Protocols Flashcards
(222 cards)
1
Q
Indications- Adrenaline
A
Anaphylaxis OR severe allergic reaction
Severe life-threatening bronchospasm OR silent chest. (Patients must only be able to speak in single words AND/OR have haemodynamic compromise AND/OR an ALOC.)
Bradycardia with poor perfusion (unresponsive to atropine AND/OR TCP)
Cardiac arrest
Croup (with stridor at rest)
Shock unresponsive to adequate fluid resuscitation (excluding haemorrhagic cause)
2
Q
Contraindications-Adrenaline
A
KSAR
3
Q
Precautions-Adrenaline
A
Hypovolaemic shock
Hypertension
Patients taking monoamine oxidase inhibitors (MAOIs)
4
Q
Side effects -Adrenaline
A
Anxiety
Hypertension
Palpitations/tachyarrhythmias
Pupil dilation
5
Q
Adrenaline adult dosages-anaphylaxis
A
IMi 500 mcg
Repeated at 5 minutes if no improvement as per ARC guidelines
NEB 5 mg
Single dose only
May be administered for minor facial or tongue swelling thought to be allergic in origin. If stridor present, IM or IV adrenaline must be administered.
IV/IO 20–50mcg (ICP only)
Repeated at 1 minute intervals
No maximum dose
6
Q
Adrenaline adult dosages- Severe life-threatening bronchospasm OR silent chest
(patients must only be able to speak in single words AND/OR have haemodynamic compromise AND/OR an ALOC.)
A
IM - 500 mcg
Repeated at 5 minutes if no improvement as per ARC guidelines
IV/IO - 20 mcg (ICP)
Repeated at 1 minute intervals.
No maximum dose
7
Q
Adrenaline adult dosages - Bradycardia with poor perfusion (unresponsive to atropine AND/OR TCP)
A
IV/IO 20 mcg (ICP)
Repeated at 1 minute intervals. No maximum dose
8
Q
Adrenaline adult dosages - Cardiac arrest
A
IV/IO 1mg
Repeated at 3-5 minute intervals as per ARC guidelines
No maximum dose
9
Q
Adrenaline adult dosages - Shock unresponsive to adequate fluid resuscitation (excluding haemorrhagic cause)
A
IV/IO 20 mcg (ICP)
Repeated at 1 minute intervals. No maximum dose
10
Q
Adrenaline paediatric dosages
Anaphylaxis OR severe allergic reaction
A
IM = or > 6 years - 300 mcg
Repeated at 5 minutes if no improvement as per ARC guidelines
< 6 years - 150 mcg
Repeated at 5 minutes if no improvement as per ARC guidelines
NEB 5 mg
Single dose only.
May be administered for minor facial or tongue swelling thought to be allergic in origin. If stridor present, IM or IV adrenaline must be administered.
IV/IO 2 mcg/kg (ICP)
Single dose not to exceed 50 mcg. Repeated at 2 minute intervals.
11
Q
Adrenaline paediatric dosages -
Severe life-threatening bronchospasm OR silent chest
(patients must only be able to speak in single words AND/OR have haemodynamic compromise AND/OR an ALOC.)
A
IM = or > 6 years - 300 mcg
Repeated at 5 minutes if no improvement as per ARC guidelines
< 6 years - 150 mcg
Repeated at 5 minutes if no improvement as per ARC guidelines
IV/IO 2 mcg/kg (ICP)
Single dose not to exceed 50 mcg. Repeated at 2 minute intervals. No maximum dose
12
Q
Adrenaline paediatric dosages - Cardiac arrest
A
IV 10 mcg/kg (ICP)
as per ARC guidelines Repeated at 3-5 minute intervals.
No maximum dose
IO 10 mcg/kg
as per ARC guidelines Repeated at 3-5 minute intervals. No maximum dose
13
Q
Adrenaline paediatric dosages - Croup (with stridor at rest)
A
NEB 5 mg
Single dose only
14
Q
Adrenaline paediatric dosages - Shock unresponsive to adequate fluid resuscitation
(excluding haemorrhagic cause)
A
IV/IO 2 mcg/kg (ICP)
Single dose not to exceed 50 mcg. Repeated at 2 minute intervals.
No maximum dose
15
Q
Adrenaline paediatric dosages - Bradycardia with poor perfusion
(unresponsive to atropine AND/OR TCP)
A
IV/IO 2 mcg/kg (ICP)
Single dose not to exceed 50 mcg. Repeated at 2 minute intervals.
No maximum dose
16
Q
Indications -Amiodarone
A
Cardiac arrest (refractory VF or pulseless VT)
17
Q
Contra-indications - Amiodarone
A
Nil in Cardiac arrest (refractory VF or pulseless VT)
18
Q
Precautions - Amiodarone
A
Cardiac arrest (refractory VF or pulseless VT): - concomitant use of anti-arrhythmics that prolong the QT interval - thyroid disease
19
Q
Side effects - Amiodarone
A
Hypotension
Bradycardia
Nausea and/or vomiting
Peripheral paraesthesia
20
Q
Amiodarone adult dosages - Cardiac arrest (refractory VF or pulseless VT) as per ARC guidelines
A
IV 300 mg
Slow push over 2 minutes.
Repeat once at 150 mg after 5 minutes Total maximum dose – 450 mg
IO 300 mg
Slow push over 2 minutes.
Repeated once at 150 mg after 5 minutes
Total maximum dose – 450 mg
21
Q
Amiodarone paediatric dosages - Cardiac arrest (refractory VF or pulseless VT) as per ARC Guidelines
A
IV 5 mg/kg (ICP)
Slow push over 2 minutes.
Single dose only
Syringe preparation: Mix 150 mg (3 mL) of amiodarone with 12 mL of glucose 10% (totalling 15 mL) in a 20 mL syringe to achieve a final concentration of 10 mg/mL.
IO 5 mg/kg
Slow push over 2 minutes.
Single dose only
Syringe preparation: Mix 150 mg (3 mL) of amiodarone with 12 mL of glucose 10% (totalling 15 mL) in a 20 mL syringe to achieve a final concentration of 10 mg/mL.
