GRI ED
Antidote: Andexanet AlphaCategory: BRecommended Stock:
Current GRI Stock: 12 vials
Location: Emergency Fridge Door
Presentation: acute liver injury, anaemia, haemorrhage, GI upset, dizziness and headache
Antidote List
Antidote: Flumazenil
Category: BRecommended Stock: 5 ampoules
Current GRI Stock: 10 ampoules
Location: Sedation cupboard
Indication: Reduced ventilation and coma that would otherwise need mechanical ventilation.
Presentation: Drowsiness, ataxia, dysarthria and nystagmus.
Antidote: GlucagonCategory: ARecommended Stock: 50 VialsCurrent GRI Stock: 10x1mg injections/20x 1mg injectionsLocation: Main Fridge / Resus FridgeIndication: Severe HypotensionPresentation: Cardiovascular collapse. Lipid soluble also cause CNS effects
Antidote: Atropine
Category: A
Recommended Stock: 10 Ampoules
Current GRI Stock: 10 ampoules/20 ampoules (600mcg) + 4 1mg pens/8 x1mg syringe
Location: IV cupboard 1/resus room/major incident bag
Indication: Bradycardia
Presentation: Cardiovascular collapse. Lipid soluble also cause CNS effects
Antidote: Calcium ChlorideCategory: ARecommended Stock: 6 AmpoulesCurrent GRI Stock: 2 x 10ml syringe
Location: IV Cupboard 2
Indication: Hypotension
Presentation: Hypotension. Bradycardic if verapamil or diltiazem
Antidote: Glucagon
Category: A
Recommended Stock: 50 Vials
Current GRI Stock: 10 x 1 mg injections / 20 x 1mg injections
Location: Main Fridge / Resus Fridge
Indication: Severe Hypotension
Presentation: Hypotension. Bradycardic if verapamil or diltiazem
Antidote: Sodium bicarbonate 8.4%Category: A
Recommended Stock: 3 polyfusers
Current GRI Stock: 10 x 250ml
Location: Resus room
Antidote: Hydroxocobalamin (Cyanokit)Category: A
Recommended Stock: 2 packs
Indication: Moderate/severe poisoning (can cause AKI due to tubular necrosis)
Antidote: Sodium thiosulphateCategory: A
Recommended Stock: 5 ampoules
Current GRI Stock: 2 x 50ml
Location: Shelf L - Emergency cupboard. Cyanide kit on Shelf N
Indication: Mild poisoning or moderate if hydroxycoabalamin not available. Adjunct in severe
Antidote: MesnaCategory: B
Current GRI Stock: Not stocked locally - only used in hours so could be sourced from pharmacy
Indication: Discuss with oncologist
Presentation: Myelosuppression and haemorrhagis cystitis
Antidote: IdarucizumabCategory: B
Recommended Stock: 2 vials
Current GRI Stock: 2 vials
Location: Emergency fridge
Indication: Active bleeding or life-threatening haemorrhage
Antidote: DigifabCategory: B
Recommended Stock: 10 Vials
Current GRI Stock: 10 Vials
Location: Emergency Fridge
Indication: Severe bradycardia or lifethreatening ventricular arrhythmia, refractory severe hyperkalaemia
Presentation: Marked bradycardia, PR and QRS prolongation, AV block
Antidote: Procyclidine injectionCategory: A
Recommended Stock: 5 ampoules
Current GRI Stock: 5 ampoules
Location: IV cupboard 1
Indication: Dystonic reactions
Antidote: FomepazoleCategory: B
Recommended Stock: 25 ampoules
Current GRI Stock: 4x 1.5mg vials
Location: Shelf M - Emergency cupboard
Indication: High anion gap metabolic acidosis or osmolar gap greater than 10 without other likely cause
Presentation: Features of intoxication initially high osmolar gap then falls with rising anion gap (due to production of toxic metabolites)
Antidote: EthanolCategory: B
Current GRI Stock: Not required as fomepazole stocked
Indication: If fomepazole is not immediately available
Presentation: Features of intoxication initially high osmolar gap then falls with rising anion gap (due to production of toxic metabolites)
Antidote: ViperaTAbCategory: A
Recommended Stock: 2 ampoules
Indication: Bites by Vipera berus
Antidote: Macrogol 3350 (polyethylene glycol) Klean-prepRecommended Stock: 12 sachets
Antidote: Protamine sulphateCategory: B
Recommended Stock: 10 ampoules
Current GRI Stock: 10 ampoules
Location: IV cupboard 1
Indication: Evidence of haemorrhage or large amount injected
Antidote: Calcium gluclonateCategory: A
Recommended Stock: 10 ampoules
Current GRI Stock: 20 ampoules
Location: IV cupboard 2/resus room
Indication: Small volume subcutanoues injections around burn site
Presentation: Highly corrosive, pain disproportionate to size of burn. Blue-grey discoloration
