Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

StJA(WA) > Occasional drugs > Flashcards

Occasional drugs Flashcards

1
Q

CophenylcainePresentation

A

Topical pump spray containing:
Lignocaine hydrochloride 50mg/ml
Phenylephrine 5mg/ml

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Cophenylcaine
Use

A
  • Local pain: abrasions, small cuts and wounds
  • Relief of mild and moderate epistaxis
  • Post tonsillectomy haemorrhage
  • Intra-oral haemorrhage
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Cophenylcaine
Type

A

topical local anaesthetic and haemorrhage control agent for the relief of surface pain, nasal and oral bleeding..

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Cophenylcaine
Actions(just definition, no onset or mechanism)

A

Topical local anaesthetic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Cophenylcaine
Contraindications

A
  • Hypersensitivity to phenylephrine, lignocaine or other anaesthetics
  • Children <2yrs- Pregnancy.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Cophenylcaine
Adverse effects

A

Oral administration may cause a Transient bitter taste.
Pause between subsequent oses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Cophenylcaine
Precautions

A
  • Used with caution in patients with cardiovascular, hepatic and/or renal disease.
  • For oral use, nozzle inserted within the anterior 1/3 of mouth to avoid gag stimulation.
  • Each spray delivers 100 microlitres of fluid. The dose of lignocaine in each squirt is 5 mg and the dose of phenylephrine in each squirt is 0.5mg.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Glucose gel
Presentation

A

15g glucose gel in tube.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Glucose gel
Use

A

Demonstrated hypoglycaemia in:
- Altered conscious state in a known Diabetic.
- Altered conscious state of unknown medical cause, where blood glucose level is below 4mmol/L.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Glucose gel
Type

A

Rapidly absorbed from oral/buccal mucosa to increase blood glucose concentration.
Contains 15g glucose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Glucose gel
Actions(inc onset & offset

A
  • Onset 2-5 minutes, duration 12-25 minutes.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Glucose gel
Contraindications

A

Nil.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Glucose gel
Adverse effects

A
  • Airway obstruction.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Glucose gel
Precautions

A

ve patient’s airway patent and in lateral position if unconscious.
- Always consider patient’s airway when administering gel.
- Even if fully recovered, patients should be encouraged to be transported to a medical facility to ensure effective follow up and review.Will liquefy over 30°C, however it is still useable..

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Adrenaline
Presentation

A

1mg in 1ml (1:1000)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Adrenaline
Use

A

Anaphylaxis
Life-threatening asthma
Severe croup
Cardiac Arrest
Post ROSC.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Adrenaline
Type

A

A naturally occurring sympathomimetic agent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Adrenaline
Dose
Cardiac Arrest /Post ROSC
Adult
Inc repeats and preparation

A

Cardiac Arrest
Adult:1mg IV/IO every 3-5 minutes

Post ROSC
Dilute 1mg Adrenaline in 9ml normal saline (1000 mcg in 10mls, 1:10,000)

Adult:50 mcg (0.5ml) every 3-5 min as required to maintain systolic blood pressure >90mmHg

Titrate Adrenaline as required, to achieve and / or maintain the SBP requirements as listed above.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Adrenaline
ActionsInc mechanism Inc onset and peak duration for IM & IV

A

Causes peripheral vasoconstriction
Stimulation of cardiac conduction system causes increased contractions
Causes bronchodilation and dilation of blood vessels in muscles.

IV/IO: Onset 30 seconds, half-life 5 minutes, duration 5-10 minutes
IM: Onset 60 seconds, half-life 5 minutes, duration 5-10 minutes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Adrenaline
Contraindications

A

There are no absolute contraindications for adrenaline.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Adrenaline
Adverse effects

A

Tachyarrhythmias, palpitations
Hypertension
Pupil dilation
Tremor
Anxiety

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Adrenaline
Precautions

A

Ischaemic Heart Disease
Hypertension
Hypovolemia
Do not walk patient pre/post IM adrenaline administration in anaphylaxis - usually a minimum of 1 hour after one dose and 4 hrs if more than 1 dose of adrenaline given
If given IV into a peripheral vein, follow each dose with a sodium chloride flush

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Atropine
Presentation

A
  • 1.2mg in 1ml plastic vial.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Atropine
Use

A
  • Symptomatic Bradycardia, haemodynamically unstable due to the bradycardia and associated with poor signs of perfusion, including:
    o Hypotension
    o Altered conscious state
    o Diaphoresis
    o Shortness of breath, and/or cyanosis
    o Syncope-
    Organophosphate poisoning with cholinergic effects
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Atropine
Type(full definition)

A

-anticholinergic agent that inhibits the action of acetylcholine on post ganglionic nerves at the neuroeffector site. This blocks vagal stimulation to allow the sympathetic response to increase pulse rate by increasing SA node firing rate, and increasing the conduction velocity through the AV node.
- An antidote to reverse the effects of cholinesterase inhibitors such as seen with organophosphate poisoning..