22
Q
Indications -Aspirin
A
Suspected ACS
Acute cardiogenic pulmonary oedema
23
Q
Contraindications - Aspirin
A
KSAR to aspirin or other NSAIDs Chest pain associated with psych stimulant overdose Bleeding disorders Current GI bleeding or peptic ulcers Patients < 12 years
24
Q
Precautions - Aspirin
A
Possible aortic aneurysm or any other condition that may require surgery
Pregnancy
History of GI bleeding or peptic ulcers
Concomitant anticoagulant therapy (excluding clopidogrel)
25
Side effects - Aspirin
```
Epigastric pain/discomfort
Nausea and/or vomiting
Gastritis
GI bleeding
NSAID induced bronchospasm
```
26
Aspirin adult dosages -
Suspected ACS
Acute cardiogenic pulmonary oedema
PO >12 years - 300 mg
| Chewed and followed by a small sip of water (where possible)
27
Indications- Atropine
Bradycardia (with poor perfusion – Pre Adrenaline)
Envenomation (with increased parasympathetic activity)
Hypersalivation (with ketamine administration)
Organophosphate toxicity (with cardiac AND/OR respiratory compromise).
28
Contraindications - Atropine
KSAR
29
Precautions -Atropine
Atrial flutter
Atrial fibrillation
AMI
Glaucoma
30
Side effects - Atropine
```
Agitation
Hallucinations
Dilated pupils
Dry mouth/dry skin/reduced bronchial and gastric secretions
Tachycardia
```
31
Atropine adult dosage -
Bradycardia (with poor perfusion)
IV/IO 600 mcg (ICP)
Repeated once after 2 minutes
Total maximum dose 1.2 mg
32
Atropine adult dosages - Envenomation (with increased parasympathetic activity)
IM 1.2 mg (ICP)
Repeated at 5 minute intervals.
No maximum dose
IV/IO 1.2 mg (ICP)
Repeated at 5 minute intervals.
No maximum dose
33
Atropine adult dosages - Hypersalivation (with ketamine administration)
IV/IO 600 mcg (ICP)
Single dose only
34
Atropine adult dosage - Organophosphate toxicity (with cardiac AND/OR respiratory compromise)
IM 1.2 mg (ICP)
Repeated at 5 minute intervals.
No maximum dose
IV/IO 1.2 mg (ICP)
Repeated at 5 minute intervals.
No maximum dose
35
Atropine paediatric dosage - Bradycardia (with poor perfusion)
IV/IO 20 mcg/kg (ICP)
Single dose not to exceed 600 mcg.
Repeated once after 2 minutes.
Total maximum dose 40 mcg/kg
36
Atropine paediatric dosage -
Envenomation (with increased parasympathetic activity)
Organophosphate toxicity (with cardiac AND/OR respiratory compromise)
IM 20 mcg/kg (ICP)
Single dose not to exceed 600 mcg.
Repeated at 5 minute intervals.
No maximum dose
IV/IO 20 mcg/kg (ICP)
Single dose not to exceed 600 mcg.
Repeated at 5 minute intervals.
No maximum dose
37
Atropine paediatric dosage -
Hyper-salivation (with ketamine administration)
IV/IO 20 mcg/kg (ICP)
| Single dose only, not to exceed 600 mcg
38
Indications - Calcium Gluconate 10%
Suspected hyperkalaemic cardiac arrest.
Severe hyperkalaemia (with haemodynamic compromise AND/OR significant cardiac rhythm disturbance)
Calcium channel blocker toxicity
Hypotension associated with a magnesium infusion (that fails to respond to intravenous fluid therapy
39
Contraindications - Calcium Gluconate 10%
KSAR
| Digoxin (digitalis) overdose
40
Precautions - Calcium Gluconate 10%
Respiratory acidosis
41
Side effects - Calcium Gluconate
Suspected hyperkalaemic cardiac arrest:
nil
```
For all other SJANT indications IV administration may cause:
syncope
hypotension
bradycardia
cardiac dysrrhythmias
cardiac arrest
```
42
Calcium Gluconate 10% adult dosage-
Suspected hyperkalaemic cardiac arrest
Severe hyperkalaemia
(with haemodynamic compromise ANT/OR significant cardiac rhythm disturbance)
Calcium channel blocker toxicity
Hypotension associated with a magnesium infusion (that fails to respond to intravenous fluid therapy)
IV/IO 10 mL (ICP)
Slow push over 2 minutes
Repeated once at 10 minutes
43
Calcium Gluconate 10% paediatric dosages-
Suspected hyperkalaemic cardiac arrest
Severe hyperkalaemia (with haemodynamic compromise ANT/OR significant cardiac rhythm disturbance)
Calcium channel blocker toxicity
Hypotension associated with a magnesium infusion (that fails to respond to intravenous fluid therapy)
IV/IO 0.2 mL/kg (ICP)
Slow push over 2 minutes
Repeated once at 10 minutes
44
Indications - Ceftriaxone
Suspected meningococcal septicaemia (with a non- blanching petechial AND/OR purpuric rash).
45
Contraindications - Ceftriaxone
< 1 month old
KSAR to cephalosporin drugs
Known anaphylaxis or severe allergic reaction to penicillin based drugs – (isolated minor drug rash attributed to penicillin does not contraindicate the use of ceftriaxone.
46
Precautions - Ceftriaxone
Nil
47
Side effects - Ceftriaxone
Nausea and/or vomiting
| Pain at the IM administration site
48
Ceftriaxone Adult dosages
| Suspected meningococcal septicaemia
with a non-blanching petechial AND/OR purpuric rash
IM 4g
The solution should be administered by deep intramuscular injection
Syringe preparation:
Reconstitute two 2 gram vials with approximately 2.4mL of water for injection to achieve a final concentration of
4 g/4 mL (1 g/mL).
