Adrenaline Flashcards
Adrenaline dose
Epipen Adult 300MCG for over 20kgs
Epipen junior 150MCG for under 20kgs
Aspirin dose
• 300mg chewable tablets
• 300 mg soluble or water dispersible tablets
Adrenaline intra and contras
Indications:
• Cardiac arrest - VF/VT, Asystole or PEA
• Cardiogenic shock
• Anaphylaxis
• Critical asthma
• Stridor due to inflammation
Contraindications:
(Known hypersensitivity plus)
• Contraindications are relative as this product is intended for use in life threatening emergencies
• Hypovolaemic shock without adequate fluid replacement
Precautions
• Consider reduced doses for:
– Elderly / frail patients
– Patients with cardiovascular disease
– Patients on monoamine oxidase inhibitors
Higher doses may be required for patients on beta blockers
Adrenaline side effects and actions
Key timings
• IM effects: Onset: 30 – 90 seconds, Peak: 4 – 10 minutes, Duration: 5 – 10 minutes
• All patients receiving adrenaline for possible anaphylaxis are to be transported to a health service provider for ongoing care
• The ideal location for IM injection is the mid-outer thigh. Other suitable sites include the midline upper arm (deltoid)
• IM adrenaline has a short duration and patients must be closely monitored for reoccurrence of symptoms
• There is an increased the risk of hypotension and tachycardia with patients taking α-blockers
• Severe hypertension and bradycardia may occur with patients taking nonselective β-blocking drugs
Side effects
• Tachycardia
• Arrhythmias
• Hypertension
• Dilated pupils
• Feeling of anxiety/palpitations
Note: May increase size of myocardial infarction
Pharmacology or actions
• A naturally occurring alpha and beta-adrenergic stimulant
• Increases heart rate by increasing SA node firing rate (Beta 1) and conduction velocity through the A-V node (Beta 1)
• Increases myocardial contractility (Beta 1)
• Increases the irritability of the ventricles (Beta 1)
• Causes bronchodilatation (Beta 2)
• Causes peripheral vasoconstriction (Alpha)
Aspirin intra and contra
Primary emergency indications
• Chest pain/discomfort
• Acute Coronary Syndrome (ACS)
Contraindications
(Known hypersensitivity plus)
• Haemophilia or other bleeding disorders
• Erosive actively bleeding gastritis or peptic ulcer
• Hypersensitivity to other salicylates
• Suspected dissecting aortic aneurysm
• Chest pain associated with psychostimulant overdose if SBP >160 mmHg
• Acute febrile illness in children and adolescents
• Severe hepatic or renal disease
Precautions
• Active peptic ulcer
• Asthma
• Patients on anticoagulants
Aspirin side effects and actions
Key timings
• Onset: for emergency indication n/a, Peak: n/a, Duration: 8 - 10 days
Special notes / (and important interactions)
• Aspirin is not to be administered by NEPT for any condition other than chest pain/discomfort of a cardiac nature
• The anti-platelet effects of Aspirin persist for the natural life of platelets
Side effects
• Heartburn, nausea, gastrointestinal bleeding
• Increased bleeding time
• Hypersensitivity reactions
Pharmacology / Actions
• An analgesic, antipyretic, anti-inflammatory and antiplatelet aggregation agent
• Actions:
– To minimise platelet aggregation and thrombus formation to retard the progression of coronary artery thrombosis in ACS
– Inhibits synthesis of prostaglandins - anti-inflammatory actions
Glucagon dose
• Vial with 1mg of powder for reconstitution prior to injection (and if in kit, 1 pre-filled syringe with 1 mL sterile water for reconstitution)
Glucagon indica and contras
Primary emergency indication(s)
• Diabetic hypoglycaemia (BGL < 4 mmol/L) in patients with an altered conscious state who are unable to self-administer oral glucose, or is unavailable
• Anaphylaxis (adult) where patients remain hypotensive following adrenaline therapy with history of heart failure or patients taking beta-blocker medication
Contraindications
(Known hypersensitivity plus)
• Nil of significance in the above indication
Precautions
• Nil of significance in the above indication
Glucagon side effects and actions
Special notes / (and important interactions)
• Patients taking beta-blockers might be expected to have a greater increase in both pulse and blood pressure
• Not all patients will respond to glucagon (e.g., those with inadequate glycogen stores in the liver (alcoholics, malnourished))
• It is important to ensure early transport/activation of paramedic back-up in all cases of hypoglycaemia
Side effects
• Nil significant
• Nausea and vomiting (rare)
Pharmacology / Actions
• A hormone normally secreted by the pancreas which raises blood glucose level
Actions:
– Causes an increase in blood glucose concentration by converting stored liver glycogen to glucose
Glucose paste dose
• Oral Glucose Gel 37.5 g containing 15 grams of glucose
Glucose paste intra and contras
Primary emergency indication(s)
• Diabetic hypoglycaemia (low blood sugar) with altered RBG < 4 mmol/L and conscious and able to cooperate.
