Medications for PPCS2 - JRCALC Flashcards
(249 cards)
1
Q
What is the indications for activated charcoal?
A
Adults and children over 1 who have ingested toxins less than 1 hour before attendance by an ambulance clinician or toxbase has advised to take activated charcoal irrespective of time
2
Q
What is activated charcoal used for?
A
The emergency treatment of acute oral poisoning and oral drug overdose
3
Q
What are the contraindications for activated charcoal?
A
Under 1 year old
Pts presenting to the ambulance clinician more than 1 hour since ingestion of toxin
pts who are vomiting
Pts with reduced gastrointestinal motility with a risk of obstruction
4
Q
How is activated charcoal administered?
A
Orally
5
Q
What is the dosage for activated charcoal?
A
Adult - 50g
Child 25g
No repeat dose
6
Q
What is the indications for adrenaline 1:1000?
A
Anaphylaxis and life threatening asthma
7
Q
What is the action of adrenaline 1:1000?
A
Reverses allergic manifestations of acute anaphylaxis.
Relieves bronchospasm in acute severe asthma
8
Q
How is adrenaline 1:1000 administered?
A
IM only
9
Q
What is the initial dose of adrenaline 1:1000?
A
500mcg
10
Q
What is the dose interval for adrenaline 1:1000
A
5 mins
11
Q
What is the repeat dose for adrenaline 1:1000
A
500mcg
12
Q
What is the max dose of adrenaline 1:1000?
A
No max dose
13
Q
What is the indications for adrenaline 1:10000
A
Cardiac arrest
Post ROSC circulatory support
14
Q
What is the action of adrenaline 1:10000?
A
It is a sympathomimetic that stimulates both alpha and beta adrenergic receptors, as a result myocardial and cerebral blood flow is enhanced during CPR and CPR becomes more effective due to increased peripheral resistance which improves perfusion pressures
15
Q
What are the contra-indications of adrenaline 1:10000
A
Do not give if patients core temp is less than 30 degrees, if the temp is between 30-35 then double the time between doses
16
Q
How is adrenaline 1:10000 administered?
A
IV or IO
17
Q
What is the initial dosage for adrenaline 1:10000 in a cardiac arrest?
A
1mg
18
Q
What is the repeat dose of adrenaline 1:10000 in a cardiac arrest?
A
1mg
19
Q
What is the dose interval for adrenaline 1:10000 in a cardiac arrest?
A
3-5 mins
20
Q
What is the max dose of adrenaline 1:10000 in a cardiac arrest?
A
No max dose
21
Q
What is the initial dose of adrenaline 1:10000 in post ROSC?
A
50mcg
22
Q
What is the dose interval for adrenaline 1:10000 post ROSC?
A
3-5 mins
23
Q
What is the repeat dose for adrenaline 1:10000 post ROSC?
A
50-100mcg
24
Q
What is the max dose for adrenaline 1:10000 post ROSC?
A
No max dose
25
What are the indications for amiodarone?
Cardiac arrest in shockable rhythms
26
What are the actions of amiodarone?
It is an antiarrhythmic - it lengthens cardiac action potential and therefore effective refractory period, prolongs QT interval on ECG.
Blocks sodium and potassium channels in the cardiac muscle.
Acts to stabilise and reduce electrical irritability of cardiac muscle
27
What are the contraindications of amiodarone?
If a patients core temp is less than 30 degrees
28
How is amiodaraone administered?
IV/IO
29
What is the initial dosage for amiodarone?
300mg after 3rd shock
30
What is the dose interval for amiodarone?
After 5th shock
31
What is the repeat dose of amiodarone?
150mg
32
What is the max dose of amiodarone?
450mg
33
What are the indications for aspirin?
Clinical or ECG evidence suggestive of an MI or ischaemia.
Suspected TIA and ALL of the following: symptoms have fully resolved, pt is not being conveyed to hospital, pt has been referred to local TIA pathway
34
What is the action of aspirin?