```
IV 4g
Slow push over 3 - 5 minutes
Syringe preparation:
Reconstitute two 2 gram vials with approximately 8.4 mL of water for injection to achieve a final concentration of
4g/10 mL (400 mg/mL)
```
49
Ceftriaxone Paediatric dosages -
| Suspected meningococcal septicaemia
with a non-blanching petechial AND/OR purpuric rash
IM 100 mg/kg (> 1 month)
The solution should be administered by deep
intramuscular injection
Syringe preparation:
Reconstitute 2 g of ceftriaxone with 3.6 mL of water for injection to achieve a final concentration of
2 g/4 mL (500 mg/mL)
```
IV 100 mg/kg (> 1 month) -ICP
Slow push over 3 - 5 minutes
Syringe preparation:
Reconstitute 2 g of ceftriaxone with 9.6 mL of water for injection to achieve a final concentration of
2 g/10 mL (200 mg/mL)
```
50
Indications - Fentanyl
Significant pain
| Sedation for the maintenance of an established ETT
51
Contraindications - Fentanyl
KSAR or hypersensitivity to fentanyl
NAS administration:
* GCS < 14
* suspected nasal or mid fractures
* blood or mucous obstructing the nasal passage
52
Precautions - Fentanyl
```
Elderly patients
Hypotension
Respiratory tract burns
Respiratory depression and/or failure
Known addiction to narcotics
Patients taking monoamine oxidase inhibitors (MAOIs)
```
53
Side effects - Fentanyl
```
Bradycardia
Drowsiness
Hypotension
Nausea and/or vomiting
Pin point pupils
Respiratory depression
Muscular rigidity (particularly muscles of respiration)
```
54
Fentanyl Adult dosages - Significant Pain
IM 25–100mcg (ICP)
Repeated at up to 50 mcg every 10 minutes No maximum dose
IV/IO 25–50mcg (ICP)
Repeated at up to 50 mcg every 5 minutes
No maximum dose
NAS 1.5 mcg/kg
Repeated once at 1 mcg/kg after 10 minutes
55
Fentanyl adult dosage - Sedation for the maintenance of an established ETT
IV/IO 25 mcg (ICP)
Consider administration with midazolam. Repeated PRN
No maximum dose
56
Fentanyl Paediatric dosages
Significant pain
NAS > 1 year – 1.5 mcg/kg
Repeated once at 1 mcg/kg at 10 minutes.
Total maximum dose 100 mcg
< 1 year – SJANT on-call medical officer consult and approval required in all situations
57
Indications - frusemide
Congestive cardiac failure
Fluid overload
Oliguria (after correction of hypotension and hypovolamia)
58
Contraindications - frusemide
KSAR
| Patients < 12 years of age
59
Precautions - frusemide.
Hypotension
60
Side effects - frusemide
Marked diuresis can lead to hypotension
| Potassium loss associated with diuresis may aggravate or potentiate dysrrhythmias
61
Adult dosages - frusemide
| Congestive cardiac failure
Fluid overload
Oliguria
after correction of hypotension and hypovolaemia
IV 40 mg (ICP)
Consider repeating after 5 minutes.
Maximum total dose 80 mg
62
Indications - Gastrolyte
Oral correction of fluid and electrolyte loss
63
Contraindications - Gastrolyte
Not be administered to infants <2 year
| Intestinal obstruction
64
Precautions - Gastrolyte
Only mixed with water
65
Side effects - Gastrolyte
Nil
66
Adult dosages Gastrolyte
Symptomatic dehydration (with the ability to self administer)
PO 1 sachet
Re-constituted with 200 ml water
May repeat PRN
67
Gastrolyte paediatric dosage
PO 1 sachet
Re-constituted with 200 ml water
May repeat PRN
68
Indications - Glucagon
Symptomatic hypoglycaemia (with the inability to self- administer oral glucose)
69
Contraindications - Glucagon
KSAR
70
Precautions - Glucagon
Nil
71
Side effects - Glucagon
Nil
72
Adult dosages - Glucagon
| Symptomatic hypoglycaemia
with the inability to self administer oral glucose
IM 1mg
| Single dose only
73
Glucagon Paediatric dosages
| Symptomatic hypoglycaemia
with the inability to self administer oral glucose
IM
>25Kg -1mg Single dose only
< 25 Kg – 500 mcg Single dose only
74
Indications - Glucose 5%
As a vehicle for drug delivery during IV drug infusion administration.
75
Contraindications - Glucose 5%
Nil
76
Precautions - Glucose 5%
Hyperglycaemia
77
Side effects - Glucose 5%
Nil
78
Glucose 5% Adult dosages
As a vehicle for drug delivery during IV drug infusion administration
IV INF
As documented on DTP
Maximum Dosage 1000ml
79
Glucose 5% Paediatric dosages
As a vehicle for drug delivery during IV drug infusion administration
```
IV INF (ICP)
As documented on DTP
```
Maximum Dosage 500ml
80
Indications - Glucose 10%
Symptomatic hypoglycaemia (with the inability to self- administer oral glucose)
81
Contraindications - Glucose 10%
Nil
82
Precautions - Glucose 10%
Tissue and/or vascular necrosis secondary to extravasation.
83
Side effects - Glucose 10%
Nil
84
Glucose 10% Adult dosages
| Symptomatic hypoglycaemia
with the inability to self administer oral glucose
IV 150 ml
Repeated at 100 mL boluses every 5 minutes until BGL > 4.0 mmol/L
IO 150 mL ( ICP)
Repeated at 100 mL boluses every 5 minutes until BGL > 4.0 mmol/L
85
Glucose 10% Paediatric dosages
| Symptomatic hypoglycaemia
with the inability to self administer oral glucose
IV 2.5 mL/kg (ICP)
Repeated at 1 mL/kg boluses every 5 minutes
until BGL > 4.0 mmol/L
IO 2.5 mL/kg (ICP)
Repeated at 1 mL/kg boluses every 5 minutes until BGL > 4.0 mmol/L
86
Indications - Glucose gel
Symptomatic hypoglycaemia (with the ability to ingest oral glucose)
87
Contra indications - Glucose gel
KSAR
Unconsciousness
Patients with difficulty swallowing
Patients < 2 years
88
Precautions - Glucose gel
Nil
89
Side effects - Glucose gel
Nausea and/or vomiting
| Diarrhoea
90
Glucose gel Adult dosages
Symptomatic hypoglycaemia (with the ability to ingest oral glucose)
PO 15g
Repeated once at 15 minutes
if BGL < 4.0 mmol/L.
