Indications

Question 1

Adrenaline

Answer 1

Cardiac arrest
Anaphylaxis OR severe allergic reaction
Severe life-threatening bronchospasm OR silent chest (only able to speak in single words AND/OR haemodynamic compromise AND/OR ALOC)
Shock unresponsive to adequate fluid resuscitation
Bradycardia with poor perfusion (unresponsive to atropine AND/OR transcutaneous pacing
Croup (moderate to severe)

Question 2

Amiodarone

Answer 2

Cardiac arrest (if refractory to three Direct Current Cardioversion Shocks)
Sustained conscious VT (haemodynamically stable)

Question 3

Aspirin

Answer 3

Suspected Acute Coronary Syndrome
Acute cardiogenic pulmonary oedema

Question 4

Box jellyfish antivenom

Answer 4

Box jellyfish (Chironex fleckeri) envenomation associated with any of the following:
- a patient currently in cardiac arrest
- decreased level of consciousness
- cardiac AND/OR respiratory distress or collapse
- total surface area affected greater than half the surface area of one limb
- intractable pain unrelieved by icepacks, methoxyflurane AND/OR narcotic analgesia.

Question 5

Ceftriaxone

Answer 5

Suspected meningococcal septicaemia (with a non-blanching petechial AND/OR purpuric rash)

Question 6

Clopidogrel

Answer 6

Patients with STEMI; AND
- who have been accepted for pPCI (as an adjunct medication to aspirin and heparin) and the receiving interventional cardiologist is requesting clopidogrel administration; OR
- who have received tenecteplase (and have been administered aspirin and enoxaparin)

Question 7

Dexamethasone

Answer 7

Croup

Question 8

Droperidol

Answer 8

Acute behavioural disturbances (with a SAT score of 2 or above)

Question 9

Enoxaparin

Answer 9

Patients with STEMI (as defined by the relevant QAS coronary artery reperfusion checklist) who have received QAS tenecteplase (as an adjunct medication to aspirin and clopidogrel)

Question 10

Fentanyl

Answer 10

Significant pain
Sedation
Autonomic dysreflexia (with a systolic BP >160 mmHg)
Induction for Rapid Sequence Intubation (RSI)
NOTE: Morphine is the preferred narcotic agent except under the following circumstances:
- allergy AND/OR adverse drug reaction to morphine;
- haemodynamic instability;
- known/suspected kidney disease;
- when NAS narcotic administration is the preferred treatment; AND/OR
- suspected ACS

Question 11

Glucagon

Answer 11

Symptomatic hypoglycaemia (with the inability to self-administer oral glucose)
Refractory anaphylaxis with persistent hypotension/shock (unresponsive to 3 x IM adrenaline injections and adequate fluid challenges)

Question 12

Glucose gel

Answer 12

Symptomatic hypoglycaemia (with the ability to self-administer oral glucose)

Question 13

Glucose 10%

Answer 13

Symptomatic hypoglycaemia (with the inability to self-administer oral glucose)

Question 14

Glyceryl trinitrate

Answer 14

Suspected acute coronary syndrome (with pain)
Acute cardiogenic pulmonary oedema
Autonomic dysreflexia (with a systolic BP > 160 mmHg)
Irukandji syndrome (with a systolic BP > 160 mmHg)

Question 15

Heparin

Answer 15

Patients with STEMI (as defined by the relevant QAS coronary artery reperfusion checklist) who have been accepted of pPCI (as an adjunct medication to aspirin AND EITHER ticagrelor OR clopidogrel)
Critical care patients requiring anticoagulation during interfacility transport

Question 16

Hydrocortisone

Answer 16

Asthma (excluding mild)
Acute exacerbation of COPD (with evidence of respiratory distress)
Refractory anaphylaxis with persistent wheeze (and unresponsive to 3 x IM adrenaline)
Suspected, or at risk of, an acute adrenal insufficiency (adrenal crisis)

Question 17

Hydroxocobalamin

Answer 17

Life-threatening cyanide toxicity (e.g. shock, respiratory failure, seizure, ALOC, or myocardial ischaemia)

