Doctor's emergency bag

Analgesia

Suggested analgesics to include in the doctor's bag include:(1)

• diamorphine - this is an effective treatment for adults in severe pain (5mg or 10mg in ampoules for reconstitution with water for injection)
  • in an adult, administered as 1.25-5mg by slow intravenous injection, especially if the patient is shocked or has peripheral vasoconstriction, or 5-10mg subcutaneously or intramuscularly
  • an alternative to diamorphine is morphine (10mg/mL injection; 10mg/5mL oral solution), which can be given subcutaneously (but not if the patient is oedematous) or intramuscularly in a dose of 10mg (15mg for heavier well-muscled patients); by slow (2mg/minute) intravenous injection in a dose of 2.5-7.5mg; or orally in a dose of 5-20mg
  • the controlled drug status of diamorphine and morphine (not oral solutions <13mg/5mL) means, of course, that they must be kept locked in a bag or container and stored in a secure and locked space (i.e. car boot or cupboard), and their use must be recorded in a controlled drugs register
• diclofenac (25mg/ml injection) - administered to adults intramuscularly deep into gluteal muscle; useful for bone pain, ureteric colic, acute back and other musculoskeletal pain. The dose may be repeated after 30 minutes with the second dose administered into the other buttock. An alternative route for diclofenac administration is via suppositories. The maximum adult dose of diclofenac via any route is 150 mg
• paracetamol (500mg tablets and 120mg/5ml paediatric oral solution or suspension)
• ibuprofen (100mg/5ml suspension) - this is also useful for reducing fever in young children

.Opioid overdose (2)

• naloxone - this should be included in the doctor's bag of any GP who may administer diamorphine. If there is an acute opioid overdose (i.e. if there is coma, bradypnoea and pinpoint pupils) in an adult then give 400 micrograms for 1 dose initially , then 800 micrograms for up to 2 doses at 1 minute intervals if no response to preceding dose, then increased to 2 mg for 1 dose if still no response (4 mg dose may be required in seriously poisoned patients). In most cases, the first dose of naloxone should be administered intramuscularly because this avoids rapid, and possibly aggressive arousal, that follows intravenous administration
  • naloxone has a shorter duration of action than many opioids and close monitoring and repeated injections may be necessary, according to the respiratory rate and depth of coma (dose can be repeated every 2-3 minutes up to a maximum of 10mg)
    • if there is still no response after the maximum dose has been given, the diagnosis of opioid overdose should be questioned - note though that the doses of naloxone mentioned may be too low for managing overdose in people who have been taking opioids long term
    • any patient who has had an opioid overdose must be admitted to hospital - this is because repeated naloxone doses, or an infusion may be required

Asthma

If acute asthma: (3)

• initial treatment is beta2-agonist administered via a large volume spacer or nebuliser e.g. salbutamol (1mg/1ml nebuliser solution) 2.5-5mg
• corticosteroid therapy may be indicated in acute asthma. Either prednisolone if patient can swallow or, in acute severe asthma, an intravenous bolus of hydrocortisone (in adults, 100mg powder as sodium succinate for reconstitution) given over at least 60 seconds
• high-flow oxygen should be given whenever possible
• refer to linked management of acute asthma

Infection (4)

• benzylpenicillin (600mg vial for reconstitution with sodium chloride or water for injection) for use in cases of suspected bacterial meningitis
  • if patient is allergic to penicillin then the patient should, in general, receive cefotaxime
  • it is too dangerous to risk using cefotaxime in patients with a history of anaphylaxis due to penicillin; a non-beta-lactam alternative for such individuals is intravenous chloramphenicol
• for uncomplicated pneumonia: amoxicillin or erythromycin if penicillin allergic
  • patients who are fit to be managed at home can be treated with oral antibiotics; patients needing intravenous antibiotics should be admitted to hospital.
• for urinary tract infections: trimethoprim
• for cellulitis or acute skin infections: flucloxacillin plus amoxicillin
• oral cephalosporin may also be carried for use as a second-line drug for urinary tract infections for older people in nursing homes and for severe urinary infections
• aciclovir (800mg tablets), 800mg five times daily for 7 days, is useful for the immediate treatment of herpes zoster in an adult

Nausea and Vomiting (5)