Total maximum dose 30 g
91
Glucose gel paediatric dosages
Symptomatic hypoglycaemia (with the ability ingest oral glucose
PO > 2 years – 15 g
Repeated once at 15 minutes if BGL < 4.0 mmol/L
Total maximum dose 30 g
92
Indications - Glyceryl Trinitrate
Suspected ACS
Acute cardiogenic pulmonary oedema
Autonomic dysreflexia (with a systolic BP > 160 mmHg)
Irukandji syndrome (with a systolic BP > 160 mmHg)
93
Contra indications - Glyceryl Trinitrate
KSAR
Heart rate < 50 OR > 150 beats per minute
Systolic BP < 100 mmHg
Acute CVA
Head trauma
Erectile dysfunction medication (e.g. Viagra® or Levitra®) in the previous 24 hours.
94
Precautions - Glyceryl Trinitrate
Suspected inferior AMI
Cerebral vascular disease
Risk of hypotension and/or syncope
Intoxication (GTN effects are enhanced)
Erectile dysfunction medication (e.g. Viagra® or Levitra®) in the previous 4 days
95
Side effects - Glyceryl Trinitrate
```
Dizziness
Hypotension
Syncope
Reflex tachycardia
Vascular headaches
```
96
Glyceryl trinitrate Adult dosages:
*Suspected ACS
(with a systolic BP >100 mmHg)
* Acute cardiogenic pulmonary oedema (with a systolic BP >100 mmHg)
* Autonomic dysreflexia (with a systolic BP > 160 mmHg)
*Irukandji syndrome
(with a systolic BP > 160 mmHg)
SL 300 mcg – 600 mcg (Tablet)
Repeated at 5 minute intervals
No maximum dose
97
Glyceryl trinitrate Paediatric dosages:
| Autonomic dysreflexia (with a systolic BP > 160 mmHg
Irukandji syndrome
with a systolic BP > 160 mmHg)
SL (ICP)
SJANT on-call medical officer consultation and approval required in all situations.
98
Indications - Hydrocortisone
Moderate OR severe asthma.
Acute exacerbation of COPD
(with evidence of respiratory distress).
Severe allergic reaction OR anaphylaxis
(requiring adrenaline administration).
Symptomatic adrenal insufficiency
(with a known history of Addison’s disease, congenital adrenal hyperplasia, pan-hypopituitarism or long-term steroid administration).
99
Contra indications - Hydrocortisone
KSAR
100
Precautions - hydrocortisone
Hypertension
101
Side effects - hydrocortisone.
Nil
102
Adult dosages hydrocortisone
Moderate OR severe asthma
Acute exacerbation of COPD (with evidence of respiratory distress)
Severe allergic reaction OR anaphylaxis (requiring adrenaline administration)
IM 200 mg (ICP)
Single dose only
IV 200 mg (ICP)
Single dose only
Slow push over 1 minute
103
Hydrocortisone adult dosages:
Symptomatic adrenal insufficiency
(with a known history of Addison’s disease, congenital adrenal hyperplasia, pan- hypopituitarism or long-term steroid administration
```
IM 100mg (ICP)
Single dose only
```
IV 100 mg (ICP)
Single dose only
Slow push over 1 minute
104
Hydrocortisone Paediatric dosages:
Moderate OR severe asthma
Severe allergic reaction OR anaphylaxis (requiring adrenaline
administration)
Symptomatic adrenal insufficiency
(with a known history of Addison’s disease, congenital adrenal hyperplasia, pan-hypopituitarism or long-term steroid administration)
IM 5 mg/kg (ICP)
Single dose only, not to exceed 100 mg
IV 5 mg/kg (ICP)
Single dose only, not to exceed 100 mg
Slow push over 1 minute
Note: In all other instances SJANT officers are not authorised to administer hydrocortisone to paediatric patients.
105
Indications - Ipratropium Bromide
Severe bronchospasm OR silent chest
| Patients must only be able to speak in single words AND/OR have haemodynamic compromise AND/OR an ALOC
106
Contra indications - Ipratropium bromide
KSAR to anticholinergics
| Patients < 2 years.
107
Precautions - Ipratropium bromide
Glaucoma
| Prostatic hypertrophy
108
Side effects - Ipratropium bromide
Dilated pupils
Dry mouth
Palpitations
109
Ipratropium bromide Adult dosages:
Severe life-threatening bronchospasm OR silent chest (patients must only be able to speak in single words AND/OR have
haemodynamic compromise AND/OR an ALOC)
NEB 500 mcg
| Single dose only
110
Ipratropium bromide Paediatric dosages:
Severe life-threatening bronchospasm OR silent chest
(patients must only be able to speak in single words AND/OR have haemodynamic compromise AND/OR an ALOC)
NEB 250 mcg
Single dose only
Note: SJANT officers are not authorised to administer ipratropium bromide to patients < 2 years of age.
111
Indications - Ketamine
Severe traumatic pain
(following 0.1 – 0.2 mg/kg morphine) associated with:
* fracture reduction and splinting;
* multiple or significant fractures requiring facilitated extrication.
Severe traumatic pain
(following 0.2 – 0.3 mg/kg morphine) associated with burns.
112
Contra indications - Ketamine
KSAR
Age < 5 years
GCS< 12
Uncontrolled hypertension (SBP > 180 mmHg AND/OR DBP > 11o mmHg)
Suspected acute ACS or acute heart failure
Known hydrocephalus or raised intra-ocular pressure
113
Precautions - Ketamine
Age > 65 years
Patients who have been administered midazolam or other CNS depressant medication
Patients with significant hypovolaemia – exaggerated effects and a delayed onset of action
Globe injuries
Complex facial injuries and fractures
Patients who have impaired respiratory function
Patients exhibiting psychotic symptoms
114
Side effects - Ketamine
```
Dissociation and trance-like state
Transient hypertonicity and nystagmus
Disinhibition
Emergence (up to 10% more common in Adults)
Hypertension
Tachycardia
Depression of consciousness
Hypersalivation
Nausea and/or vomiting
Laryngospasm
Respiratory depression (rare)
```
115
Ketamine Adult dosages
Severe traumatic pain
(following 0.1 – 0.2 mg/kg morphine) associated with:
fracture reduction and splinting;
multiple or significant fractures requiring facilitated extrication
IV /IO 10–20mg (ICP)
Repeated every 2 – 3 minutes Total maximum dose 1 mg/kg
Syringe preparation:
Mix 200 mg (2 mL) of ketamine with 18 mL sodium chloride 0.9% OR water for injection in a 20 mL syringe to achieve a final concentration of
10 mg/mL.