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Atropine
Actions

A

.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Atropine
Contraindications

A

.- Known hypersensitivity.
- Patients with cardiac transplant.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Atropine
Adverse effects

A
  • Tachycardia and/or palpitations
  • Dilated pupils and/or blurred vision
  • Dry mouth and/or urinary retention
  • Confusion, restlessness (large doses)
  • Hot, dry skin (large doses).
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Atropine
Precautions

A

May not be effective in patients with 3rd degree AV block
- Isolated Bradycardia or link to traumatic cause is not an indication for atropine. All reversible causes should be addressed prior to consideration of Atropine.
- It is advisable that a 12 Lead ECG is conducted prior to medication administration to rule out Acute Myocardial Infarction (STEMI) and Third-degree atrioventricular (AV) block.
o If in doubt transmit 12-lead ECG to CSP SOC to discuss, or seek ASMA advice.
- Bradycardia in children is usually a result of hypoxia or vagal stimulation. Ensure all reversible causes addressed and consider commencing resuscitation as per CPG if unresponsive.
- Atropine may affect patients with glaucoma.
- The maximum dose of Atropine that has shown to produce the desired effect in healthy adults is up to 3mg for bradycardia.
In organophosphate poisoning: atropinisation might require significant repeat dosages and is achieved when with an increased HR, dilated pupils and decreased secretion, do not delay transport as atropinisation might not be achievable in the pre-hospital setting..

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Glucagon
Presentation

A

1mg in 1ml vial, accompanied by diluent for injection.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Glucagon
Use

A

For demonstrated hypoglycaemia where oral glucose cannot be administered and IV access cannot be obtained in a safe and timely manner.
- Altered conscious state in a known diabetic or of otherwise unknown cause where blood glucose level is below 4mmol/L..

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Glucagon
Type

A
  • A hyperglycaemic agent that converts stored liver glycogen to glucose to increase blood glucose concentration..
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Glucagon
Actions(just onset & duration)

A
  • Onset 4-7 minutes, duration 10-30 minute.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Glucagon
Contraindications

A
  • Hypersensitivity.
  • Known pheochromocytoma.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Glucagon
Adverse effects

A
  • Nausea/vomiting
  • Gastric pain
  • Transient rise of blood pressure for patients taking beta blockers..
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Glucagon
Precautions

A
  • Glucagon is effective in treating hypoglycaemia only if sufficient liver glycogen is present (eg: it does not work on alcohol or anorexia induced hypoglycaemia).
  • Even if fully recovered, patients should be encouraged to be transported to a medical facility to ensure effective follow up and review.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Glucose IV
Presentation (size and composition)

A

500ml bag 10% glucose (10g per 100ml).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Glucose IV
Use

A

Demonstrated hypoglycaemia where oral glucose administration is inappropriate in:- Altered conscious state in known diabetic or of otherwise unknown cause where blood glucose level is below 4mmol/L.
- Cardiac arrest, only if hypoglycaemia is suspected as a contributory cause of the arrest, not an early indication..

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Glucose IV
Type
(onset and contents)

A

hypertonic crystalloid solution that provides a readily available source of energy (Glucose).
onset within 1 minute
contains 100mg glucose anhydrous/ml

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Glucose IV
Actions (just onset)

A
  • Onset within 1 minute.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Glucose IV
Contraindications

A
  • Not to be used if there is no patent IV access.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Glucose IV
Adverse effects

A
  • Hyperglycaemia
  • Diuresis
  • Tissue necrosis
  • Thrombophlebitis.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Glucose IV
Precautions

A
  • Patients should ideally be cannulated with a large gauge cannula into a large vein, with patency confirmed with a free flowing bolus (>20ml) of 0.9% normal saline, before administering glucose 10% using a 20ml syringe via the injection port, titrated to effect. Administration via an IO should utilise a 20ml syringe and a three way tap.
  • High concentration of IV glucose may aggravate dehydration due to its hypertonicity whereby it draws water from the cells.
  • IV glucose is corrosive and IV patency must be ensured before administration.
  • Careful titration of glucose in head injured patients is vital as glucose leaking into CNS tissue will aggravate the injury, resulting in cerebral oedema.
  • Monitor blood glucose level carefully; beware of drop in level again after the patient has recovered.
  • Even if fully recovered, patients should be encouraged to be transported to a medical facility to ensure effective follow up and review.
  • IO administration is only as a last resort after all other avenues have been exhausted and the patient needs lifesaving glucose.
  • Do not wait on scene for glucose to take effect..
  • Note that repeat doses of Glucose 10% (Intravenous) may need to be repeated to achieve normoglycaemia.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Heparin
Presentation

A

Ampoule of 5,000 international units (IU) in 5mL.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Heparin
Use

A
  • Patients with STEMI going directly to Cardiac Catheterisation Laboratory as per receiving hospital 12-lead ECG interpretation..
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Heparin
Type

A

naturally occurring anticoagulant which inhibits the clotting of blood by enhancing the rate at which antithrombin III neutralises thrombin and activated factor X (Xa)..

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Heparin
Actions(just onset)

A
  • Onset of action is immediate following IV administration..
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Heparin
Contraindications

A
  • Hypersensitivity to Heparin
  • Presence of known haemorrhagic states.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Heparin
Adverse effects

A
  • Haemorrhage.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Heparin
Precautions

A
  • Haemorrhagic risks in case of possible traum.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Ipratropium bromide
Presentation

A

250mcg in 1ml nebule
20mcg per puff MDI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Ipratropium bromide
Use

A

Severe bronchospasm:
Adult:
- Severe to life-threatening asthma or COPD
Paediatric:
- Severe to life-threatening asthma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Ipratropium bromide
Type

A

anticholinergic bronchodilator. It inhibits the vagal reflexes that mediate bronchospasm..