Question 18

Ibuprofen

Answer 18

Moderate pain due to acute inflammation and tissue injury

Question 19

Influenza vaccine

Answer 19

Prevention of seasonal influenza for QAS employees
(Note: Influenza vaccines may only be administered by paramedics with specific approval of the QAS medical director)

Question 20

Ipratropium bromide

Answer 20

Moderate bronchospasm (unresponsive to initial QAS salbutamol NEB)
Severe bronchospasm

Question 21

Loratadine

Answer 21

Symptomatic urticaria (without evidence of anaphylaxis)

Question 22

Magnesium sulphate

Answer 22

Box jellyfish (Chironex fleckeri) envenomation (unresponsive to antivenom therapy)
Eclampsia
Irukandji syndrome (with intractable pain unrelieved by narcotic analgesia AND/OR systolic BP >160 mmHg)
Torsades de Pointes
Severe life-threatening asthma (only in patients who have required IM/IV adrenaline (epinephrine))

Question 23

Methoxyflurane

Answer 23

Pain

Question 24

Midazolam

Answer 24

Generalised seizures/focal seizures (GCS <12)
Sedation:
- for maintenance of an established SAD/ETT
- for procedures (e.g. TCP or cardioversion)
- CPR induced consciousness
- to facilitate safe assessment and treatment of agitated head injured patient
- as an adjunct to opiate analgesia (fracture splinting/extrication/burns)
- for ketamine emergence
Acute behavioral disturbance (with a SAT score >2) unresponsive to droperidol (max dose) administration

Question 25

Morphine

Answer 25

Significant pain
Sedation
Autonomic dysreflexia (with systolic BP >160 mmHg)
NOTE: Morphine is the preferred narcotic agent except under the following circumstances:
- allergy AND/OR adverse drug reaction to morphine;
- haemodynamic instability;
- known/suspected kidney disease;
- when NAS narcotic administration is the preferred treatment; AND/OR
- suspected ACS

Question 26

Naloxone

Answer 26

Respiratory depression (secondary to the administration of narcotic drugs)

Question 27

Ondansetron

Answer 27

Significant nausea AND/OR vomiting

Question 28

Oxygen

Answer 28

A wide range of condition resulting in, or potentially resulting in systemic AND/OR localised hypoxia

Question 29

Oxytocin

Answer 29

Active management of the third stage of labour (following confirmed deliver of all fetuses) AND the prevention of primary post-partum haemorrhage
Management of uncontrolled primary or secondary post-partum haemorrhage

Question 30

Paracetamol

Answer 30

Mild to moderate pain
Fever (causing distress)

Question 31

Salbutamol

Answer 31

Bronchospasm
Suspected hyperkalaemia (with QRS widening AND/OR AV dissociation)

Question 32

Sodium chloride 0.9%

Answer 32

Inadequate tissue perfusion/shock
Hypovolaemia
Significant burns (Total Body Surface Area >20% for adults or >10% for paediatrics)
To dissolve and dilute drugs (for the purpose of IM, IV, or IO administration)
As a flush following IV or IO drug administration

Question 33

Sucrose 24%

Answer 33

Short term procedural pain management (e.g. IV cannulation)
Distress due to pain

Question 34

Tenecteplase

Answer 34

Patient with STEMI who meet the criteria for pre-hospital tenecteplase administration (as defined by the relevant QAS coronary artery reperfusion checklist)

Question 35

Ticagrelor

Answer 35

Patients with STEMI (as defined by the relevant QAS coronary artery reperfusion checklist) who have been accepted for pPCI (as an adjunct medication to aspirin and heparin) AND the receiving interventional cardiologist is requesting ticagrelor administration

Question 36

Tranexamic acid

Answer 36

Recent traumatic injuries (3 hours or less) with a COAST score of 3 or greater
Management of uncontrolled primary post-partum haemorrhage (3 hours or less)

Question 37

Water for injection

Answer 37

To dissolve AND/OR dilute drugs for the purpose of IM, IV, or IO administration