116
Ketamine adult dosage:
Severe traumatic pain
(following 0.2 – 0.3 mg/kg morphine) associated with:
burns
IV /IO 10–20mg (ICP)
Repeated every 2 – 3 minutes Total maximum dose 1 mg/kg
Syringe preparation:
Mix 200 mg (2 mL) of ketamine with 18 mL sodium chloride 0.9% OR water for injection in a 20 mL syringe to achieve a final concentration of 10 mg/mL.
117
Ketamine Paediatric dosages:
Severe traumatic pain
(following 0.1 – 0.2 mg/kg morphine) associated with:
fracture reduction and splinting;
multiple or significant fractures requiring facilitated extrication
ICP only
IV /IO > 1 year - 100 mcg/kg (0.1 mg/kg) Repeated every 2 – 3 minutes
Total maximum dose 1 mg/kg
Syringe preparation:
Mix 200 mg (2 mL) of ketamine with 18 mL sodium chloride 0.9% OR water for injection in a 20 mL syringe to achieve a final concentration of
10 mg/mL. Decant 18 mL of the prepared solution and dilute with a further 18mL of sodium chloride 0.9% in a 20 mL syringe to achieve a final concentration of 1 mg/mL.
118
Ketamine paediatric dosage:
Severe traumatic pain
(following 0.2 – 0.3 mg/kg morphine ) associated with:
burns
IV /IO > 1 year - 100 mcg/kg (0.1 mg/kg) ICP
Repeated every 2 – 3 minutes
Total maximum dose 1 mg/kg
Note: SJANT officers are not authorised to administer ketamine to patients < 1 years of age.
119
Indications - Lignocaine 2%
Conscious VT (without haemodynamic compromise)
To reduce the pain associated with IO drug and fluid administration following EZ-IO® needle insertion (when the patient is not in cardiac arrest)
Local anaesthesia
120
Contra indications - Lignocaine 2%
Conscious VT without haemodynamic compromise:
- KSAR
- bradycardia
- current heart failure
- heart block or conduction defects
- Torsades de Pointes
To reduce the pain associated with IO drug and fluid administration following EZ-IO® needle inserted (when patient is not in cardiac arrest):
- KSAR
Local anaesthesia for the purpose of radial artery line placement:
- KSAR
121
Precautions - Lignocaine 2%
Conscious VT without haemodynamic compromise:
- hypotension and poor perfusion
Local anaesthesia for the purpose of radial artery line placement:
- potential for intravascular injection
122
Side effects - lignocaine 2%
Convulsions
Hypotension
Nausea
Tinnitus
123
Lignocaine Adult dosages:
| Conscious VT
without haemodynamic compromise
IV 1 – 1.5 mg/kg (ICP)
slow IV push over 2 minutes
Repeated once at half the initial dose at 10 minutes.
Total maximum dose 300 mg
124
Lignocaine adult dosages:
To reduce pain associated with IO drug and fluid administration following EZ-IO® needle insertion
(when the patient is not in cardiac arrest)
IO 60 mg (ICP)
(40 mg followed by a rapid sodium chloride 0.9% 10 mL flush, followed by an additional 20 mg).
Total maximum dose 60 mg.
125
Lignocaine 2% Paediatric dosages:
To reduce pain associated with IO drug and fluid administration following EZ-IO® needle insertion
(when the patient is not in cardiac arrest)
IO 1 mg/kg (ICP)
single dose only
Maximum dose 20 mg
Note: In all other instances, SJANT officers are not authorised to administer lignocaine 2% to paediatric patients.
126
Indications - Magnesium sulphate
Box jellyfish (Chironex fleckeri) envenomation (unresponsive to vinegar, ice, narcotic)
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 require IM/IV adrenaline)
127
Contra Indications - Magnesium sulphate
KSAR
Heart block
Renal failure
128
Precautions - Magnesium sulphate
Renal impairment
129
Side effects - Magnesium sulphate
Pain at the cannulation site
Magnesium toxicity
- hypotension/respiratory depression
- loss of deep tendon reflexes
130
Magnesium sulphate Adult dosages
| Severe life-threatening asthma
only in patients who have required IM/IV adrenaline
IV 10 mmol (ICP)
Slow push over 10 minutes.
Single dose only
IO 10 mmol (ICP)
Slow push over 10 minutes.
Single dose only
131
Magnesium sulphate dosages:
Torsades de Pointes
IV / IO 10 mmol (ICP)
Slow push over 10 minutes.
Repeated once at 10 minutes
Total maximum dose 20 mmol
132
Magnesium sulphate dosages:
| ```
Irukandji syndrome
with intractable pain unrelieved by narcotic analgesia AND/OR systolic BP > 160 mmHg
```
IV/IO Loading dose – 20 mmol (ICP)
Slow push over 10 minutes.
Repeated once at 10 minutes (only if indicated for ongoing treatment).
133
Magnesium sulphate Adult dosages:
Eclampsia
IV Loading dose – 20 mmol (ICP)
Slow push over 10 minutes.
Repeated once at 10 minutes (only if indicated for ongoing treatment).
134
Magnesium sulphate adult dosages:
Box jellyfish (Chironex fleckeri) envenomation (unresponsive to vinegar, ice, narcotic)
IV /IO 20 mmol (ICP)
Slow push over 10 minutes.
Single dose only
135
Magnesium sulphate Paediatric dosages:
| Severe life-threatening asthma
only in patients who have required IM/IV adrenaline
IV / IO 0.1 mmol/kg (ICP)
(rounded up to the nearest 0.5 mmol)
Slow push over 10 minutes.
Single dose only, not to exceed 5 mmol
136
Magnesium sulphate paediatric dosages:
Torsades de Pointes
IV /IO 0.1 mmol/kg (ICP)
(rounded up to the nearest 0.5 mmol)
Slow push over 10 minutes.
Single dose not to exceed 5 mmol
Repeated once at 10 minutes
Total maximum dose 10 mmol
137
Magnesium sulphate Paediatric dosages:
Irukandji syndrome
(with intractable pain unrelieved by narcotic analgesia AND/OR systolic BP > 160 mmHg)
Box jellyfish (Chironex fleckeri) envenomation
(unresponsive to vinegar, ice, narcotic)
IV / IO 0.1 mmol/kg (ICP)
(rounded up to the nearest 0.5 mmol)
Slow push over 10 minutes.