Has an anti platelet action which reduces clot formation
35
What are the contraindications for aspirin?
Known allergy/sensitivity
Children under 16
Active gastrointestinal bleeding
Haemophilia or other known clotting disorders
Severe hepatic failure with jaundice
36
How is aspirin administered?
Orally
37
What is the initial dose of aspirin?
300mg - NO REPEAT DOSE
38
What is the max dose of aspirin?
300mg
39
What are the indications for atropine ?
Symptomatic bradycardia in the presence of ANY of these adverse signs:
Absolute bradycardia (pulse less than 40 per min)
Systolic BP below expected for age
Paroxysmal ventricular arrythmias requiring suppression
inadequate perfusion causing confusion
Bradycardia following ROSC
40
What are the contra-indications for atropine?
Should not be given to treat bradycardia in suspected hypothermia.
Do not give to patients with cardiac transplants - their hearts will not respond to vagal blocking by atropine and paradoxical high degree AV block or sinus arrest may result
41
What are the actions of atropine?
Reverses effects of vagal overdrive.
Increases HR by blocking vagal activity in sinus bradycardia, second or third degree heart block. Enhances A-V conduction
42
How is atropine administered?
IV/IO
43
What is the initial dose for atropine?
600mcg
44
What is the dose interval for atropine?
3-5 mins
45
What is the repeat dose for atropine?
600mcg
46
What is the max dose for atropine?
3mg
47
What are the indications for benzylpenicillin?
Suspected meningococcal disease in the presence of:
A non-blanching rash and/or signs and symptoms suggestive of meningococcal septicaemia
48
What is the action of benzylpenicillin?
Antibiotic: narrow-spectrum
49
What are the contra-indications for benzylpenicillin?
Known severe penicillin allergy
50
How is benzylpenicillin administered?
IV/IO or IM
51
What is the initial dose for benzylpenicillin?
1.2g - NO REPEAT DOSE
52
What is the max dose for benzylpenicillin?
1.2g
53
What are the indications for chlorphenamine?
Symptomatic allergic reactions failing short of anaphylaxis but causing pt distress.
Alleviating distressing cutaneous symptoms in anaphylaxis only after emergency treatment with adrenaline and the pt is stable and oral antihistamine administration is not possible
54
What are the contraindications of chlorphenamine?
Known hypersensitivity.
Pts who have been treated with monoamine oxidase inhibitors within the last 14 days
55
What is the action of chlorphenamine?
Blocks the effect of histamine released during an allergic reaction
56
How is chlorphenamine administered?
IM, IV and oral
57
What is the initial dose for IM/IV chlorphenamine?
10mg - NO REPEAT DOSE
58
What is the initial dose of oral chlorphenamine?
4mg - NO REPEAT DOSE
59
What is the indication for dexamethasone?
Croup in children
60
What is the contra-indication for dexamethasone?
Impending respiratory failure
61
What is the action of dexamethasone?
Corticosteroid - reduces subglottic inflammation
62
How is dexamethasone administered?
Orally
63
What is the initial dose for dexamethasone?
5.2mg or 6mg - NO REPEAT DOSE
64
What are the indications for diazepam?
Pts with prolonged convulsions (lasting 5 mins or more) or repeated convulsions (3 or more in an hour) and are currently convulsing.
Eclamptic convulsions if it lasts over 2-3 mins or if it is recurrent
Symptomatic cocaine toxicity (severe hypertension, chest pain or convulsions)
65
What are the actions of diazepam?
Central nervous system depressant, acts as an anticonvulsant and sedative
66
What is the contra-indication for diazepam?
Patients with known hypersensitivity
67
How is diazepam administered?
IV, IO or rectal
68
What is the initial dose of diazepam?
10mg
69
What is the dose interval for diazepam?
10 mins
70
What is the repeat dose for diazepam?
10mg
71
What is the max dose for diazepam?
20mg
72
What are the indications for furosemide?
pulmonary oedema and/or respiratory distress due to acute failure
73
What are the contra-indications for furosemide?