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Ipratropium bromide
Actions

A
  • Combined with a nebulised short acting beta-2 agonist (Salbutamol), Ipratropium bromide produces significantly greater bronchodilation than a beta-2 agonist alone.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Ipratropium bromide
Contraindications

A
  • Hypersensitivity.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Ipratropium bromide
Adverse effects

A
  • Headache.
  • Nausea, dizziness
  • Dry Mouth, throat irritation
  • Taste disturbance
  • Skin rash
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Ipratropium bromide
Precautions

A
  • Glaucoma
  • Avoid contact with eyes..
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Ketamine
Presentation

A

Oral administration:
25mg sublingual wafer
Intravenous/intraosseous administration:
200mg in 2mL.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Ketamine
Use

A

IV: Second line agent for severe pain of traumatic origin post IV Fentanyl administration. ASMA consult needed if IV Fentanyl minimum dose (age dependent as per CPG) has not been given prior to IV Ketamine administration.
IM: First line agent for severe pain of traumatic origin should other means of administering pain medication not be available
Combative Traumatic Brain Injury
Paramedic only - (RASS 4) First line agent for severely disturbed or abnormal behaviour where there is an immediate risk to safety and rapid tranquilisation is required and no other sedative medications have already been administered to this patient

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

Ketamine
Type

A
  • Rapid acting dissociative anaesthetic.
    Use of a sedative agent should never be considered routine.Have a high threshold to offer or administer
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Ketamine
Actions(onsets)

A
  • IM onset: 5-10 minutes
  • IV onset: 1 minute.
62
Q

Ketamine
Contraindications

A
  • Hypersensitivity
  • Active cardiovascular disease including cardiac chest pain, heart failure, severe or poorly controlled hypertension
  • Patients with delayed transfer of care (i.e. ‘ramped’)
  • Disturbed and abnormal behaviour CLEARLY not RASS 4 or where other sedative agents have already been administered (ASMA authority required)
  • Rapid tranquilisation only: age <16
  • Age <1 Year of age
63
Q

Ketamine
Adverse effects

A
  • Blood pressure and pulse frequently elevated
  • Random purposeless movements, muscle twitching and rash are common
  • Hypersalivation
  • Emergence reactions (10%)
  • Transient laryngospasm
  • Transient apnoea or respiratory depression.
64
Q

Ketamine
Precautions

A

Psychiatric, thyroid, min dose, opiod-dependent, sedation warnings
Used with caution in patients with stable psychiatric disorders such as Schizophrenia
Use with caution in patients with hyperthyroidism or receiving thyroid replacement due to increased risk of hypertension and tachycardia.
Analgesia - IV Fentanyl minimum dose (age dependant as per CPG) should be given prior to IV Ketamine administration
Analgesia for non-traumatic pain in opioid-dependent patients - consider SOC CSP consult

Sedation warnings

65
Q

Lignocaine
Presentation

A

20mg/2ml OR 50mg/5mL; (both 1%) in a plastic ampoule.

66
Q

Lignocaine
Use

A

Local anaesthesia for:
- IV cannulation
- IO infusion
- Suturing
- Finger thoracostomy in the conscious patient.

67
Q

Lignocaine
Type

A

Reversible interrupt impulse conduction in peripheral nerves and stabilise excitable cell membranes by blocking sodium channels

68
Q

Lignocaine
Actions

A
  • Onset 1-2 minutes.
69
Q

Lignocaine
Contraindications

A
  • Hypersensitivity
70
Q

Lignocaine
Adverse effects

A
  • Tinnitus, dizziness, anxiety, confusion, perioral numbness
  • Cardiovascular effects: Bradycardia, hypotension, dysrhythmias
  • CNS effects
  • Respiratory depression.
71
Q

Lignocaine
Precautions

A
  • Adverse drug reactions are rare when lignocaine is used as a local anaesthetic and is administered correctl.
72
Q

Midazolam
Presentation

A

15mg in 3mls (5mg/ml).

73
Q

Midazolam
Use

A

Prolonged seizure activity - generalised seizure lasting ≥ 5 minutes OR recurrent / status seizure activity as per CPG
Focal seizure activity which is prolonged (≥ 5 minutes) and is associated with a GCS ≤ 12 as per CPG
Second-line IV agent for maintenance of sedation after Droperidol administration for Disturbed and/or Abnormal Behaviour

74
Q

Midazolam
Type

A

water-soluble benzodiazepine that has anxiolytic, sedative and anticonvulsive characteristics. This is due to its bonding with receptors in the CNS; its action to increase the inhibitory effect of the g-aminobutyric acid (GABA) neurotransmitter on the GABA receptors and subsequent membrane threshold.