Antidote: Calcium gluconate gelCategory: A
Recommended Stock: 1 pack
Current GRI Stock: 2 packs
Location: Cupboard under counter (left)
Indication: Apply repeatedly until pain has ceased
Antidote: DesferrioxamineCategory: B
Recommended Stock: 40 vials
Current GRI Stock: 10 vials
Location: Shelf D - Emergency cupboard
Indication: Give ASAP before waiting for serum iron result if severe poisoning. Give if level >5mg/l and symptomatic. Consider if iron levels rising
Antidote:Macrogel 3350 (Klean-prep)Category: B
Recommended Stock: 12 sachets
Indication: Give ASAP before waiting for serum iron result if severe poisoning. Give if level >5mg/l and symptomatic. Consider if iron levels rising
Antidote: Pyridoxine (high dose injection)Category: B
Recommended Stock: 100 ampoules
Indication: CNS symptoms
Antidote: Intralipid 20%Category: A
Recommended Stock: 1.5 litres
Current GRI Stock: 1 litre
Location: Sedation cupboard
Antidote: MethylthioniniumCategory: A
Recommended Stock: 5 ampoules
Current GRI Stock: 5 ampoules
Location: Sedation cupboard
Antidote: Calcium folinateCategory: B
Recommended Stock: 5 ampoules
Current GRI Stock: 5 ampoules
Location: Emergency fridge
Antidote: FomepazoleCategory: B
Recommended Stock: 25 ampoules
Current GRI Stock: 4x 1.5mg vials
Location: Shelf M - Emergency cupboard
Antidote: Calcium folinateCategory: B
Recommended Stock: 15 ampoules
Current GRI Stock: 5 ampoules
Location: Emergency fridge
Indication: Clinical symptoms of methotrexate toxicity (mucositis, oropharyngeal ulceration) or signs of bone marrow suppression, hepatotoxicity or renal dysfunction. Or if >3mg/kg in 24 hours or unknown dose.
Antidote: DantroleneCategory: B
Recommended Stock: 48 ampoules
Current GRI Stock: 24 vials
Location: Serotonin syndrome bag
Indication: Severe NMS
Presentation: Exposure to dopamine antagonist or agonist withdrawal, hyperthermia, rigidity, raised CK
Antidote: NaloxoneCategory: A
Recommended Stock: 30 ampoules
Current GRI Stock: 10 ampoules
Location: IV cupboard 1
Indication: Respiratory depression
Presentation: Respiratory depression, pin-point pupils
Antidote: AtropineCategory: A
Recommended Stock: 10 ampoules
Current GRI Stock: 10 ampoules
Location: IV cupboard 1/resus room/major incident bag
Indication: If increased secretions, rhinorrhoea, bradycardia, hypotension, bronchorrhoea or bronchospasm. Give every 5 minutes until secretions are minimal
Antidote: AcetylcysteineCategory: A
Recommended Stock: 20 ampoules
Current GRI Stock: 60 ampoules
Location: IV cupboard 1
Indication: If over treatment line or staggered overdose
Antidote: CyproheptadineCategory: B
Recommended Stock: 30 tablets
Current GRI Stock: 30 tablets
Location: Serotonin syndrome bag
Indication: In serious cases. Standard treatment is benzodiazepines and most self resolve within 24 hours
Antidote: Chlorpromazine
Current GRI Stock: 10 ampoules
Location: Serotonin syndrome bag
Indication: Severe cases
Antidote: L-carnitineCategory: B
Indication: Consider in large overdoses with coma, hyperammonaemia or hepatotoxicty or valproate concentration greater than 450mg/l
Antidote: OctreotideCategory: B
Recommended Stock: 5 ampoules
Current GRI Stock: 10 ampoules
Location: Emergency fridge
Indication: Persistent hypoglycaemia despite glucose to suppress endogenous insulin production (non-diabetic or T2DM patients)
Antidote: Sodium bicarbonate 8.4%Category: A
Recommended Stock: 3 polyfusers
Current GRI Stock: 10 x 250ml
Location: Resus room
Indication: Prolonged QRS (infusion amounts on toxbase)
Agent: Sodium bicarbonate 1.4%Category: A
Recommended Stock: 12 polyfusers
Location: Resus room
Indication: e.g salicylates and phenobarbitol. Target pH 7.5-8.5
Antidote: Phytomenadione (vitamin K1)Category: B
Recommended Stock: 2 tables, 10 ampoules
Current GRI Stock: 5 x 2mg ampoules, 10 x 10mg ampoules
Location: IV cupboard 1
Indication: Dose dependent on INR levels and whether there is active bleeding
Antidote: Activated CharcoalCategory: A
Recommended Stock: 7 packs (50g pack)
Current GRI Stock: 8 packs (250ml solution)
Location: Cupboard under counter (left)
Indication: Presentation < 1 hour of ingestion