Reduced GCS with liver cirrhosis
Cardiogenic shock
Severe renal failure with anuria
Children under 18
74
What is the action of furosemide?
A potent diuretic with a rapid onset (within 30 mins) and short duration
75
How is furosemide administered?
IV
76
What is the initial dose for furosemide?
40mg - NO REPEAT DOSE
77
What are the indications for glucagon?
Hypoglycaemia or unconscious patients why hypoglycaemia is considered a likely cause
Should only be administered when oral glucose is not possible or is ineffective and/or IV access to administer 10% glucose is not possible
78
What are the contra-indications for glucagon?
Pheochromocytoma
Do not give through IV injection because of increased vomiting associated with IV use
79
What is the action of glucagon?
A hormone that induces the conversion of glycogen to glucose in the liver, thereby raising blood glucose levels
80
How is glucagon administered?
IM
81
What is the initial dose for glucagon?
1mg - NO REPEAT DOSE
82
What are the indications for glucose 10%?
Hypoglycaemia or suspected hypoglycaemia when oral administration is not possible and rapid improvement in clinical state and blood glucose level is required.
An unconscious patient where hypoglycaemia is considered a likely cause.
Management of hypoglycaemia in patients who have no responded to the administration of IM glucagon after 10 mins
83
What is the action of glucose 10%?
Reversal of hypoglycaemia by direct delivery of glucose to the systemic circulation
84
What are the contra-indications for glucose 10%?
IM or subcutaneous injection
85
How is glucose 10% administered?
IV OR IO infusion
86
What is the initial dose for glucose 10%?
10g
87
What is the dose interval for glucose 10%?
5 mins
88
What is the repeat dose for glucose 10%?
10g
89
What is the max dose for glucose 10%?
30g
90
What is the indication for glucose 40% gel?
Known or suspected hypoglycaemia in a conscious patient where there is no risk of choking or aspiration
91
What are the contra-indications for glucose 40% gel?
None
92
What is the action of glucose 40% gel?
Rapid increase in blood glucose levels via buccal absorption
93
How is glucose 40% gel administered?
Buccal
94
What is the initial dose for glucose 40% gel?
10-20g
95
What is the dose interval for glucose 40% gel?
15 mins
96
What is the repeat dose for glucose 40% gel?
10g
97
What is the max dose for glucose 40% gel?
None
98
What are the indications for GTN?
Cardiac chest pain due to angina or MI when systolic BP is greater than 90mmHg.
Acute heart failure with ischaemia or uncontrolled hypertension.
Patients with suspected cocaine toxicity presenting with chest pain
99
What are the contra-indications for GTN?
Hypotension in angina or MI or less than 110mmHg in acute heart failure.
Hypovolaemia.
Head trauma.
Cerebral haemorrhage.
Unconscious patients
Known severe aortic or mitral stenosis
Viagra in last 24 hours
100
What are the actions of GTN?
A potent vasodilator drug resulting in:
1. Dilation of coronary arteries/relief of coronary spasm
2. Dilation of systemic veins resulting in lower pre-load
3. Reduced blood pressure
101
How is GTN administered?
Sublingual spray or oral tablet
102
What is the initial dose for GTN in patients with angina, MI or suspected cocaine toxicity?
400-800mcg/ 1-2 sprays
103
What is the repeat dose for GTN in patients with angina, MI or suspected cocaine toxicity?
400-800mcg/ 1/2 sprays
104
What is the dose interval for GTN in patients with angina, MI or suspected cocaine toxicity?
5-10 minutes
105
What is the max dose for GTN in patients with angina, MI or suspected cocaine toxicity?
No max dose
106
What is the initial dose for GTN in patients with heart failure?
400-800mcg/ 1-2 sprays
107
What is the repeat dose for GTN in patients with heart failure?
400-800mcg/ 1-2 sprays
108
What is the dose interval for GTN in patients with heart failure?
5-10 mins
109
What is the max dose for GTN in patients with heart failure?
2.4mg/6 sprays
110
What are the indications for heparin?