Contraindications
(Known hypersensitivity plus)
• Inability to swallow due to altered conscious state
Precautions
• Nil of significance for the above indication
Glucose side effects and actions
Key timings
• If no response within 15 minutes, repeat dosage
Special notes / (and important interactions)
• Not all patients will respond to glucose paste and it is important to ensure early escalation of care / transport
• Not recommended for children under 2 years of age
Side effects
• Nil significant
Pharmacology / Actions
• Oral glucose gel
Glyceryl Trinitrate (GTN) dose
• 0.6mg tablets Anginine ® and Lycinate ® tablets
• 0.3mg and (0.6mg Nitrostat ® tablets (Nitrostat tablets cannot be split.)
Glyceryl Trinitrate (GTN) intras and contras
indication(s)
• Cardiac chest pain/discomfort
• Hypertension associated with acute cardiogenic pulmonary oedema
• Hypertension associated with acute coronary syndrome
Contraindications
(Known hypersensitivity plus)
• Haemorrhage or head trauma
• Known hypersensitivity
• Systolic blood pressure < 100 mmHg
• Heart rate > 150 beats per min or < 50 beats per min
• Sildenafil and/or vardenafil use in the previous 24 hours or tadalafil use in the previous 48 hours
• Note: Tadalafil (Cialis) may also be prescribed to men for treatment of benign prostatic hypertrophy
• Ventricular tachycardia
Precautions
• No previous administration of GTN
• Elderly or frail patients
• Recent Myocardial Infarction
• Concurrent use with other tocolytics
Glyceryl Trinitrate (GTN) side effects and actions
• GTN tablets are susceptible to heat and moisture. Tablets must be stored tightly sealed in their original container.
• Avoid administering patient’s own medication as it may not have been stored in optimal conditions
• Nitrostat tablets cannot be split. Anginine and Lycinate may be split.
Side effects
• Hypotension
• Tachycardia
• Headache
• Nausea and vomiting
• Syncope
• Dizziness
• Skin flushing of face and neck (uncommon)
• Bradycardia (occasionally)
Pharmacology / Actions
• Nitrate- a vascular smooth muscle relaxant and vasodilator
Actions:
– Venous dilatation promotes venous pooling and reduces venous return to the heart (reduces preload)
– Arterial dilatation reduces systemic vascular resistance and arterial pressure (reduces afterload)
• The effects of the above are:
– Reduced myocardial oxygen demand
– Reduced systolic, diastolic, and mean arterial blood pressure, whilst usually maintaining coronary perfusion pressure
– Mild collateral coronary arterial dilatation may improve blood supply to ischaemic areas of myocardium
– Mild tachycardia secondary to slight fall in blood pressure
Methoxyflurane dose
• 3mL bottle each bottle contains 99.9% methoxyflurane
Penthrox ® kit contains, bottle, inhaler, and (model dependant) sometimes a charcoal exhaust filter
Methoxyflurane intras and contras
indication(s)
• For relief of moderate-severe pain by self-administration
Contraindications
(Known hypersensitivity plus)
• Renal impairment/failure
• Head injury or loss of consciousness
• Personal or family history of malignant hyperthermia
• Exceeding total dose of 6 mL in a 24-hour period
Precautions
• The inhaler must be hand-held by the patients so that if unconsciousness occurs it will fall from the patient’s face.
