Medications

Question 1

Adrenaline 1 in 1,000 (IM)

Answer 1

✅ Anaphylaxis
✅ Life threatening Asthma
Antero-lateral thigh 💉

Question 2

Adrenaline 1 in 1,000 (Neb)

Answer 2

✅ Severe/ Life-threatening Croup

Question 3

Adrenaline 1 in 10,000 (IV/IO)

Answer 3

✅ Cardiac arrest

Question 4

Amiodarone (IV/IO)

Answer 4

✅ Only after 3rd shock in
SHOCKABLE RHYTHM ONLY
✅ After 5th shock

Question 5

Aspirin 300mg (Oral)

Answer 5

✅ Adults with suspected NSTEMI or STEMI
❌ Multiple contraindications

Question 6

Atropine for Bradycardia (IV/IO)

Answer 6

✅ Symptomatic Bradycardia for all ages
❌ Hypothermic pt’s
❌ Cardiac transplant

Question 7

Atropine for OP poisoning (IV/IO/IM)

Answer 7

✅ Suspected OP poisoning in Children under 8
✅ In the absence of Duodote for pt’s 8+
❌ None in presence of life threatening OPP

Question 8

Benzylpenicillin (🐌IV/IO/IM)

Answer 8

✅ Suspected Meningococcal Disease from birth
❌ Known SEVERE allergy ONLY

Question 9

Carbetocin (🐌IV/IM)

Answer 9

✅ Primary Post-partum haemorrhage within 24 hours after birth.
ONLY AFTER DELIVERY, uterine massage is ineffective and after 20 weeks gestation
❌ Received Syntometrine
❌ Before all foetuses delivered

Question 10

Chlorphenamine (IM/IV)

Answer 10

✅ Symptomatic Allergic reaction in pt’s 1 month +
❌ MAOI’s within last 14 days

Question 11

Co-amoxiclav (🐌IV/IO)

Answer 11

✅ Obvious or suspected open fracture in pt’s 1yr +
❌ Multiple

Question 12

Dexamethasone (Oral)

Answer 12

✅ Mild to Life-threatening Croup in pt’s 1mth- 10 yrs
❌ Hypertension
❌ Infection or Sepsis

Question 13

Diazepam (🐌IV/IO/Rectal)

Answer 13

✅ Convulsion of 5 mins+ OR 3rd convulsion in an hour AND currently convulsing from birth
✅ Eclamptic Convulsion
✅ Symptomatic Cocaine Toxicity
❌ Not for seizure secondary to hypoglycaemia

Question 14

Duodote (IM, mid-lateral thigh)

Answer 14

✅ Over 8 years with suspected OPP/ nerve agent
❌ None in life threatening

Question 15

Furosemide (🐌 IV)

Answer 15

✅ Respiratory distress in pt’s with pulmonary oedema or acute HF
❌ Under 18
❌ Cardiogenic Shock
❌ Reduced GCS with liver cirrhosis
❌ Severe Renal Failure

Question 16

Glucagon (IM ONLY)

Answer 16

✅ Hypoglycaemia where oral and IV glucose are not possible in pt’s from birth to adults
❌ Pheochromocytoma (Adrenal medulla tumour)

Question 17

Glucose 10% (IV/IO)

Answer 17

✅ Hypoglycaemia in pt’s unable to receive oral 40%
❌ None if Oral route is inappropriate and hypo is confirmed

Question 18

Glucose 40% (Buccal)

Answer 18

✅ Known or suspected hypoglycaemia
❌ None

Question 19

GTN (sublingual)

Answer 19

✅ In Acute HF if Systolic is OVER 110
✅ Cardiac CP from suspected ACS if Systolic over 90
✅ Suspected cocaine toxicity with CP
❌ Several
🟠 CAUTION in pt’s with suspected posterior or R-Ventricle MI

Question 20

Hydrocortisone (🐌IV/IO/IM)

Answer 20

✅ Severe/ Life-threatening Asthma
✅ Acute Exacerbation of COPD
✅ Adrenal Crisis (Such as Addisons)
❌ Known allergy only

Question 21

Ibuprofen (Oral)

Answer 21

✅ Mild to moderate pain in pt’s 3 months+
✅ Pyrexia with discomfort
❌ Several see JRCALC

Question 22

Fluids (IV/IO)

Answer 22

✅ Trauma, isolated head injury to maintain BP of 110
✅ Trauma, penetrating to trunk to maintain a good central pulse OR maintain BP 60
✅ Trauma, penetrating limb to maintain peripheral pulse or BP 90
✅ Trauma, blunt trunk or limb to maintain peripheral pulse or BP 90
✅ Crush syndrome should receive 2L regardless of BP
✅ Burns, see JRCALC for percentages
✅ Dehydration from any medical cause
✅ Sepsis
✅ DKA
✅ Anaphylaxis

Question 23

Ipratropium Bromide (Neb)

Answer 23

✅ Acute severe/ life-threatening Asthma
✅ Acute asthma unresponsive to salbutamol alone
✅ Exacerbation of COPD, unresponsive to salbutamol
❌ None

Question 24

Lidocaine (IO)

Answer 24

✅ Life threatening presentation and IV cannot be established in conscious pt
❌ Several see JRCALC