Single dose not to exceed 5 mmol
Repeated once at 10 minutes.
Total maximum dose 10 mmol
138
Indications - Methoxyfluorane
Pain
139
Contra indications - Methoxyfluorane
KSAR
Patients < 5 year
Concurrent use of tetracycline antibiotics
History of significant liver or renal disease
Pre eclampsia
History of malignant hyperthermia
140
Precautions - Methoxyfluorane
ALOC
| Intoxicated or drug affected patients
141
Side effects - Methoxyfluorane
ALOC
Cough
Renal/hepatic failure (following repeated high dose exposure)
142
Methoxyfluorane Adult dosages:
Pain
INH 3 mL self-administered
Repeated once after 20 minutes.
Total maximum dose 6 mL.
143
Methoxyfluorane Paediatric dosages:
Pain
INH 3 mL > 5 year, self-administered
Single dose only.
144
Indications - Metoclopramide
Nausea AND/OR vomiting
Prophylactic use if the patient has previously experienced nausea AND/OR vomiting with narcotics AND/OR motion sickness
Suspected Spinal Injuries
Aero Medical Evacuation
145
Contra indications - Metoclopramide
KSAR
Patients < 12 years
History of dystonic reactions
Not to be given within 6 hours of phenothiazine administration (e.g. Stemetil® (prochlorperazine)/ promethazine)
GI haemorrhage
Patients with bowel obstruction or perforation
146
Precautions - Metoclopramide
Patients with undiagnosed abdominal pain
147
Side effects - Metoclopramide
Drowsiness, lethargy
Dry mouth
Oculogyric crisis
Dystonic reaction
148
Metoclopramide Adult dosages:
Nausea AND/OR vomiting
Prophylactic use if the patient has previously experienced nausea AND/OR vomiting with narcotics AND/OR motion
sickness
As per indications
IM > 12 years – 10 mg
IV >12 years – 10 mg
Slow push over 1 – 2 minutes.
149
Indications - Midazolam
Seizures/convulsions
Sedation for:
*maintenance of established ETT
*severely agitated patients (not due to pain) agitated head injuries *to facilitate assessment and treatment
*procedures (e.g. TCP or cardioversion)
*ketamine disinhibition or agitated emergence
150
Contra indications - Midazolam
KSAR to benzodiazepines
| Patients being restrained in a prone position
151
Precautions - Midazolam
Reduced dosages may be required in elderly patients, patients with chronic renal failure, congestive cardiac failure, or shock.
Can cause severe respiratory depression in patients with COPD.
Myasthenia gravis
Multiple sclerosis
152
Side effects - Midazolam
Hypotension
| Respiratory depression particularly when associated with alcohol or narcotics.
153
Midazalom Adult dosages:
Seizures/convulsions
IN 5 mg
Repeated PRN after 2 minutes
Maximum dose 10 mg
IM 5 mg
Repeated PRN every 10 minutes
Maximum dose 20 mg
IV Up to 2.5mg
Repeated PRN every 5 minutes
No maximum dose
IO Up to 2.5mg (ICP)
Repeated PRN every 5 minutes
No maximum dose
154
Midazolam adult dosages:
Sedation for maintenance of an established ETT
IV / IO 1 - 2.5 mg (ICP)
Consider administration with morphine/fentanyl.
RepeatedPRN. Maximumdose20mg
155
Midazolam adult dosages:
Sedation for agitated head injuries (to facilitate assessment and treatment)
IV/IO 1 - 2.5 mg (ICP)
Repeated PRN every 5 minutes until patient is coopreative or allows administration of oxygen and maintenance of spinal immobilisation. Should be avoided in significant hypovolaemia.
Maximum dose 20 mg
SJANT medical officer consultation and approval required to exceed maximum dose.
156
Midazolam Adult dosages:
Sedation for procedures (e.g. TCP or cardioversion)
IV / IO 1mg (ICP)
Repeated every 2 minutes until moderate level of
sedation achieved.
Maximum dose 20 mg
157
Midazolam adult dosages:
Sedation for severely agitated patients (not due to pain)
IM 2.5-5mg
Repeated PRN every 10 minutes to achieve moderate sedation.
Total maximum dose 20 mg.
IV 1 – 2.5 mg
Repeated PRN every 5 minutes to achieve moderte
sedation.
Total maximum dose 20 mg.
SJANT medical officer consultation and approval required to exceed maximum dose.
158
Midazolam adult dosages:
Sedation for ketamine disinhibition or agitated emergence
IV 1 – 2.5 mg (ICP)
Repeated PRN.
Total maximum dose 5 mg
159
Midazolam Paediatric dosages:
Seizures/convulsions
IM 200 mcg/kg
Single dose not to exceed 5 mg
Repeated at half the initial dose (max 2.5 mg) at 10 minute intervals.
No maximum dose
IN 5 mg
Repeated PRN after 2 minutes
Maximum dose 10 mg
IV / IO 100 mcg/kg (ICP)
Single dose not to exceed 2.5 mg.
Repeated at 5 minute intervals.
160
Midazolam paediatric dosages:
Sedation for patients suffering ketamine disinhibition or agitated emergence
IV / IO 50 mcg/kg (ICP)
Single dose not to exceed 2.5 mg.
Repeated after 5 minutes
Total maximum dose of 5 mg
161
Midazolam paediatric dosages:
Sedation for maintenance of an established ETT
IV / IO Up to 100 mcg/kg (ICP)
Single dose not to exceed 2.5 mg.
Consider administration with morphine. Repeated after 5 minutes
No maximum dose
162
Midazolam Paediatric dosages:
Sedation for all other indications
IM
SJANT on-call medical officer consultation and approval required in all situations.
100 mcg/kg
Single dose not to exceed 2.5 mg. Repeated PRN after 5 minutes
Total maximum dose 5 mg
IV / IO
SJANT on-call medical officer consultation and approval required in all situations.