ST elevation MI where heparin is required as adjunctive therapy with tenecteplase to reduce the risk of re-infaction.
111
What is the action of heparin?
Anticoagulant
112
What are the contra-indications for heparin?
Haemophilia and other haemorrhagic disorders.
Thrombocytopenia
Recent cerebral haemorrhage
Severe hypertension
Severe liver disease
Oesophageal varices
Peptic ulcer
Major trauma
Recent surgery to eye or nervous system
Acute bacterial endocarditis
Spinal or epidural anaesthesia
113
How is heparin administered?
IV single bolus
114
What is the initial dose for heparin for someone less than 67kg?
4000 units
115
What is the repeat dose of heparin?
1000 units
116
When would you give a repeat dose of heparin?
If heparin infusion has not commenced within 45 mins of the original bolus of thrombolytic agent
117
What is the max dose of heparin for someone less than 67kg
4000 units
118
What is the initial dose of heparin for someone 67kg+?
5000 units
119
What is the max dose of heparin for someone 67kg+
5000 units
120
What are the indications for hydrocortisone?
Severe or life-threatening asthma
Acute exacerbation of COPD
Adrenal crisis which is time critical
Prevention of adrenal crisis in pts who suffer
Pregnant women with known Addison's disease who are in established labour
121
What is the action of hydrocortisone?
Glucocorticoid steroid drug that restores blood pressure, blood sugar, cardiac synchronicity and volume. Therapeutic actions include suppression of inflammation and immune response
122
How is Hydrocortisone administered?
IV/IO post ROSC
IM
123
What is the initial dose of hydrocortisone?
100mg - NO REPEAT DOSE
124
What is the max dose of hydrocortisone?
100mg
125
What are the indications for ibuprofen?
Relief of mild to moderate pain
Pyrexia with discomfort
Soft tissue injuries
126
What are the actions of ibuprofen?
Analgesic
Antipyretic
Anti-inflammatory
127
What are the contra-indications for ibuprofen?
Dehydration
Hypovolaemic
Known to have renal insufficiency
Patients with active upper gastrointestinal disturbance
Women in the last trimester of pregnancy
Child with chickenpox
Patients who have previously shown hypersensitivity reactions
Pts with active peptic ulcer
Patients with severe heart failure, renal failure or hepatic failure
Patients on anticoagulant drugs e.g warfarin
128
How is ibuprofen administered?
orally
129
What is the initial dose for ibuprofen?
400mg
130
What is the dose interval for ibuprofen?
8 hours
131
What is the max dose of ibuprofen?
1.2g per 24 hours
132
What are the indications for ipratropium bromide?
Acute, severe or life-threatening asthma
Acute asthma unresponsive to salbutamol
Exacerbation of COPD, unresponsive to salbutamol
Expiratory wheezing
133
What is the action of ipratropium bromide?
It is an antimuscarinic bronchodilator, it may provide short term relief in acute asthma
134
What are the contra-indications for ipratropium bromide?
None in the emergency situation
135
How is ipratropium administered?
Nebulised with 6-8L of oxygen - limit to 6 mins in COPD patients
136
What is the initial dose of ipratropium bromide?
500mcg - NO REPEAT DOSE
137
What is the max dose of ipratropium bromide?
500mcg
138
What are the indications for magnesium sulfate in adults over 12 years?
Severe exacerbations of asthma, not responding to continuous salbutamol
Eclampsia
Severe pre-eclampsia - BP 160/110 or more
Torsades de Pointes
139
What are the indications for magnesium sulfate in children 2-11 years?
Severe acute asthma or continuing respiratory deterioration in anaphylaxis, not responding to continuous salbutamol nebulisation
140
What are the contra-indications for magnesium sulfate?
Known hypermagnesaemia
141
What are the actions of magnesium sulfate?
Relaxes bronchial muscles
Competitively blocks entry of calcium into synaptic endings reducing neuromuscular transmission
142
How is magnesium sulfate administered?