75
Q

Midazolam
Actions

A

This is due to its bonding with receptors in the CNS; its action to increase the inhibitory effect of the g-aminobutyric acid (GABA) neurotransmitter on the GABA receptors and subsequent membrane threshold.
- Midazolam is lipid-soluble in physiological pH and it reaches the CNS quickly.
Use of a sedative agent should never be considered routine. Have a high threshold to offer or administer

76
Q

Midazolam
Contraindications

A

Hypersensitivity
Use of Midazolam for sedation after Ketamine requires ASMA authority

77
Q

Midazolam
Adverse effects

A
  • Respiratory depression
  • Hypotension
  • Anterograde and retrograde amnesia
  • Myasthenia Gravis.
78
Q

Midazolam
Precautions

A

Early monitoring as soon as practicable is required when administering midazolam; including SpO2, respiratory rate, pulse and blood pressure
SpO2 and EtCO2 monitoring must be applied whenever level of consciousness drops consistent with the Sedative Warnings section below.
Psychostimulants, in toxic levels can produce severe agitation and psychotic behaviour
Paediatric patients:
Intramuscular administrations should always be prepared in a 1mL IM syringe
Have a low threshold to consult with ASMA when repeat or maintenance doses are required for sedation
Sedation warning

79
Q

Naloxone
Presentation

A

0.4mg (400mcg) in 1ml vial.

80
Q

Naloxone
Use

A
  • Reversal of respiratory depression in a suspected narcotic overdose.
81
Q

Naloxone
Type

A
  • Naloxone is a pure opioid antagonist .
82
Q

Naloxone
Actions

A

.exerts its effect by competitive inhibition at the opioid receptor sites. It prevents or reverses the effects of opioids, including respiratory depression, sedation and hypotension. In the absence of opioids it exhibits essentially no pharmacological activity.

83
Q

Naloxone
Contraindications

A

Hypersensitivity to Naloxone

84
Q

Naloxone
Adverse effects

A

Withdrawal symptoms such as:
- Aggression
- Agitation
- Nausea/vomiting
- Dilated pupils and lacrimation.

85
Q

Naloxone
Precautions

A

Polypharmacy overdose.
Naloxone half-life may be less than that of a longer acting opioids (e.g. methadone, diphenoxylate, codeine).
Response to Naloxone is rapid, reconsider diagnosis if there is a failure to respond to 2mg Naloxone.
Patients may be aggressive post Naloxone and administration due to hypoxia.
Scene safety and personal safety are paramount.

86
Q

Prednisolone
Presentation

A

30mL of 25mg in 5mL suspension of Redipred.

87
Q

Prednisolone
Use

A
  • Mild / Moderate croup
  • Severe croup after nebulised Adrenaline administration.
88
Q

Prednisolone
Type

A

Redipred 30mL elixir for oral administation

89
Q

Prednisolone
Actions

A
  • Prednisolone is a steroid. It prevents the release of inflammatory mediators.
    Peak effect within 1hr
90
Q

Prednisolone
Contraindications

A
  • Known hypersensitivity to corticosteroids
  • Live virus immunisation within last 48 hours (e.g. MMR, Chicken Pox, Yellow Fever).
91
Q

Prednisolone
Adverse effects

A
  • Side effects occur following prolonged use and are of little consequence in an emergency setting
  • Vomiting.
92
Q

Prednisolone
Precautions

A
  • 30ml Bottle is single patient use only
  • Children who are on immunosuppressant drugs are more susceptible to infections than healthy children, e.g.: Chicken pox and measles
  • Impaired immune responsiveness.
93
Q

Salbutamol
Presentation

A
  • Salbutamol nebules5mg in 2.5mL
  • Metered Dose Inhaler (MDI)100mcg per puff.
94
Q

Salbutamol
Use

A

Bronchospasm and respiratory distress associated with wheeze:
- Acute Bronchial Asthma
- Severe allergic / anaphylactic reactions
- Acute Pulmonary Oedema of non-cardiac origin
- Bronchitis
- COPD
- Smoke inhalation
- Salt Water Aspiration Syndrome (SCUBA divers).

95
Q

Salbutamol
Type

A

.- Short acting Beta 2 agonist that causes relaxation of bronchial smooth muscle (bronchodilation

96
Q

Salbutamol
Actions (just onset & Max)

A

Onset: 2-5 minutes maximum by 10 minutes.

97
Q

Salbutamol
Contraindications

A
  • Known hypersensitivity to Salbutamol
  • Cardiogenic Pulmonary Oedema
  • Age <12 months
98
Q

Salbutamol
Adverse effects

A
  • Muscle tremor
  • Tachycardia, palpitations
  • Headache
99
Q

Salbutamol
Precautions

A

.spacer / MDI is the preferred route for Salbutamol administration where the patient presents with influenza like illness.
- The use of a Multi Dose Inhaler (MDI) and spacer is equally as effective as nebulisation, in all asthma situations, where the patient is still able to adequately inhale.
- Use of a nebuliser is recommended where the patient loses this ability.
- If hypoxic, nebulise Salbutamol in preference to MDI, to address both hypoxia and bronchospasm. The nebulised route also makes it possible to administer Ipratropium Bromide simultaneously.

100
Q

Amiodarone
Presentation

A

150mg in a 3ml ampoule.

101
Q

Amiodarone
Use

A

Cardiac Arrest with persistent/shock resistant Ventricular Fibrillation/pulseless Ventricular Tachycardia, post 3rd shock(ANZCOR 2016).

