ICU Drug Guide

Adjunct vasopressor in septic shock to spare noradrenaline dose

Procedural sedation/analgesia, adjunct in ARDS, bronchospasm, sub-dissociative analgesia

Hyperglycaemia in critical illness (target 6–10 mmol/L), DKA management

Raised ICP, hyponatraemia (symptomatic), refractory intracranial hypertension

Raised ICP, cerebral oedema, acute angle-closure glaucoma

Vasopressor-refractory septic shock, adrenal crisis, ARDS (adjunct), post-cardiac surgery vasodilation

Shock-refractory VF/pulseless VT in cardiac arrest; haemodynamically unstable VT; AF with rapid rate not responding to other measures (specialist)

Shock when noradrenaline unavailable (cardiogenic or septic); bradycardia unresponsive to atropine (infusion)

Acute severe/life-threatening asthma not responding to initial treatment; torsades de pointes; hypomagnesaemia

Life-threatening asthma / bronchospasm not responding to salbutamol and ipratropium (ICU/HDU setting)

Neonatal seizures (first-line), status epilepticus second-line where phenytoin/levetiracetam not available

Reversal of benzodiazepine sedation (iatrogenic) in selected patients; NOT routine in benzodiazepine overdose of unknown/mixed ingestion

Organophosphate poisoning (nerve agents / pesticides) with nicotinic toxicity (weakness, fasciculations) - with atropine

Beta-blocker overdose with bradycardia/hypotension; severe hypoglycaemia when no IV access

Reversal of unfractionated heparin effect; partial reversal of LMWH (enoxaparin)

Symptomatic methaemoglobinaemia (SpO2 stuck around 85%, chocolate-brown blood, methaemoglobin above 20-30% or symptomatic)

Acute iron poisoning with systemic toxicity (shock, acidosis, serum iron above approx 90 micromol/L / 500 mcg/dL), or large ingestion with symptoms

PPH treatment when oxytocin is unavailable or has failed; PPH prevention where oxytocin is not available (community/low-resource)

Acute severe hypertension in pregnancy/postpartum (BP 160/110 mmHg or above, sustained 15 min)

Acute severe hypertension in pregnancy/postpartum when labetalol is unavailable or contraindicated

Second-line uterotonic for postpartum haemorrhage when oxytocin fails and no hypertensive disease