Precautions / Notes Flashcards
(28 cards)
Adrenaline
Precautions / Notes
Ischaemic Heart Disease
Hypertension
Hypovolaemia
Do not walk patient pre or post IM adrenaline administration in anaphylaxis - usually a minimum of 1 hour after 1 dose of Adrenaline and 4 hours if more than 1 dose of Adrenaline given
If given IV into a peripheral vein, follow each dose with a sodium chloride flush
Amiodarone
Precautions / Notes
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)
Aspirin
Precautions / Notes
Actively bleeding peptic ulcers.
Suspected AAA.
Aspirin / salicylate-sensitive asthmatics
Atropine
Precautions / Notes
Atropine may not be effective in patients in third-degree atrioventricular (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.
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.
Cophenylcaine
Precautions / Notes
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.
Pause between subsequent doses
Droperidol
Precautions / Notes
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
Fentanyl
Precautions / Notes
Elderly patients
Respiratory depression: especially those at risk e.g. patients with severe COPD
Patients currently on MAO inhibitors or MAO inhibitor use within previous 14 days
Caution in larger doses of women in active labour
Use of IV Ketamine as analgesic prior to minimum (age dependant) dose of IV Fentanyl requires ASMA authorisation:
Paediatric: 100 microg
Adult < 70 years old: 200 microg
Adult > 70 (or frail): 100 microg
Administer slowly
Cease administration prior to calculated dose if desired effect is obtained.
Patients under extended care (e.g. ‘ramped’ patients) who have already been administered pain relief should have careful consideration with regards to the dosages of fentanyl administered, titrating only to effect.
Glucagon
Precautions / Notes
Glucagon is effective in treating hypoglycaemia only if sufficient liver glycogen is present (i.e. it does not work on alcohol or anorexia induced hypoglycaemia).
Give complex carbohydrates orally when patient has responded to prevent recurrent hypoglycaemia
Even if fully recovered, patients should be encouraged to be transported to a medical facility to ensure effective follow up and review.
Glucose 10%
Precautions / Notes
Patients should ideally be cannulated with a large gauge cannula into a large vein, with patency confirmed with a free flowing bolus (>20 mL) of 0.9% normal saline, before administering glucose 10% using a 20 mL syringe via the injection port, titrated to effect. Administration via an IO should utilise a 20 mL 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.
Glucose Oral Gel
Precautions / Notes
Monitoring Required: Blood Glucose Level
If unconscious, have patients in lateral position and airway patent
Do not delay transport for paediatric patients
Potential airway obstruction with oral administration, particularly in young children (under 1 year), administer per instructions with caution
PI/AP/Extended care scoped officers:
Severe Hypoglycaemia (loss of consciousness, seizure), consider Glucagon/IV Glucose
GTN
Precautions / Notes
Nitrates are an early intervention and should not be delayed until on the stretcher or inside the ambulance
Administer to the patient in a seated or semi-recumbent position
Prime the bottle before using it for the first time by pressing the nozzle 5 times, spraying it into the air
Do not shake GTN bottle prior to administration
Assess BP before every dose
Severe hypotension is an uncommon side effect
Intoxication (effect are enhanced)
Phosphodiesterase 5 inhibitor medication administration in previous 4 days
Heparin
Precautions / Notes
Haemorrhagic risks in case of possible trauma.
Hydrocortisone
Precautions / Notes
Dosage to be given in line with patients own management plan or as below (Management) if no management plan available
Normal Saline
Precautions / Notes
Adult patients with penetrating trauma, ectopic pregnancy or aortic aneurysm with hypotension and signs of impaired organ perfusion may benefit from permissive hypotension (systolic blood pressure of 70mmHg)
Fluid Therapy for shock, DKA & Hyperosmolar Hyperglycaemic State: Initial fluid therapy is directed toward expansion of the intravascular, interstitial, and intercellular volume, all of which are reduced in hyperglycaemic crises and restoration of renal perfusion.
Ipratropium Bromide
Precautions / Notes
Glaucoma
Avoid contact with eyes.
Ketamine
Precautions / Notes
Caution in patients with stable psychiatric disorders such as Schizophrenia
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 (IM / IV / IO) in opioid-dependent patients – consider SOC CSP consult
Lignocaine
Precautions / Notes
Adverse drug reactions are rare when lignocaine is used as a local anaesthetic and is administered correctly.
Loratadine
Precautions / Notes
Severe hepatic impairment2
Elderly: risk of sedation and anticholinergic effects increased2
Not to be administered within 24 hours of previous antihistamine dose without ASMA approval
Antihistamines have no role in the treatment or prevention of respiratory or cardiovascular symptoms in acute anaphylaxis.
Methoxyflurane
Precautions / Notes
Monitoring required: Monitor for over-sedation and apneoa, particularly in children under 51,4
Equipment required: Penthrox® Inhaler Device with charcoal filter attached2
Renal impairment: renal toxicity in high doses2. May worsen declining renal function.
Children under 5 may require assistance using the device1
Elderly: possible reduction in blood pressure or heart rate2
Midazolam
Precautions / Notes
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
Naloxone
Precautions / Notes
Polypharmacy overdose.
Half-life of naloxone is < 1 hour; repeat doses may be required to maintain effect with longer acting opioids and those with active metabolites (e.g. methadone, diphenoxylate, codeine). Observe patients who respond to naloxone for 2-3 hours after administration for signs of re-narcotisation.
Response to Naloxone is rapid; reconsider diagnosis if there is a failure to respond to 2 mg Naloxone.
Patients may be aggressive post Naloxone and administration due to hypoxia. Scene safety and personal safety are paramount.
IN naloxone is only for EMT scope only, unless no other routes available. For more information, see here.
Olanzapine
Precautions / Notes
Address organic causes for behavioural presentations at all times- eg. CVA, TBI, Hypoxia, Hypoglycaemia, etc
Dementia patients – apply caution. Use lower doses
Oral dispersible tablet may be dissolved in water (may slightly delay onset of action but still preferable in non-emergent cases)
‘Agitated or Excited Delirium’, ‘Acute Behavioural Disturbance’ and ‘Drug Induced Psychosis’ are some alternative terms that may be used by other agencies
Ondansetron
Precautions / Notes
Monitoring Required: ECG monitoring may be required for IV administration of high or repeated doses in patients with prolonged QT or risk factors for QT interval prolongation1,4,5
Serotonin Syndrome: Risk of Serotonin Syndrome in concomitant use of other serotonergic drugs (e.g. SSRIs and SNRIs)
Hepatic Impairment: reduces clearance and prolongs half life2
Phenylketonuria: wafers contain aspartame, administer with caution2
Pregnancy, First Trimester: not recommended, seek advice from CSPSCC/STORC7
Children with gastroenteritis with diarrhoea as the prominent symptom: ondansetron may worsen diarrhoea3
Rapid injection may cause dizziness and transient visual disturbances.4
Oxygen
Precautions / Notes
If the target saturations cannot be maintained with the nasal cannula or medium concentration mask then change to a non-rebreather oxygen mask.
Oxygen increases the toxicity in paraquat poisoning, target saturations of 88–92%.
Remember that some conditions can affect SpO2 readings e.g. carbon monoxide poisoning and cold digits