102
Q

Amiodarone
Type

A

Amiodarone has effects within the first four classes of the Vaughan-Williams classification. However it is primarily classified as a Class III antidysrhythmic agent that prolongs the action potential duration and hence the refractory period of atrial, nodal and ventricular tissue. It has characteristics of all Vaughan-Williams classes of antidysrhythmics.

103
Q

Amiodarone
Dose

Adult

A

Cardiac Arrest
Adult:300mg in 6ml IV/IO as soon as practicable after 3rd shock
Repeat dose of 150mg in 3ml may be administered after 5th shock

104
Q

Amiodarone
Dose
Paed

A

Cardiac Arrest

Paediatric / Infant:5mg/kg IV/IO (to maximum 300mg) as soon as practicable after 3rd shock
Repeat 5mg/kg IV/IO (to maximum 150mg) after 5th shock

105
Q

Amiodarone
Actions

A

Immediate onset, peak <10min, duration 30-60mins.

106
Q

Amiodarone
Contraindications

A

No contraindications in cardiac arrest
Not compatible with Saline (if infusion dose is advocated by a specifically authorised person)

107
Q

Amiodarone
Adverse effects

A

Bradycardia
Hypotension
Polymorphic tachycardias
Nausea
Tremor
Dizziness
Paraesthesia
Headaches.

108
Q

Amiodarone
Precautions

A

Heart failure
Thyroid dysfunction
Amiodarone is only indicated for shock resistant or recurrent VF / pulseless VT
MUST NOT be diluted into NaCl (e.g. if infusion doses are advised via ASMA / CSP).

109
Q

Presentation - Hydrocortisone

A

Vial: 100mg in 2mL (powder for reconstitution)

110
Q

Use - Hydrocortisone

A

Patients with known adrenal insufficiency who are symptomatic of adrenal crisis

111
Q

Type - Hydrocortisone

A

n adrenocortical steroid that produces an anti-inflammatory process.

112
Q

Contraindications - Hydrocortisone

A

Known hypersensitivity

113
Q

Adverse effects - Hydrocortisone

A

Tachycardia

114
Q

Actions - Hydrocortisone

A

This inhibits the accumulation of inflammatory cells at inflammation sites, phagocytosis, lysosomal enzyme release and synthesis and/or release of mediators of inflammation. Additionally, it prevents and suppresses cell mediated immune reactions.

115
Q

Precautions - Hydrocortisone

A

Hypertension
The specific method of preparing hydrocortisone for injection can be found here.
Rarely, patients in adrenal crisis may present with severe psychosis

116
Q

Presentation - Droperidol

A

.10mg/2ml (equivalent to 5mg/ml)

117
Q

Use - Droperidol

A

Disturbed and Abnormal Behaviour (RASS 1 ~ 3) if considered appropriate where risk to safety is evident and de-escalation has not been effective.
Dementia and frail patients where Olanzapine cannot be administered or is ineffective.

118
Q

Type - Droperidol

A

neuroleptic, antipsychotic agent that acts on Alpha and Dopamine receptors, resulting in sedation

119
Q

Actions - DroperidolInc onset and offset

A

Onset of effect usually 3-5 mins both IM and IV
Use of a sedative agent should never be considered routine. Have a high threshold to offer or administer.

120
Q

Contraindications - Droperidol

A

Known allergy
Known Parkinson’s Disease
Where Ketamine has been administered to sedate this episode
Age < 6 years old
Post-ictal Disturbed & Abnormal Behaviour

121
Q

Adverse effects - Droperidol

A

Extrapyramidal effects / Dyskinesia
Increased falls risk
Hypotension
Apply monitoring as soon as practicable

122
Q

Precautions - Droperidol

A

Organic, post-ROSC, dementia, delirium, sedation warnings
Address organic causes for behavioural presentations at all times- eg. CVA, TBI, Hypoxia, Hypoglycaemia, etc
Post-ROSC agitation - consult ASMA / SOC CSP
Dementia patients – apply caution. Use lower doses
‘Agitated or Excited Delirium’, ‘Acute Behavioural Disturbance’ and ‘Drug Induced Psychosis’ are some alternative terms that may be used by other agencies
Sedation warnings

123
Q

Use - TXA

A

Significant trauma (< 3 hours) with signs of hypovolaemia or
Significant active haemorrhage that requires the use of
o Tourniquet/s
o Haemostatic/pressure dressing/s
Suspected head injury (< 3hours) with GCS motor score of 4 (withdrawing from pain) or below
Severe Primary or Secondary Post-Partum Haemorrhage (> 1000 mL) or PPH with signs of hypovolaemia (birth/bleed occurred < 3hrs)
Significant post-tonsillectomy haemorrhage

124
Q

Presentation - TXA

A

1g Tranexamic Acid in 10ml vial (100mg/ml).

125
Q

Type - TXA

A

Antifibrinolytic
Tranexamic Acid (TXA) is a synthetic derivative of the amino acid lysine that inhibits fibrinolysis (clot breakdown) by blocking the lysine binding site on plasminogen, competitively inhibiting the activation of plasminogen to plasmin.
Hepatic metabolism with renal excretion

126
Q

Actions - TXA

A

Onset: Within minutes
Duration: 17 hours
Half-life: 3 hours

127
Q

Contraindications - TXA

A

Known hypersensitivity to Tranexamic Acid.
Injury time more than 3 hours (associated with increase in mortality).

