.▶Child:Initially 100 nanograms/kg/minute, adjusted
according to response, higher doses up to
1. 5 micrograms/kg/minute have been used in acute
hypotension
Croup (when not effectively controlled with corticosteroid
treatment)
▶BY INHALATION OF NEBULISED SOLUTION
▶Child 1 month–11 years: 400 micrograms/kg (max. per
dose 5 mg), dose to be repeated after 30 minutes if
necessary
PHARMACOKINETICS
▶The effects of nebulised adrenaline for the treatment of
croup lasts for 2 – 3 hours.
Emergency treatment of acute anaphylaxis (under expert
supervision)|Angioedema (if laryngeal oedema is
present) (under expert supervision)
▶BY INTRAMUSCULAR INJECTION
▶Child 1 month–5 years: 150 micrograms, doses may be
repeated several times if necessary at 5 minute
intervals according to blood pressure, pulse, and
respiratory function, suitable syringe to be used for
measuring small volume; injected preferably into the
anterolateral aspect of the middle third of the thigh
▶Child 6–11 years: 300 micrograms, doses may be
repeated several times if necessary at 5 minute
intervals according to blood pressure, pulse, and
respiratory function, to be injected preferably into the
anterolateral aspect of the middle third of the thigh
▶Child 12–17 years: 500 micrograms, to be injected
preferably into the anterolateral aspect of the middle
third of the thigh, doses may be repeated several times
if necessary at 5 minute intervals according to blood
pressure, pulse, and respiratory function,
300 micrograms ( 0. 3 mL) to be administered if child
small or prepubertal
Acute anaphylaxis when there is doubt as to the adequacy
of the circulation (specialist use only)|Angioedema (if
laryngeal oedema is present) (specialist use only)
▶BY SLOW INTRAVENOUS INJECTION
▶Child: 1 microgram/kg (max. per dose 50 micrograms),
using dilute 1 in10 000adrenaline injection, dose to be
repeated according to response, if multiple doses
required, adrenaline should be given as a slow
intravenous infusion stopping when a response has
been obtained
EMERADE®150 MICROGRAMS
Acute anaphylaxis (for self-administration)
▶BY INTRAMUSCULAR INJECTION
▶Child (body-weight up to 15 kg): 150 micrograms, then
150 micrograms after 5 – 15 minutes as required
▶Child (body-weight 15–30 kg): 150 micrograms, then
150 micrograms after 5 – 15 minutes as required, on the
basis of a dose of 10 micrograms/kg, 300 micrograms
may be more appropriate for some children136 Myocardial ischaemia BNFC 2018 – 2019
Cardiovascular system2