100 mcg/kg
Single dose not to exceed 2.5 mg. Repeated PRN after 5 minutes
Total maximum dose 5 mg
163
Indications - Morphine
Significant pain
Autonomic dysreflexia
(with a systolic BP > 160 mmHg)
Sedation for the maintenance of an established ETT
164
Contra indications - Morphine
KSAR
165
Precautions - Morphine
```
Elderly patients
Hypotension
Respiratory tract burns
Respiratory depression and/or failure
Known addiction to narcotics
Patients on monoamine oxidase inhibitors (MAOIs)
```
166
Side effects - Morphine
```
Bradycardia
Drowsiness
Hypotension
Nausea and/or vomiting
Pin point pupils
Respiratory depression
```
167
Morphine Adult dosages:
Significant pain
Autonomic dysreflexia (with a significant BP > 160 mmHg)
IM 2.5–10mg
Repeated at up to 5 mg every 10 minutes Maximum dose 20 mg
IV 2.5-5mg
Repeated at up to 5 mg every 5 minutes
Titrate to pain control
No maximum dose
IO 2.5-5mg (ICP)
Repeated at up to 5 mg every 5 minutes
Titrate to pain control
No maximum dose
168
Morphine adult dosages:
Sedation for the maintenance of an established ETT
IV 2.5 mg (ICP)
Consider administration with midazolam. Repeated PRN.
No maximum dose
IO 2.5 mg (ICP)
Consider administration with midazolam. Repeated PRN.
No maximum dose
169
Morphine Paediatric dosages:
Significant pain
Autonomic dysreflexia (with a significant BP > 160 mmHg)
IM > 1 year – 100 – 200 mcg/kg
Single maximum dose 5 mg
Total maximum dose 200 mcg/kg
< 1 year – SJANT on-call medical officer consultation and approval required in all situations.
IV/IO > 1 year –100 mcg/kg
Single maximum dose 2.5 mg
Repeated at 50 mcg/kg (maximum 2.5 mg) at 10 minute intervals
No maximum dose
< 1 year – SJANT on-call medical officer consultation and approval required in all
situations.
170
Morphine Paediatric dosages:
Sedation for the maintenance of an established ETT
IV/IO > 1 year – 100 mcg/kg (ICP)
Single dose not to exceed 2.5 mg.
Consider administration with midazolam
No maximum dose
< 1 year – SJANT on-call medical officer consultation and approval required in all situations.
Note: SJANT officers are not authorised to administer morphine to paediatric patients presenting with cardiogenic chest pain.
171
Indications - Naloxone
Respiratory depression (secondary to the administration of narcotic drugs).
172
Contra indications - Naloxone
KSAR
173
Precautions - Naloxone
Use with caution on patients with pre-existing cardiac disease.
174
Side effects - Naloxone
Narcotic reversal can cause combativeness, vomiting, sweating, tachycardia and hypertension.
May produce acute withdrawal convulsions in the chronic narcotic user.
Pulmonary oedema
175
Naloxone Adult dosages:
Respiratory depression (secondary to the administration of narcotic drugs)
IM 800 mcg
Maximum Dose : 4.0 mg
IV 50 mcg
Repeated PRN to facilitate airway management, titrating to patients response.
No maximum dose.
176
Naloxone Paediatric dosages:
Respiratory depression (secondary to the administration of narcotic drugs)
IM 20 mcg/kg
Single dose only, not to exceed 800 mcg.
IV/IO 20 mcg/kg (ICP)
Titrating to patients response No maximum dose.
177
Indications - Ondansetron
```
Nausea AND/OR vomiting.
Prophylactic use if the patient has previously experienced
nausea AND/OR vomiting with narcotics.
Suspected Spinal Injuries
Aero Medical Evacuation
```
178
Contra indications - Ondansetron
KSAR to Ondansetron or other 5-HT3 receptor antagonists.
| Patients under the age of 3 years
179
Complications - Ondansetron
Hepatic impairment
| Intestinal obstruction
180
Side effects - Ondansetron
```
Headache
Constipation
Sensation of warmth or flushing
Extrapyramidal effects
Dysrrhythmias
```
181
Ondansetron Adult dosages:
Nausea AND/OR vomiting
Prophylactic use if the patient has previously experienced nausea AND/OR vomiting with narcotics
ODT 4mg
| Single dose only
182
Ondansetron Paediatric dosages:
Nausea AND/OR vomiting
Prophylactic use if the patient has previously experienced nausea AND/OR vomiting with narcotics
ODT > 3 years – 2 mg
Single dose only
Note: SJANT officers are not authorised to administer Ondansetron to paediatric patients under the age of 3 years.
183
Contra indications - Oxygen
Known paraquat poisoning with SpO2 > 88
| History of bleomycin therapy with SpO2 >88.
184
Precautions - Oxygen
Patients with paraquat poisoning or bleomycin lung injury may be harmed by supplemental oxygen. Avoid oxygen unless the patient is hypoxaemic – target Sp02 88 – 92%
Prolonged administration to premature neonates.
High concentration given to COPD patients with hypoxic drive.
185
Side effects - oxygen
Hypoventilation in some COPD patients with hypoxic drive.
| Drying of airway mucous membranes.
186
Indications - Paracetomol
Minor pain and fever
187
Contra indications - Paracetomol
KSAR
| Patients < 25 Kg
188
Complications - Paracetomol
Hepatic or renal dysfunction
| Patients taking anticoagulant medications
189
Side effects - Paracetomol
Nausea
190
Paracetomol Adult dosages:
Minor pain and fever
PO 0.5 g – 1 g
Repeated every 4 hours
Total max dose 4 g in 24 hours
191
Paracetomol Paediatric dosages:
Minor pain and fever
PO > 25Kg -20mg/kg Single dose only
Must not be administered within 4 hours of previous paracetamol administration.
Note: SJANT officers are not authorised to administer paracetamol to paediatric patients less than ≤ 25 Kg.
192
Indications - Salbutomol
Bronchospasm
| Suspected hyperkalaemia (with QRS widening AND/OR AV dissociation)
193
Contra indications - Salbutomol
KSAR
| Patients < 2 years
194
Precautions - Salbutomol
Acute pulmonary oedema
| Ischaemic heart disease
195
Side effects - Salbutomol
Anxiety
Tachyarrhythmias
Tremors
Hypokalaemia and metabolic acidosis
196
Salbutomol Adult dosages:
Bronchospasm
NEB 5 mg
Repeated PRN
No maximum dose
197
Salbutomol adult dosages:
Suspected hyperkalaemia (with QRS widening AND/OR AV dissociation)
NEB 20 mg
| Single dose only
198
Salbutomol Paediatric dosages:
Bronchospasm
NEB = or > 2 years - 5 mg
Repeated PRN
No maximum dose
Note:
SJANT officers are not authorised to administer salbutamol to paediatric patients presenting with bronchospasm under the age of 2 years.