IV
143
What is the initial dose of magnesium sulfate in asthma?
2g - NO REPEAT DOSE
144
What is the initial dose of magnesium sulfate in eclampsia and severe pre-eclampsia?
4g - NO REPEAT DOSE
145
What is the initial dose of magnesium sulfate in Torsades de Pointes?
2g - NO REPEAT DOSE
146
What is the indication for penthrox?
The emergency relief of moderate to severe pain in conscious adult patients with trauma and associated pain
147
What are the contra-indications for penthrox?
Under 18s
Recent use of penthrox, more than 15ml in the previous week
Patients with known allergy or hypersensitivity to penthrox or anaesthetic gases
Patients with liver damage or impairment
CKD stage 4/5
Altered level of consciousness due to any cause
Clinically evident cardiovascular instability e.g hypotensive, heart failure
Respiratory depression
Personal or family history of malignant hyperthermia born severe adverse reaction to inhaled anaesthetic gases
148
What is the action of penthrox?
Inhaled analgesic designed for self administration using a handheld device under supervision, can be used as a non opioid alternative to morphine or in conjunction with morphine four very severe pain. It is believed to reduce conduction of pain signals across gap junctions
149
How is penthrox administered?
Inhaler
150
What is the initial dose for penthrox?
3ml (1 bottle)
151
What is the repeat dose for penthrox?
3ml (1bottle)
152
What is the dose interval for penthrox?
none
153
What is the max dose for penthrox?
6ml (2 bottles)
154
What are the indications for metoclopramide hydrochloride?
Nausea and vomiting in adults aged 18 or over
Prevention and treatment of nausea and vomiting following administration of morphine
155
What are the contra-indications for metoclopramide hydrochloride?
Under 18s
Renal failure
Phaeochromocytoma
Gastrointestinal obstruction
Perforation/haemorrhage/ 3-4 days after GI surgery
Cases of drug overdose
156
What is the action of metoclopramide hydrochloride?
Anti-emetic which acts centrally as well as on the GI tract
157
How is metoclopramide hydrochloride administered?
IM or IV
158
What is the initial dose for metoclopramide hydrochloride?
10mg - NO REPEAT DOSE
159
What is the max dose for metoclopramide hydrochloride?
10mg
160
What are the indications for midazolam?
Pts who have prolonged convulsion lasting 5 mins or more or repeated convulsions (3 or more in an hour) and are currently convulsing.
Convulsion continuing 10 mins after first dose of medication
161
What are the contra-indications for midazolam?
None
162
What is the action of midazolam?
Short acting benzodiazepine with anxiolytic, sedative and anticonvulsant properties.
163
How is midazolam administered?
Buccal
164
What is the initial dose of midazolam?
10mg
165
What is the repeat dose of midazolam?
10mg
166
What is the dose interval for midazolam?
5-10 mins
167
What is the max dose for midazolam?
20mg
168
What are the indications for misoprostal?
Primary or secondary PPH where there is excessive bleeding from the birth canal which is uncontrolled by the use of syntometrine where available or where syntometrine is contraindicated or unavailable.
Confirmed miscarriage with excessive bleeding from the birth canalwhich is uncontrolled by the use of syntometrine where available or where syntometrine is contraindicated or unavailable.
169
What are the contraindications for misoprostal?
If there is any specific reason to suspect another foetus is in the uterus.
Known anaphylaxis to misoprostal or any other component of the product or to other prostaglandins
170
What are the actions of misoprostal?
It is a uterotonic medicine which stimulates contraction of the uterus for the control of bleeding after birth.
171
How is misoprostal administered?
Sublingual or rectal
172
What is the initial dose for misoprostal?
800mcg - NO REPEAT DOSE
173
What is the max dose for misoprostal?
800mcg
174
What are the indications for morphine?
Pain associated with suspected MI.
Severe pain as a component of a balanced analgesia regimen.
175
What are the contra-indications for morphine?
Children under 1
Respiratory depression - less than 10
Hypotension - below 90mmHg
Head injury with significantly impaired level of consciousness
Known hypersensitivity
176
What are the actions of morphine?