128
Q

Adverse effects - TXA

A

Hypotension (fast infusion rate)
Headache
Dizziness
Convulsions (lowers seizure threshold)
Nausea and/or vomiting
Diarrhoea

129
Q

Precautions - TXA

A

TXA administration in the traumatic patient in the metropolitan area should ordinarily prompt transport to a major trauma centre
Rapid administration may lead to hypotension and dizziness.
No medications or blood products (except 0.9% Sodium Chloride Solution) should be added or co-administered through the same giving set.
Give as early as possible post event. Survival benefit is reduced by 10% for every fifteen minute delay with no benefit seen after 3 hours
Address critical interventions (airway management, control of major haemorrhage etc.) before administration of tranexamic acid.
Tranexamic acid administration should not delay transfer, noting it may be administered en route.
Slow IV push is the first line management option.
TXA can be given via an infusion, however, familiarity in using infusions and availability of an appropriate label to identify the infusion should dictate if this option is utilised.
Safety during pregnancy has not been demonstrated, but the balance of risk is such that it should be administered if the indications are met in life threatening circumstances

130
Q

Dose - Cophenylcaine
Adult & paed & neonate

A

Adult:

Intranasal: Max 10 squirts (5 squirts per nostril)
Topically: Max 5 squirts
Oral use: 1 spray then pause, repeat if required to max. 5 sprays.
Paediatric:

Intranasal:
2-4 years: 1 squirt per nostril
4-8 years: 2 squirts per nostril
8-12 years: 3 squirts per nostril
Topically: Max 5 squirts
Oral use: 1 spray then pause, repeat if required to max. 5 sprays.
Maximum dosages should not be administered more than once in 24 hours.

131
Q

Dose - Glucose Gel
Adult & Paed & Neonate

A

Adult:

Squeeze contents of tube (or as much as practical) into lower cheek pouch over gums/cheek and externally massage cheek.
Repeat after 10 minutes if still altered consciousness or deteriorating.
Child:

Administer small amounts of oral glucose gel into lower cheek pouch over gums/cheek and externally massage cheek.
Repeat after 10 minutes if still altered consciousness or deteriorating.
Do not delay transport.
Neonate/Infant:

Process for buccal administration of oral glucose gel:
Wearing a clean glove, gently dry the infant’s buccal mucosa with gauze/pad.
Place a small amount of oral glucose gel onto gloved finger and gently massage into the infants buccal mucosa.
DO NOT administer the gel directly from the tube into the infants mouth.
Use only a portion of the tube, titrate to effect.
Repeat as necessary after 10 minutes if still altered consciousness or deteriorating.
Do not delay transport.

132
Q

Dose - Glucose 10%
Adult & paed & neonate

A

Adult:

15 g (150 mL) IV
If BGL < 4 mmol/L after 5-10 minutes, give 10 g (100 mL) IV titrating to effect
Paediatric:

2 mL/kg (0.20g/kg or 200mg/kg) up to 15 g (150 mL) IV/IO
If BGL < 4 mmol/L after 5-10 minutes, give 0.2 g/kg IV/IO titrating to effect
Newborn:

2 mL/kg (0.20 g/kg or 200 mg/kg)
Repeat once only, if clinically indicated (BGL <2 mmol/L)

133
Q

Dose - Glucagon
Adult & paed
(inc repeats)
(inc age for adult dose)

A

Intramuscular injection into deltoid muscle or mid-lateral thigh

Adult:

1mg in 1ml IM.
Repeat IM Glucagon after 10 minutes if unable to obtain IV access and patient still has inadequate GCS and blood glucose level.
Paediatric:

<5 years: 0.5mg in 0.5ml
6-12 years: 1.0mg in 1.0ml
Single dose only

134
Q

Dose - Adrenaline
CA - Adult & Paed

A

Adult:

1 mg IV/IO, repeat every 3-5 minutes as clinically indicated
Paediatric / Newborn:

Dilute 1 mL of 1:1000 adrenaline solution with 9 mL sodium chloride 0.9% to produce 1000 microg in 10 mL (1:10,000)
10 microg/kg = 0.1 mL/kg of 1:10,000 adrenaline solution IV/IO, repeat every 3-5 minutes as clinically indicated. Maximum bolus dose 1mg (10mL of 1:10,000 adrenaline solution).

135
Q

Dose - Adrenaline
Post-ROSC - Adult & Paed

A

Dilute 1 mL of 1:1000 adrenaline solution with 9 mL sodium chloride 0.9% to produce 1000 microg in 10 mL (1:10,000)

Adult:

50 microg (0.5 mL) every 3-5 min as required to maintain systolic blood pressure >100 mmHg
Paediatric:

1 microg/kg every 3-5 min (maximum bolus 50 microg (0.5 mL)) to maintain systolic blood pressure > 80 mmHg
Titrate Adrenaline as required, to achieve and / or maintain the SBP requirements as listed above.