Question 25

Penthrox (Inhaled)

Answer 25

✅ 18+ with moderate/severe pain from trauma ❌ Multiple see JRCALC

Question 26

Midazolam (Buccal)

Answer 26

✅ Convulsion of 5 mins+ OR 3rd convulsion in an hour AND currently convulsing from birth WHERE IV ACCESS CANNOT BE ESTABLISHED ✅ Eclamptic Convulsion WHERE IV ACCESS CANNOT BE ESTABLISHED ✅ Symptomatic Cocaine Toxicity ❌ Psychogenic non-epileptic seizure ❌ Two doses of BZ’s already given

Question 27

Misoprostol (Oral/Rectal)

Answer 27

✅ Primary PPH where IV uterotonic contraindicated or unavailable ✅ Primary PPH not responding to oxytocin, syntometrine or Carbetocin ✅ Confirmed miscarriage with life-threatening haemorrhage under 20 weeks gestation WITH NO FETUS IN UTERO ❌ IV uterotonic available ❌ Fetus in utero ❌ Undiagnosed miscarriage

Question 28

Morphine (IV/IO/IM/SC/Oral)

Answer 28

✅ Pain associated with suspected myocardial Infarction ✅ Severe Pain and BP above 90 (in adults) ✅ Breathlessness and pain in End of Life pt’s ❌ Under 1 ❌ Respiratory Depression ❌ Hypotension ❌ Head Injury with below AV(P)U or GCS below 9 ❌ Known Hypersensitivity 🟠 Extreme Caution in Pregnancy 🟠 Chest Injury 🟠 Hepatic or Renal Failure (consider small doses) 🟠 Head Injury 🟠 Low weight/frail/elderly 🟠 Alcohol Intoxication 🟠 On antidepressants, sedatives or tranquillisers

Question 29

Naloxone (IV/IO/IM) [IN in pt’s 12 years +)

Answer 29

✅ Reversal of respiratory depression due to acute opioid toxicity ✅ Unconsciousness associated with respiratory depression where opioid overdose is a possibility ❌ Neonates should be treated with BVM and O2

Question 30

Entonox (Inhaled)

Answer 30

✅ Moderate to severe pain ✅ Labour pain ❌ Head injury with impaired consciousness ❌ Decompression sickness ‘The Bends’ ❌ Violent psychiatric pt’s ❌ Abdo pain with suspected obstruction ❌ Intraocular injection within 8 weeks 🟠 Suspected or confirmed pneumothorax, polytrauma or penetrating torso injury

Question 31

Ondansetron (🐌IV/IM)

Answer 31

✅ Treatment of nausea or vomiting ✅ Prevention and treatment of opiate-induced nausea & vomiting ✅ For travel associated nausea or vomiting in children ❌ Under 1 month old ❌ Known hypersensitivity ❌ Congenital long QT syndrome 🟠 Prolonged QT interval 🟠 Hepatic impairment 🟠 Pregnancy 🟠 Breastfeeding

Question 32

Oxygen (Inhaled)

Answer 32

✅ Illness requiring oxygen ✅ Significant illness or injury in children ❌ Explosive environment 💥

Question 33

Paracetamol (Oral/🐌IV)

Answer 33

✅ Mild to moderate pain ✅ High temperature with discomfort ❌ Severe Liver disease ❌ Max cumulative dose already reached 🟠 Renal impairment 🟠 Pregnancy 🟠 Adults under 50kg will need a reduced dose

Question 34

Prednisolone (Oral)

Answer 34

✅ For supply to pt’s following an episode of acute asthma that is suitable for home management ❌ No pre-existing asthma diagnosis ❌ Initial presentation of near life-threatening asthma ❌ Any Asthma red flags ❌ Suspected or confirmed infection ❌ Myocardial Infarction in past 4 weeks ❌ Recent live viral vaccine ❌ Currently taking oral steroids ❌ Already received 2x doses in past month 🟠 Breastfeeding 🟠 Pregnancy 🟠 Diabetics

Question 35

Salbutamol (Nebulised)

Answer 35

✅ Acute asthma where inhaler therapy not effective ✅ Expiratory wheeze due to anaphylaxis, beta-blocker overdose, smoke inhalation or other lower airway cause ✅ Exacerbation of COPD ❌ None 🟠 Hypertension 🟠 Angina 🟠 Hyperthyroidism 🟠 Late pregnancy 🟠 Abnormal softening of airway

Question 36

Tranexamic Acid (🐌IV/IO)

Answer 36

✅ Known or suspected severe internal or external haemorrhage within 3 hours of bleed starting ✅ Any pt receiving a tourniquet/ haemostatic gauze/ pressure dressing/ chest dressing ✅ Pt in traumatic cardiac arrest ✅ Traumatic brain injury in pt’s 18+ with GCS 12 or less within 3 hours of injury ✅ Post-partum haemorrhage AFTER administration of a uterotonic ❌ Known anaphylaxis to TXA ❌ Obvious resolution of haemorrhage ❌ Haemorrhage started over 3 hours ago 🟠 Pregnancy 🟠 History of convulsions or new convulsions 🟠 Known history of acute venous/arterial thrombosis 🟠 Several Renal impairment