Strong opioid analgesic, it produces sedation, euphoria and analgesia, it may both depress respiration and induce hypotension. Histamine is released following morphine administration and this may contribute to vasodilatory effects, this may also account for the urticaria and bronchoconstriction that are sometimes seen.
177
How is morphine administered?
Ideally IV but can be given orally or IM
178
What is the initial dose for morphine?
10mg - but give slowly and 2mg at a time
179
What is the repeat dose for morphine?
10mg
180
What is the dose interval for morphine?
5 mins
181
What is the max dose of morphine?
20mg
182
What are the indications for naloxone?
The reversal of acute opioid or opiate toxicity for respiratory arrest or respiratory depression.
Unconsciousness associated with respiratory depression of unknown cause where opioid overdose is a possibility.
In cardiac arrest where opioid toxicity is considered to be the likely cause
183
What are the contra-indications for naloxone?
Neonates born to opioid addicted mothers
184
What are the actions of naloxone?
Complete or partial reversal of the respiratory depression effects of opioid drugs.
185
How is naloxone administered?
IV/IO/IM/ intranasal
186
What is the initial dose of naloxone?
400mcg
187
What is the repeat dose of naloxone?
400mcg or 800mcg in cardiac arrest
188
What is the dose interval for naloxone?
3 mins or 1 min in cardiac arrest
189
What is the max dose of naloxone?
4000 mcg or 10000mcg in cardiac arrest
190
What are the indications for entonox?
Moderate to severe pain
Labour pains
191
What are the contra-indications for entonox?
Chest injury or clinically suspected pneumothorax.
Severe head injuries with impaired consciousness due to possible presence of intracranial air
Violently disturbed psychiatric patients
Decompression sickness
An intraocular injection of gas within the last 8 weeks
abdominal pain where intestinal obstruction is suspected
192
What is the action of entonox?
Inhaled analgesic agent
193
How is entonox administered?
Mouthpiece
194
What are the indications for ondansetron?
Prevention and treatment of opiate induced nausea and vomiting
195
What are the contra-indications for ondansetron?
Known sensitivity of ondansetron.
Infants less than 1 month old
congenital long QT syndrome
196
What is the action of ondansetron?
An anti-emetic that blocks 5HT receptors both centrally and in the gastrointestinal tract
197
How is ondansetron administered?
IV/IM
198
What is the initial dose for ondansetron?
4mg
199
What is the repeat dose for ondansetron?
4mg
200
What is the dose interval for ondansetron?
30 mins
201
What is the max dose for ondansetron?
8mg
202
What are the indications of oxygen?
Critical illnesses requiring high levels of supplemental oxygen.
serious illness requiring moderate levels of supplemental oxygen if the patient is hypoxaemic
COPD and other conditions requiring controlled or low dose oxygen therapy
203
What is the contra-indication for oxygen?
Explosive environments
204
What are the actions of oxygen?
Essential for cell metabolism, adequate tissue function is essential for normal physiological function.
Oxygen assists in reversing hypoxia by raising the concentration of inspired oxygen
205
What are the indications for paracetamol?
Mild/moderate pain for oral
moderate/severe pain for IV
206
What are the contra-indications for paracetamol?
Known paracetamol allergy
Already taken within last 4 hours
207
What are the actions of paracetamol?
Analgesis and antipyretic
208
What is the initial dose for oral paracetamol?
1g
209
What is the repeat dose for oral paracetamol?
1g
210
What is the dose interval for oral paracetamol?
4-6 hours
211
What is there max dose of oral paracetamol?
4g
212
What is the initial dose for IV paracetamol
1g
213
What is the repeat dose for IV paracetamol?
1g
214
What is the dose interval for IV paracetamol?
4-6 hours
215
What is the max dose for IV paracetamol?
4g
216
What are the indications for prednisolone?
Treatment of moderate to severe exacerbations of asthma.