136
Q

Dose - Adrenaline
Anaphylaxis/Life threatening asthma
Adult & Paed

A

Adult:

0.5 mg IM into lateral mid-thigh (0.5 mL of 1:1000), repeat every 5 minutes as clinically required
Paediatric > 1 month:

10 microg/kg IM into lateral mid-thigh (0.01 mL of 1:1000) (maximum single dose = 0.5 mg or 0.5 mL), repeat every 5 minutes as clinically required

137
Q

Dose - Adrenaline
Croup

A

Infants (>1 month) / Paediatric:

Nebulise 5 mg (5 mL of 1:1000) undiluted, as a single dose

138
Q

Dose - Amiodarone
Adult & Paed

A

Adult:

300mg in 6ml IV/IO as soon as practicable after 3rd shock
Repeat dose of 150mg in 3ml may be administered after 5th shock
Paediatric / Infant:

5mg/kg IV/IO (to maximum 300mg) as soon as practicable after 3rd shock
Repeat 5mg/kg IV/IO (to maximum 150mg) after 5th shock

139
Q

Dose - Hydrocortisone
Adult & Paed

A

Dosage to be given should be in line with patients own management plan.
In the absence of patients own management plan the following dosages should be followed:
Adult:

IM:
100mg single dose
Paediatric:

IM:
Age Weight Dosage
< 6 Months <7kg 25mg
6 months to 2 years 8 - 12 kg 50mg
3 - 10 years 13 - 30kg 75mg
>10 years >30kg 100mg

140
Q

Dose - Ipratropium Bromide (inc repeats)
Adult neb
Adult MDI
Paed neb (inc age cut off)
Paed MDI

A

Adult:

Nebulised (combined with salbutamol):
500 microg in 2 mL (250 microg/mL)
Dilute solution for nebulisation to 2-3ml with sodium chloride 0.9%
Repeat nebulised dose every 20mins; maximum of 3 doses.
MDI:
8 puffs (160 microg), 1 breath per puff - if possible, give via spacer
Repeat MDI dose every 20 minutes; maximum of 3 doses.
Paediatric:

< 6 years > 6 years Subsequent dose if required Notes

Nebulised 250 microg in 1 mL 500 microg in 2 mL Repeat nebulised dose every 20 minutes; maximum of 3 doses. Dilute solution for nebulisation to 2-3mL with sodium chloride 0.9%
MDI 4 puffs (80 microg) 8 puffs (160 microg) Repeat MDI dose every 20 minutes; maximum of 3 doses Give via spacer

141
Q

Dose - Salbutamol
MDI & Neb

A

MDI / Space chamber as per Clinical Skill
Adult/Child > 6 years:

4-12 puffs (400-1200 microg), repeat every 20 minutes (or sooner if needed) for the first hour
Paediatric < 6 years:

2-6 puffs (200-600 microg), repeat every 20 minutes (or sooner if needed) for the first hour
Using an MDI with spacer:
Press once firmly on the MDI to discharge 1 puff into the spacer
Instruct the patient to breathe in and out normally for 4 breaths
Repeat 1 puff at a time until the appropriate number of puffs have been taken
Repeat as clinically required as per dosing schedule above
Nebulised as per Clinical Skill
Use 1-2 nebules (5-10 mg in 2.5-5 mL) with 6-8 L/min oxygen in a nebuliser mask
Give salbutamol via continuous nebulisation in life threatening asthma
Repeat as clinically required

142
Q

Dose - Ketamine
Analgesia
Adult & Paed
I & IV/IO

A

Adult:

IM (pre-hospital only):
Initial dose: 1 mg/kg
Subsequent doses at 5 minute intervals – 0.5 mg/kg
Concentration: 200 mg/2 ml = 100 mg/ml
IV/IO (pre-hospital only):
Initial dose: 5 - 20 mg titrated to effect over at least 1 minute
Subsequent doses at 5 minute intervals: 5 - 10 mg titrated to effect
Paediatric:

IM (pre-hospital only):
Initial dose: 1 mg/kg;
Subsequent doses at 5 minute intervals: 0.5 mg/kg;
Concentration: 200 mg/2 ml = 100 mg/ml
IV/IO (pre-hospital only):
0.1 mg/kg administered over at least 1 minute and titrated to effect
Repeat at 5 minute intervals as required

143
Q

Dose - Ketamine
RASS4 - Adult only
IM & IV/IO

A

IM:

Adult 16 or over

Initial dose (agreed ideal body weight):
up to 2 mg/kg repeat if necessary to a maximum cumulative dose of 200 mg in moderate to severe alcohol intoxication OR
up to 4 mg/kg repeat if necessary to a maximum cumulative dose of 400 mg in nil to mild alcohol intoxication
Adequate sedation may be achieved with lower doses on a case-by-case basis

IV access obtained as soon as practicable:
ASMA consult required where IV access is not achieved and further sedation required.
IV for maintenance of ketamine-induced sedation only:

0.5 mg/kg repeated every 5 - 10 minutes ONLY IF REQUIRED

144
Q

Dose - Ketamine
Combative TBI

A

IM:

Initial dose: 2 mg/kg to a maximum of 200 mg (agreed ideal body weight)
IV access obtained as soon as practicable
IV/IO:

0.5 mg/kg repeated every 5-10 minutes IF REQUIRED

145
Q

Dose - Lignocaine
Intradermal, IO and Finger

A

Intradermal:

0.1mL
Intraosseous:

Small child: 10mg in 1mL
Small adult/large child: 20mg in 2mL
Adult: 40mg in 4mL (2 ampoules)
May be repeated at a second site if needed.