SJANT officers are not authorised to administer salbutamol to paediatric patients presenting with suspected hyperkalaemia with QRS widening AND/OR AV dissociation.
199
Indications - Sodium bicarbonate 8.4%
Cardiac arrest:
* > 15 minutes duration;
* secondary to suspected hyperkalaemia (e.g. chronic renal failure);
* secondary to tricyclic antidepressant (TCA) overdose
Significant injury with potential for crush syndrome
TCA overdose with cardiac rhythm disturbance (prolonged QRS.QT interval) OR attributed seizure activity.
Suspected hyperkalaemia (with QRS widening AND/OR AV dissociation)
200
Contra indications - Sodium bicarbonate 8.4%
Nil.
201
Complications - Sodium bicarbonate 8.4%
Administration of sodium bicarbonate 8.4% in the paediatric resuscitation may worsen respiratory acidosis.
202
Side effects - Sodium bicarbonate 8.4%
Cerebral oedema
| Congestive heart failure
203
Sodium bicarbonate 8.4% Adult dosages:
Cardiac arrest
- > 15 minutes duration
- secondary to suspected hyperkalaemia (e.g. chronic renal failure)
- secondary to TCA overdose
Significant injury with potential for crush syndrome
TCA overdose with cardiac rhythm disturbance
(prolonged QRS/QT interval) OR attributed seizure activity
Suspected hyperkalaemia
(with QRS widening AND/OR AV dissociation)
```
IV 100mL ( ICP only except potential for crush syndrome)
Single dose only
```
```
IO 100mL (ICP)
Single dose only
```
204
Sodium bicarbonate 8.4% Paediatric dosages:
Cardiac arrest
- > 15 minutes duration
- secondary to suspected hyperkalaemia (e.g. chronic renal failure)
- secondary to TCA overdose
Significant injury with potential for crush syndrome
TCA overdose with cardiac rhythm disturbance
(prolonged QRS/QT interval) OR attributed seizure activity
Suspected hyperkalaemia
(with QRS widening AND/OR AV dissociation)
IV 1mL/kg (ICP only)
Single dose only
IO 1 mL/kg (ICP only)
Single dose only
205
Indications - Sodium chloride 0.9%
Hypovolaemic shock (Inadequate tissue perfusion)
Burns deep dermal/full thickness > 15%
Cardiogenic shock (Inadequate tissue perfusion)
To dissolve and dilute drugs for the purpose of IM, IV or IO administration
As a flush following IV or IO drug administration.
206
Contraindications - Sodium chloride 0.9%
Nil
207
Precautions - Sodium chloride 0.9%
Patients with acute and/or history of heart failure
Pre-existing renal failure
Uncontrolled haemorrhage (unless associated with severe head injury.
208
Side effects - Sodium chloride 0.9%
Excessive administration will result in fluid overload.
209
Sodium chloride 0.9% Adult dosages:
Hypovolaemic shock
*Inadequate tissue perfusion/shock
Burns deep dermal/full thickness > 15%
IV INF 250 - 500mL aliqots
Repeat as required – titrate according to the
patient’s physiological response to treatment.
Total maximum dose 40 mL/kg.
IO INF 250 - 500mL aliqots (ICP only)
Repeat as required – titrate according to the
patient’s physiological response to treatment.
Total maximum dose 40 mL/kg.
Further fluid may be administered by ICP officers following SJANT on-call medical officer consultation and approval.
210
Sodium chloride 0.9% adult dosages:
To dissolve and dilute drugs for the purpose of IM, IV or IO administration
IM
As documented on DTP
IV
As documented on DTP
IO
As documented on DTP
211
Sodium chloride 0.9% adult dosages:
As a flush following IV or IO drug administration
IV
PRN
IO
PRN
212
Sodium chloride 0.9% Paediatric dosages:
Hypovolaemic shock
*Inadequate tissue perfusion/shock
Burns deep dermal/full thickness > 15%
IV INF 20 mL/kg (ICP only)
May be repeated once following assessment of patient’s needs and physiological response to treatment.
Total maximum dose 40 mL/kg.
Further fluid may be administered by ICP officers following SJANT on-call medical officer consultation and approval.
IO INF 20 mL/kg (ICP only)
May be repeated once following assessment of patient’s needs and physiological response to treatment.
Total maximum dose 40 mL/kg.
Further fluid may be administered by ICP officers following SJANT on-call medical officer consultation and approval.
213
Sodium chloride 0.9% paediatric dosages:
To dissolve and dilute drugs for the purpose of IM, IV or IO administration
IM
As documented on DTP
IV (ICP only)
As documented on DTP
IO
As documented on DTP
214
Sodium chloride 0.9% Paediatric dosages:
As a flush following IV or IO drug administration
IV (ICP only)
PRN
IO
PRN
215
Indications - water for injection
To dissolve and dilute drugs for the purpose of IM, IV, NEB or IO administration.
216
Contraindications - water for injection
Nil
217
Precautions - water for injection
Nil
218
Side effects - water for injection
Nil
219
Water for injection Adult dosages:
To dissolve and dilute drugs for the purpose of IM, IV or IO administration
IM
As documented on DTP
IV
As documented on DTP
IO
As documented on DTP
220
Water for injection Paediatric dosages:
To dissolve and dilute drugs for the purpose of IM, IV or IO administration
IM
As documented on DTP
IV (ICP only)
As documented on DTP
IO
As documented on DTP
221
Sodium chloride adult dosages:
Cardiogenic shock
Inadequate tissue perfusion/shock
IV/IO INF 250mL aliqots (ICP only)
Repeat as required – titrate according to the
patient’s physiological response to treatment.
Excessive fluid infusion may lead to cardiogenic pulmonary oedema in the cardiac patient.
Total maximum dose 1000 ml
222
Sodium chloride paediatric dosages:
Cardiogenic shock
*Inadequate tissue perfusion/shock
IV/IO INF
SJANT on-call medical officer consultation and approval required in all situations.