Treatment of exacerbation of COPD
217
What are the contra-indications for prednisolone?
Had prednisolone within last 2 hours.
Pts not included in the inclusion criteria
Vomiting or unable to swallow
Known hypersensitivity to steroid or excipients.
Suspects or known systemic infection
Active peptic ulcer disease
218
What is the action of prednisolone?
It is a glucocorticoid steroid that suppresses part of the immune system and reduces inflammation and swelling
219
What is the initial dose of prednisolone?
40mg - NO REPEAT DOSE
220
What are the indications for salbutamol?
Acute asthma attack where normal inhaler therapy has failed to relieve symptoms.
Expiratory wheezing associated with allergy, anaphylaxis, beta blocker overdose, smock inhalation or other lower airway cause.
Exacerbation of COPD
221
What are the contra-indications for salbutamol?
none in emergency situation
222
What is the action of salbutamol?
It is a selective beta 2 adrenoreceptor stimulant drug that has a relaxant effect on the smooth muscle in airways
223
What is the initial dose for salbutamol?
5mg
224
What I the repeat dose for salbutamol?
5mg
225
What is the dose interval for salbutamol?
5 mins
226
What is the max dose for salbutamol?
None
227
What are the indications for sodium chloride 0.9%?
Medical conditions with or without haemorrhage
Burns
Limb crush injury
Trauma related haemorrhage
As a flush
228
What are the contra-indications for sodium chloride 0.9%
Do not give solely to keep a vein open
229
What is the action of sodium chloride 0.9%?
Increases vascular volume which consequently raises cardiac output and improves perfusion
230
How is sodium chloride 0.9% administered?
IV/IO
231
What are the doses for sodium chloride 0.9%
See JRCALC
232
What are the indications for sodium lactate compound?
Blood and fluid loss to correct hypovolaemia and improve tissue perfusion when sodium chloride 0.9% isnt available.
Dehydration
233
What are the contra-indications for sodium lactate compound?
Neonates
Diabetic hyperglycaemic ketoacidotic coma and pre coma
234
What is the action of sodium lactate compound?
Increases vascular volume which consequently raises cardiac output and improves perfusion
235
What is the dosage of sodium lactate compound?
see JRCALC
236
What are the indications of syntometrine?
Primary or secondary PPH where there is excessive bleeding from the birth canal.
Confirmed miscarriage or termination of pregnancy with excessive bleeding where a patient has gone home
237
What are the contra-indications of syntometrine?
Known or suspected foetus in utero.
Current severe hypertension over 140mmHg
Known anaphylaxis tenth active substances
Severe cardiac, liver or kidney disease
238
What are the actions of syntometrine?
The oxytocin in syntometrine is a synthetic form which stimulates contraction of the uterus. Ergometrine also produces a sustained uterine contraction for the control of bleeding after birth
239
How is syntometrine administered?
IM
240
What is the initial dose of syntometrine?
500mcg of ergometrine and 5 units of oxytocin -0 NO REPEAT DOSE
241
What are the indications of Tenecteplase?
Acute ST segment elevation MI with 6 hours of symptom onset where PPCI is not readily available
242
What are the contra-indications for tenecteplase?
See JRCALC for checklist
243
How is tenecteplase administered?
IV
244
What is the initial dose for tenecteplase?
Weight dependent - see JRCALC
Only 1 dose - no repeats
Max dose varies form 6000 units to 10,000 units
245
What are the indications for tranexamic acid?
Actual or suspected severe haemorrhage
Head injury
Traumatic cardiac arrest
PPH
pregnancy
246
What are the contra-indications for tranexamic acid?
Bleeding started more than 3 hours ago
Previous anaphylaxis to this drug
Obvious resolution of haemorrhage]
247
How is tranexamic acid administered?
IV/IO or IM
248
What is the initial dose of tranexamic acid?
1g - NO REPEAT DOSE unless in PPH then can give a further 1g after 30 mins
249
What is the action of tranexamic acid?
It is an anti-fibrinolytic which reduces the breakdown of blood clot