• in adults with vestibular disorders cyclizine (50mg/5ml), either administered intramuscularly or intravenously, can be used; alternatives include prochlorperazine and metoclopramide.
• cyclizine
  • can also be given to reduce the likelihood of opioid-induced vomiting
  • however cyclizine is not recommended if a patient has suffered a myocardial infarct because it causes peripheral vasoconstriction (counteracting the haemodynamic effect of opioids). In this situation a better choice is metoclopramide
• domperidone (10mg tablets) is a useful antiemetic
  • has the advantage over metoclopramide and prochlorperazine of being less likely to cause dystonia
  • also used to treat women with vomiting due to emergency hormonal contraception
  • Note - the maximum daily dose of domperidone is limited to 30 mg (10 mg up to three times daily) for adults and adolescents aged 12 and older weighing 35 kg or more, usually limited to a maximum of one week. In 2014, the UK MHRA restricted domperidone use and reclassified it to a prescription-only medicine due to a small increased risk of serious cardiac side effects, including QT prolongation and ventricular arrhythmias.
• metoclopramide and prochlorperazine are alternative antiemetics
  • can cause acute dystonia including oculogyric crisis, particularly in young and elderly people. This effect can be reversed by procyclidine (5mg/mL injection). A dose of 5-10mg (occasionally more than 10mg), given intramuscularly or intravenously, is usually effective in 5-10 minutes but may take up to 30 minutes to provide relief
  • Note - metoclopramide treatment is restricted to a maximum duration of 5 days due to a significant risk of serious neurological adverse effects. Adults are limited to a maximum of 30 mg per 24 hours (usually 10 mg three times daily)

Psychiatric emergencies (6)

• if acutely anxious, agitated or psychotic adult, establishing a good rapport and attempting to calm them down are more appropriate emergency measures than giving medication
  • if there are any concerns about personal safety, the GP should not attend the patient alone
  • if medication for reducing anxiety or agitation is considered necessary, it should be given by mouth wherever possible, rather than by injection
    • if parenteral treatment (i.e. for rapid tranquillisation) is necessary, the intramuscular route is safer than the intravenous route
    • oral treatment options include:
      • haloperidol (1.5mg tablets) 1.5-5mg, or,
      • lorazepam (1mg tablets) 1-2mg
      • doses depend on the weight of the patient and the degree of psychiatric disturbance
  • a patient who is very agitated, hyperactive or violent can be given 2-10mg of haloperidol (5mg/mL injection) intramuscularly or 1-2mg of lorazepam (4mg/mL injection) intramuscularly
    • haloperidol, chlorpromazine, metoclopramide and prochlorperazine can cause oculogyric crisis or acute dystonia (especially in young and very old people) and this can be reversed by procyclidine (5mg/5ml) 5-10mg dose in an adult given intramuscularly, and repeated after 20 minutes if symptoms persist
  • for a patient with acute agitation due to organic disease, treatment with lorazepam 1-2mg orally is reasonable
    • dose depends on the patient's size and degree of agitation
    • if the patient is too agitated to take drugs by mouth, then parenteral lorazepam should be given.
    • if respiratory depression occurs (though unlikely with the intramuscular doses recommended), it can be quickly reversed by giving flumazenil
    • flumazenil is contraindicated in patients with life-threatening conditions that are controlled by benzodiazepines (e.g. raised intracranial pressure or status epilepticus)
    • patients with benzodiazepine-induced respiratory depression should be admitted to hospital.

Bleeding

• sodium chloride infusion (0.9%, 500mL) with a giving set and intravenous cannula - this facilitates fluid volume replacement in patients with severe bleeding
• if severe bleeding after a delivery or incomplete miscarriage
  • syntometrine given intramuscularly (intravenous use no longer recommended), will often stop the bleeding after a delivery or an incomplete miscarriage

Dehydration

• oral rehydration salts

Diabetic emergencies (7)

• glucose for hypoglycaemia - available as an oral gel in a dispenser (Glucogel)
• glucagon (1mg/ml injection) is useful if glucose ineffective or impossible to administer
  • if an adult patient does not respond to glucagon after 10 minutes, or those who have been hypoglycaemic for some time and may have exhausted their supplies of liver glycogen, up to 50mL of intravenous glucose solution (20% intravenous infusion) should be given into a large vein through a large-gauge needle
  • if the hypoglycaemia has been caused by an oral antidiabetic drug or an insulin overdose, the patient should be transferred to hospital