• Occasionally the operator may need to assist but must continuously assess the level of consciousness
• Pre-eclampsia
• Concurrent use with Oxytocin may cause hypotension
Methoxyflurane side effects and actions
Key timings
• Analgesia commences after 8 - 10 breaths and lasts for approximately 3 - 5 minutes once discontinued
Special notes / (and important interactions)
• Maximum 6 mL can be given within 24-hours
• If stronger analgesia is required, patient can cover dilutor hole with finger during inhalation
• Continuous administration reduces time of analgesia
• The maximum initial priming dose is 3 mL. This will provide approximately 25 minutes of analgesia and may be followed by one further 3 mL dose once the initial dose is exhausted if required
• Do not administer in a confined space. Ensure adequate ventilation in vehicle
• Malignant hyperthermia is a very rare condition that can be induced by volatile anaesthetics such as methoxyflurane. Ask patients about any history or family history of adverse reactions to inhaled anaesthetics
• In patients with muscular dystrophy, volatile agents may precipitate life-threatening rhabdomyolysis
Side effects
• Dizziness
• Headache
• Amnesia - retrograde
• Nausea and Vomiting
• Cough
• Fever
• Decrease in blood pressure and bradycardia (rare)
Pharmacology / Actions
• Belongs to the fluorinated hydrocarbon group of volatile anaesthetic agents
– Short acting
Ondansetron dose
Wafer or tablet - 4mg and 8mg
Ondansetron intras and contras
indication(s)
• All undifferentiated nausea and vomiting
Contraindications
(Known hypersensitivity plus)
• Concurrent Apomorphine use
Precautions
• Can increase large bowel transit time
• Patients with liver disease should not receive more than 8 mg of Ondansetron per day
• Care should be taken with patients on diuretics who may have an underlying electrolyte imbalance
• Ondansetron contains aspartame and should not be given to patients with phenylketonuria
• Concurrent use of Tramadol
• Pregnancy
• Known Long Q-T syndrome
• Hypokalaemia or hypomagnesaemia
Ondansetron side effects and actions
Key timings
• Oral (ODT) Wafers
– Onset: 2 minutes, Peak: 20 minutes, Duration: 120 minutes
Special notes / (and important interactions)
• Ondansetron may not be effective for all types of nausea and vomiting
Side effects
• Headache
• Constipation
• Fever
• Prolonged QTc
Pharmacology / Actions
• Anti-emetic primarily a 5HT
Paracetamol dose
• 500mg tablets or capsules
Paracetamol intras and contras
indication(s)
• Mild pain relief including headache
Contraindications
(Known hypersensitivity plus)
• Children < 1 month of age
• Paracetamol already administered within past 4 hours
• Total paracetamol intake within past 24 hours exceeding 4 g (adults) or 60 mg/kg (children)
Precautions
• Overdose may cause liver failure
• Liver impairment
• Hepatic dysfunction/failure
• Renal impairment
• Elderly / frail
• Malnourished
Paracetamol side effects and actions
Key timings
• Onset: 30 minutes, Peak: N/A, Duration: 4 hours
Special notes / (and important interactions)
• Paracetamol is not indicated for the treatment of fever in the emergency setting
• There are several brands of Paracetamol available in Australia. Paracetamol is also found in many combination medicines, both prescription and over-the counter. Carefully determine previous Paracetamol intake before dose administration
• Hepatic damage is very rare when Paracetamol is taken at recommended dosages
• Paracetamol is not to be used as analgesia for suspected ACS
Side effects
• Hypersensitivity reactions including severe skin rashes (rare)
• Haematological reactions (rare)
Pharmacology / Actions
• Analgesic and antipyretic agent
Salbutamol dose
• Inhalation ampoule: Single dose units of 5 mg in 2.5 mL nebules / polyamps
• Inhalation ampoule: Single dose units of 2.5 mg in 2.5 mL nebules / polyamps
• Pressurised Metered Dose Inhaler (pMDI) with 0.1 mg per actuation/dose.
Salbutamol intras and contras
Indication(s)
• Respiratory distress with suspected bronchospasm:
– asthma
– Anaphylaxis
– COPD
– Other causes of bronchospasm
Contraindications
(Known hypersensitivity plus)
• Nil of significance in the above indications.
Precautions
• Large doses of Salbutamol have been reported to cause intracellular metabolic acidosis.
Salbutamol side effects and actions
Key timings
• Inhaled effects: Onset: 5 – 15 minutes, Peak: n/a, Duration: 15 – 50 minutes.
Special notes / (and important interactions)
• Interaction: Beta-adrenergic blocking drugs inhibit the bronchodilator action of salbutamol and other sympathomimetic bronchodilators
• Salbutamol nebules / polyamps have a shelf life of one month after the wrapping is opened. The date of opening of the packaging should be recorded
• Nebules should be stored at an ambient temperature < 30 degrees Celsius
• The effectiveness of salbutamol differs between patients, it is important to escalate care early
• Continue to administer oxygen 8 L/min between doses.
Side effects
• Tachycardia
• Palpitations
• Muscle tremor
Pharmacology / Actions
• Bronchodilator
• A synthetic beta-adrenergic stimula
