Prescribing in Medical Emergencies

Question 1

Resuscitation medication

Answer 1

Shockable Rhythm - Adrenaline should be given on the third cycle of chest compressions - 1mg adrenaline and 300 mg amiodarone

Non-Shockable Rhythm - 1 mg Adrenaline ASAP.

Repeat doses of adrenaline every 3-5 minutes in both shockable and non-shockable until obvious signs of life.

Question 2

CPR

Answer 2

30 chest compressions to 2 breaths at a depth of 5-6cm for 100 to 120bpm. If a definitive airway is in place then continuous chest compressions should be given.

Question 3

Post Cardiac Arrest Treatment Aims

Answer 3

O2 94-98%
Temperature <37.7 for at least 72 hours
MAP >65mmHg
Do not routinely give corticosteroids after arrest.

Question 4

Drugs that lead to cardiac arrest

Answer 4

Opioids
TCA
Benzodiazepines

Question 5

Reversible causes of cardiac arrest

Answer 5

Hypoxia
Hypovolaemia
Hypo/hyperkalemia
Hypothermia
Tamponade
Thromboembolism
Toxins
Tension Pneumothorax

Question 6

CPR and thromboembolism

Answer 6

Echo if suspected at cardiac arrest. CPR continue for up to 90 minutes post thrombolysis.

Question 7

Type 1 allergic drug reaction

Answer 7

Urticaria, itching, angioedema, bronchospasm and hypotension within 30 min of drug administration

Question 8

Drug reaction allergy - Parenteral vs oral

Answer 8

Reaction to parenteral drugs are more severe than oral - median time to cardiac arrest is 5 minutes.

Question 9

Who can administer adrenaline

Answer 9

IM - anyone incase of emergency

IV - only prescribed and administered by experienced physicians with close cardiac monitoring.

Question 10

Which reactions to report in drugs

Answer 10

Any serious drug reaction to the yellow card scheme

Question 11

Observation timescale for drug reactions

Answer 11

6-12 hours and measure tryptase ASAP, and again at 1-2 hours.

Question 12

Which medications would have a higher risk of reaction in a pt with penicillin allergy

Answer 12

1st and 2nd gen cephalosporins
Beta-lactam Abx
Carbapenems

Question 13

Post anaphylaxis workup

Answer 13

Prednisolone for up to 3 days
Non-sedating antihistamine for up to 3 days
Medical alert band if necessary
Allergy is documented.
Warn the patient
Written information
Adrenaline auto-injectors
Report to yellow card scheme

Question 14

RF for drug reactions

Answer 14

Atopic individuals
Co-existing conditions - (HIV, EBV, CF)
Chronic urticaria
Frequent and prolonged doses
Women
Topical treatments

Question 15

Most common drugs causing reactions

Answer 15

Chlorhexadine
Opioids
Non-beta lactam antimicrobials
Penicillins and other beta-lactams
Muscle relaxants
Radiocontrast
Plasma expanders.

Question 16

Adrenaline dosages for age groups

Answer 16

Child <6 months = 100-150mcg
Child 6 months - 6 years = 150mcg
6-12 years = 300 mcg
12+ = 500cg

Question 17

Dosage for cetirizine for 12+

Answer 17

10-20mg.