Anaphylaxis (8)

• airway should be secured and to help restore blood pressure, the patient should be laid supine with the feet raised above the level of the head
• epinephrine (adrenaline) (1mg/mL ampoules, i.e. 1:1000)
  • should be given intramuscularly for anaphylaxis or acute angio-oedema with threatened airway obstruction
• chlorphenamine (chlorpheniramine) (10mg/mL injection)

Seizures: (9)

• drug of choice for the initial management of status epilepticus in adults is lorazepam (4mg/mL injection) 4mg by slow intravenous injection into a large vein
• rectal diazepam is an alternative for prolonged or serial seizures and for status epilepticus in adults
• midazolam given by the buccal route (e.g. via a syringe) may be more acceptable to some patients

Myocardial infarction:(10)

• aspirin (300mg soluble tablets)
• diamorphine for analgesia
  • diamorphine should not be injected intramuscularly in patients with myocardial infarction because this may delay the analgesic effect and be ineffective in a patient with shock. It may also increase the risk of local bleeding into the muscle if the patient is subsequently given a thrombolytic drug
• atropine (600mcg/mL), 300mcg intravenously increasing to 1mg as necessary, should be administered if the patient has bradycardia (pulse rate < 50 beats per minute) plus hypotension (systolic blood pressure < 90 mmHg)
• glyceryl nitrate spray

( Some GPs have previously administered thrombolytic therapy in patients with clinical and ECG evidence of acute myocardial infarction to ensure that this treatment is given as soon as possible. However, primary percutaneous coronary intervention (PCI) is now the preferred coronary reperfusion strategy for adults with acute ST-segment-elevation myocardial infarction (STEMI) presenting within 12 hours of symptom onset.)

Left heart failure (11)

• furosemide (frusemide) (10mg/mL injection) 20-50mg should be given
• diamorphine (5mg powder for reconstitution with water for injection) should be given (with an antiemetic) by slow intravenous injection (1mg/minute) in a dose of 2.5-5mg for symptomatic relief in acute left ventricular failure
• glyceryl trinitrate can help to relieve pulmonary oedema in acute left ventricular failure

To relieve pulmonary oedema, furosemide* (10mg/mL injection) 20-50mg should be given by slow intravenous injection.

Hypoadrenalism

• acute hypoadrenalism (resulting in shock and hypotension) is likely to require hospital admission for intravenous fluids and regular parenteral hydrocortisone. In an adult, hydrocortisone 100mg by slow intravenous or intramuscular injection provides adequate circulating corticosteroid levels for any severe stress only for a period of 4-6 hours
• patients who have had a hypoadrenal crisis requiring parenteral therapy should be admitted to hospital in all but the mildest cases

Please note that summary of product characteristics must be consulted before prescribing any drug mentioned.

Reference

1. NICE; BNF; Treatment summaries; Analgesics. (online 2026)
2. Royal College of Emergency Medicine. Guideline for the Assessment and Management of Acute Opioid Toxicity in Adults in the Emergency Department. Last revised April 2024.
3. NICE. Asthma: diagnosis, monitoring and chronic asthma management (BTS, NICE, SIGN). NICE guideline NG245. Published November 2024
4. RCGP. Summary of antimicrobial prescribing guidance - managing common infections. Version 1.2, September 2024
5. NICE; BNFC; Treatment summaries - Nausea and labyrinth disorders. (online 2026)
6. Dorrian S. RCEM Learning. Disturbed or Psychiatric Patients in the ED. Last reviewed July 2025
7. NICE; BNF; Treatment summaries - diabetic hyperglycaemic emergencies. (online 2026)
8. NICE. Anaphylaxis: assessment and referral after emergency treatment. NICE guideline NG258. Published May 2026
9. NICE. Epilepsies in children, young people and adults. NICE guideline NG217. Published April 2022, last updated August 2026
10. NICE. Acute coronary syndromes. NICE guideline NG185. Published November 2020
11. NICE. Acute heart failure: diagnosis and management. Clinical guideline CG187. Published October 2014, last updated November 2021