Finger Thoracostomy:

50mg in 5mL

146
Q

Dose - Midazolam - Seizures
Adult & Paed, IM & IV
including dilution

A

Adult < 70 years:

IM
5 mg, repeat once after 10 min if needed and no IV access.
IV/IO
2.5 - 5 mg, repeat dose 2.5 mg every 5 min as needed to 15 mg max.
Adult ≥ 70 years or frail:

IM
2.5 mg, repeat once after 10 min if required and no IV access.
IV/IO
2.5 mg, repeat dose 1 mg every 5 min as needed to 15 mg max.
Paediatric:

IM
0.2 mg/kg max single bolus 5 mg, repeat once after 10 min if needed and no IV access.
IV/IO
0.1 mg/kg to a max single bolus dose of 2.5 mg, repeat as needed every 5 min to a 10 mg max.
The use of Midazolam in both adults and paediatric patients for other seizure types outside of CPG requires ASMA authority.

147
Q

Dose - Midazolam - Maint of sedation
Adult & Paed, IM & IV

A

DILUTION
IV / IO
Dilute 15 mg / 3 ml with 12 ml NaCl in 20 ml syringe (equivalent to 1 mg/ml)
Part dilution into a 10 ml syringe is no longer advocated

Adult < 70 years of age:
IV
1 - 2 mg, titrated to effect every 5 - 10 mins as required to a total max dose 5 mg
Adult ≥ 70 years or frail:

IV
0.5 - 1 mg, titrated to effect every 5 - 10 mins as required to a total max dose 5 mg
Paediatric (6-15 years of age):

IV
0.5 mg - 1 mg, titrated to effect every 5 - 10 mins as required to a total max dose 5 mg

148
Q

Dose - TXA
Adult & Paed

A

Adult IV / IO:

1 g slowly over 10 minutes (Rapid administration may cause hypotension)
OR
1 g in 250 mL of normal saline, slow IV / IO infusion over 10 minutes.
SINGLE DOSE ONLY
Paediatric (<12 years) IV / IO:

15 mg/kg slowly over 10 minutes (max injection rate 50 mg/minute)
OR
15 mg/kg in 100 mL of normal saline, slow IV / IO infusion over 10 minutes.
Maximum total dose of 1 g
SINGLE DOSE ONLY

149
Q

Dose - Naloxone
Adult & Paed - IM/IV/IO

A

Adult:

IM/IV/IO:
0.4-0.8 mg (400-800 microg) repeat dose every 2 minutes as required, titrated to clinical response to a maximum of 10 mg.
IN:
One spray (1.8 mg) of Nyxoid® into nostril.
Repeat at 2 minutes in opposite nostril if the patient does not respond.
Paediatric:

IM/IV/IO:
0.01 mg/kg (10 microg/kg, maximum dose 0.4 mg (400 microg), repeat every 2-3 minutes minutes as required, titrated to clinical response.
If high suspicion of overdose, a 0.1 mg/kg (100 microg/kg) dose (maximum 2 mg) may be given following a lack of response to initial dose.

150
Q

Dose - Prednisolone

A

Each 1ml of solution contains 5mg of prednisolone
Administer 1mg/kg to maximum single dose of 25mg
Single dose only

151
Q

Dose - Droperidol
Adult & Paed - IM/IV/IO
including dilution

A

IV / IO
Dilute 10 mg/2 ml with 8 ml NaCl (equivalent to 1 mg/ml)
Adults < 70 years old:

IM (preferred route):
10 mg
IV:
2.5 - 5 mg titrate to effect
Repeat as necessary each 15 mins to a maximum cumulative dose 20 mg/24 hrs (via all routes). Consider switch to IV Midazolam only if necessary after maximum dose reached.
Adults > 70 years of age or frail or with dementia:

IM (preferred route):
5 mg
IV:
2.5 mg
Repeat as necessary each 15 mins to a maximum cumulative dose 10 mg/24 hrs (via all routes). Consider switch to IV Midazolam only if necessary after maximum dose reached.
Paediatrics 6-15 years old:

IM (preferred route):
0.2 mg/kg to a maximum of 5 mg
Repeat as necessary each 15 mins to a maximum cumulative dose 10 mg/24 hrs (via all routes).
IV:
0.2 mg/kg to a maximum of 5 mg
Repeat as necessary each 30 mins to a maximum cumulative dose 10 mg/24 hrs (via all routes).

152
Q

Adrenaline
Dose
Cardiac Arrest /Post ROSC
Paed

A

Cardiac Arrest
Paediatric / Newborn:Dilute 1mg adrenaline in 9ml normal saline (1000 mcg in 10mls, 1:10,000)10mcg/kg = 0.1ml/kg (1:10000) every 3-5 minutes.

Post-ROSC
Paediatric:1mcg/kg every 3-5 min (max bolus 50mcg) to maintain systolic blood pressure > 80 mmHg

StJA(WA) (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions