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Paramedic Drugs (South Africa) > Adult dosages > Flashcards

Adult dosages Flashcards

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1
Q

Corticosteroids

Pt with severe asthma attack

or

severe allergy/anapylaxis

A

Hydrocortisone:

200-500mg IVI slowly

(5mg/kg)

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2
Q

Salbutamol

Premature/obstructed labour/prolapsed cord

Maintenance infusion?

A

Dilute

2 mg [4 x 500 mcg/ml] into 200 ml N/S (10mcg/ml solution)

Start with 10 mcg/min.

May increase by 10 mcg/min every 10 min to a max of 45 mcg/min

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3
Q

Lorazepam

Pt with active convulsions

Initial dose?

If not terminated by intial dose?

Maximum dose?

A

2-4mg slowly IVI

If required an additional 4mg IVI may be administered after 10 minutes

Titrate to effect (use the lowest effective dosage)

Maximum 8mg/12hours

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4
Q

Lignocaine Hydrochloride (Lidocaine) (Systemic)

Endotracheal Intubation Sequence

(for raised ICP)

A

Specifically indicated for patients who may already have an element of raised intracranial pressure, the addition to which would compromise the patient

administer 1.5mg/kg 3 minutes before intubation

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5
Q

Thiamine Hydrochloride

Pt with suspected Wernicke’s encephalopathy

A

100 mg IVI bolus, slowly

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6
Q

Magnesium Sulphate

Pt in cardiac arrest unresponsive to conventional therapy

A

1-2g (2 to 4ml of a 50% solution)

Dilute 1g/2ml vial to 10ml sterile water = 10% solution

Give slowly, not exceeding 1.5ml/min, with continuous careful monitoring

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7
Q

Salbutamol

Pt in obstructed labour

IV Bolus dose and rate?

A

Slow IV

100-250 mcg IV

Administer

1ml/min until:

  • Total of 250mcg/10min has been given, i.e. 10ml
  • Mother’s heart rate >120bpm
  • Contraction cease
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8
Q

Dextrose 50%

Pt in hypoglycemic coma

A

10g (20ml of a 50% solution) slowly IVI

Repeat

every 5 minutes should blood glucose remain

First give 100mg Thiamine if available and indicated

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9
Q

Glyceryl Trinitrate

Pt with cardiac chest pain

A

One tablet sublingual

OR

one spray (without inhaling) onto oral mucosa

(preferably sublingual)

Repeat

every 5 minutes until pain is relieved, or max dose taken

Maximum of 3 sprays/tablets

  • Terminate administration if systolic blood pressure:
    • -Decreased by more than 10% in a normotensive patient -Decreases by more than 30% in a hypertensive patient -Measures lower than 90mmHg
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10
Q

Lignocaine Hydrochloride (Lidocaine) (Systemic)

Pt with chest pains, BP 80/60mmHg, HR 92, with arrhythmia

loading dose?

When must the bolus dose be terminated?

A

Loading dose:

1mg/kg slowly IVI

Bolus doses must be terminated when either:

  • A maximum of 3mg/kg has been administered, or
  • The blood pressure drops by >10%, or
  • Ventricular arrhythmia ceases, or -

Signs of toxicity develop

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11
Q

Thiamine Hydrochloride

Pt with suspected thiamine deficiency (eg alcoholims, malnourishment)

Dose prior IV 50% Dextrose administration

A

100 mg IVI bolus, slowly

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12
Q

Atropine Sulphate

Pt with refractory symptomatic bradycardia

First dose?

A

0.5mg IVI push

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13
Q

Midazolam

  • Adult dose -

Maintenance Infusion for a transfer of a 100kg intubated pt on mechanical ventilator

How many mls/hour if using 200mls NS?

(maximum recommended dose)

A

0.03mg/kg/hr-0.1mg/kg/hr

VR = SR/SS x VS

VR=(0.1mgx100)/15mg x 200ml

VR=133mls/hr

when used in combination with narcotic analgesics

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14
Q

Adrenaline

Pt in cardiac arrest

A

Intravenous:

1 mg IVI push

Tracheal:

2 mg diluted with 10 ml of water for injection preferred

Repeat every 3-5 minutes

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15
Q

Flumazenil

Pt overdosed on Valium (benzodiazepine) and is only responding to pain and breathing at a rate of 10/min.

Intitial dose?

A

Initial bolus:

0.2mg slowly IVI over 15 seconds

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16
Q

Magnesium Sulphate

Pt with convulsions in toxaemia of pregnancy

Infusion dose and rate?

A

3g in 200ml 0.9% sodium chloride solution

at a rate not exceeding 3ml/min

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17
Q

Lignocaine Hydrochloride (Lidocaine) (Systemic)

80kg male pt with stable BP, no chest pain, HR of 180 and the following ECG rhythm. Amiodarone is not available

loading dose?

When must bolus dose be terminated?

A

Loading dose:

1mg/kg slowly IVI

Bolus doses must be terminated when either:

  • A maximum of 3mg/kg has been administered, or
  • The blood pressure drops by >10%, or
  • Ventricular arrhythmia ceases, or
  • Signs of toxicity develop
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18
Q

Sodium Bicarbonate 8.5%

Pt in cardiac arrest due to suspected cocaine overdose

A

1ml/kg (8.5%) slowly IVI with free flowing line

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19
Q

Lignocaine Hydrochloride (Lidocaine) (Systemic)

Pt in cardiac arrest with the following arrhythmia.

(Amiodarone is not available)

Bolus dose?

Repeat dose?

Maxium total dose?

A

Administer a bolus dose of

1mg/kg IVI/IO push

0.5mg/kg IVI/IO (or 1 mg/kg ET) every 5 minutes

Maximumm total bolus dose

3 mg/kg IVI

Following successful defibrillation, follow with maintenance infusion

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20
Q

Naloxone Hydrochloride

  • Adult dose-
A
  • 0.4mg slowly IVI/IMI (0.1mg/kg)
  • Repeat every 5 minutes, up to 2mg
  • Should 2mg fail to elicit the desired response, then overdose with agents other than opiods should be considered
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21
Q

Flumazenil

Pt overdosed on Valium (benzodiazepine), responds only to pain and has a RR 10/min. You have already administered a bolus of 0.2mg IVI

Repeat dose?

(Include max dose that can be administered)

A

Repeat:

0.1mg at 1 minute intervals

Max dose:

1mg

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22
Q

Metoclopramide Monohydrochloride

Pt that is feeling nauseous and is vomitting

A

>60 kg:

10 mg slowly IVI/IMI

< 60 kg:

5 mg slowly IVI/IMI

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23
Q

Calcium Chloride 10%

Pt with Verapamil (calcium channel blocker) overdose

A

10ml of calcium chloride 10% solution, slowly IVI

If being administered pre-arrest, administer at 1ml/min

24
Q

Magnesium Sulphate

Pregnant female convulsing (toxemia of pregnancy)

Bolus dose?

A

2-4g of a 10% solution given very slowly,

with careful monitoring not exceeding 1.5ml/min

(10% solution is obtained by diluting the 1g/2ml vial to 10ml with sterile water)

25
Q

Adenosine

Pt with otherwise stable signs and symptoms with the following ECG (HR 170)

A

Rapid 6mg IV push

(followed immediately by rapid 20mls IV push)

12mg IV push if no response after 2minutes

12mg IV push may be considered if no response after 2minutes

26
Q

Magnesium Sulphate

Pt in acute severe asthma unresponsive to conventional therapy

A

1-2g (2 to 4ml of a 50% solution)

Dilute 1g/2ml vial to 10ml sterile water = 10% solution

Give slowly, not exceeding 1.5ml/min, with continuous careful monitoring

27
Q

Midazolam

Induction

A

​

1mg/15 to 30 seconds IVI

28
Q

Sodium Bicarbonate 8.5%

Pt with suspected Amitriptyline overdose, decreased LOC, systolic BP of 75mmHg

A

1ml/kg (8.5%) slowly IVI with free flowing line

29
Q

Adrenaline

  • Adult Dose -

Symptomatic Bradycardia (SBP

A
  • IV infusion 2-10 mcg/min
  • Titrate to effect
30
Q

Diazepam

  • Adult dose-

Convulsions when IV access is unsuccessfull

A

Rectally:

10mg (maximum 20mg)

31
Q

Glucagon

  • Adult dose-

Severe anaphylactic reaction

A
  • 1-2mg every 5 min IM or
  • slow IV if unresponsive to adrenaline, & especially if on beta blockers
32
Q

Sodium Bicarbonate 8.5%

  • Adult dose-

105 kg trapped pt who is about to be relased from under a truck

How many mls?

A

1ml/kg (8.5%) slowly IVI with free flowing line

105 ml

33
Q

Glucagon

Calcium Channel blocker/beta blocker OD

Intial dose?

and

Follow up infusion rate?

A

3mg IV initially as adjuvant treatment

followed by 3mg/hour infusion

34
Q

Amiodarone Hydrochloride

Pt in cardiac arrest with VF refractory to defibrillation or pulses VT

A

300 mg IVI as a rapid bolus

Consider additional dose of

150 mg in 3 to 5 minutes if VF persists

35
Q

Lignocaine Hydrochloride (Lidocaine) (Systemic)

65 yrs old male in cardiac arrest with the following arrhythmia.

(Amiodarone is not available. and you are not able to establish IV access)

Bolus dose through ETT?

A

​

2 mg/kg ET as last resort

36
Q

Diazepam

  • IV Adult dose-

Convulsions

A
  • 5mg/min slowly IVI (0.15mg/kg)
  • Repeat every 2-5 minutes
  • Titrate to effect (use the lowest effective dosage Maximum 20 mg
37
Q

Glucagon

Pt in hypoglycemic coma and you are unable to obtain IV access to administer 50% Dextrose.

A

1mg IMI/IVI/SC

IMI is preferred route

38
Q

Midazolam

Maintenance Infusion for sedation?

A

0.03mg/kg/hr-0.1mg/kg/hr

when used in combination with narcotic analgesics

39
Q

Midazolam

Pt presenting with active convulsions

A

0.15mg/kg slowly IVI (maximum 0.3mg/kg)

IMI not recommended as first line route - absorption too slow

ONLY give IMI if no IV access available

0.15mg/kg IMI

(maximum 0.3mg/kg)

40
Q

Clopidogrel

Pt with true aspirin allergy with suspected AMI

A

Administer

300mg orally,

i.e. four of the 75mg tablets

41
Q

Lignocaine Hydrochloride (Lidocaine) (Systemic)

Stable VT/Complex Ventricular Ectopy with Myocardial Ischaemia or causing haemodynamic compromise -

Maintenance infusion after restoration of stable rhythm?

A

1-4mg/min (20-50mcg/kg/min)

upon restoration of a stable rhythm

Reappearance of arrhythmia during a constant infusion of lignocaine should be treated with

0.5mg/kg slow IVI bolus dose,

and an increase in the infusion rate in incremental doses

(maximal rate = 4mg/min)

42
Q

Adrenaline

Pt with Anaphylaxis

A

0.3mg (1:1000) undiluted (anterolateral thigh)

Repeat :

every 15-20 minutes

43
Q

Amiodarone

Stable pt with VT/SVT and HR180

Inital dose?

Follow up infusion?

Maximum cummulative dose?

A

150 mg IVI over 10 minutes (15mg/min),

followed by infusion:

slow IVI of 1 mg/minute (360 mg over 6 hours)

Maximum cumulative dose

2.2 g IV/24 hours

44
Q

Salbutamol

Pt with acute bronchospasm

IV infusion dose and rate?

Total dose?

A

250 mcg/10min

Administer 1ml/min over 10 min

Total of

250mcg/10 min

45
Q

Adrenaline

  • Adult Dose -

75 kg pt in severe life-threatening asthma attack

Initial dose?

A

0.01mg/kg divided into 3 doses of 0.3mg

0.3mg undiluted (1:1000)

46
Q

Thiamine Hydrochloride

Pt with suspected Wernicke’s encephalopathy

A

100 mg IVI bolus, slowly

47
Q

Midazolam

Sedation

A

1mg/min slowly IVI

titrate to effect

48
Q

Diazepam

Sedation

A

1mg every 30 seconds IV

titrated to effect when necessary

49
Q

Lignocaine Hydrochloride (Lidocaine) (Systemic)

Pt with Stable VT/Complex Ventricular Ectopy with Myocardial Ischaemia or causing haemodynamic compromise

loading dose?

A

Loading dose:

1mg/kg slowly IVI

50
Q

Atropine Sulphate

Refractory Symptomatic Bradycardia after first dose

What is the next and maximum dose?

A

Repeat:

0.5-1mg every 3 to 5 minutes

Maximum:

3mg (0.04mg/kg) = total vagolytic dose

51
Q

Furosemide

Pt with pulmonary oedema

A

0.5mg - 1mg/kg IVI slowly

over 1-2minutes

52
Q

Promethazine

Pt with severe anaphylaxis

A

25mg deep IMI or

slowly IVI after 10-fold dilution with water for injection

53
Q

Atropine Sulphate

Organophosphate poisoning

A

0.5-2.5mg IVI

Repeat:

every 4 minutes until atropinization occurs (decreased bronchial secretions is single most reliable factor)

Titrate to effect

No absolute maximum dose

54
Q

Morphine Sulphate

Pt requiring pain management

A

Dilute to concentration of 1mg/ml and titrate to effect at

1mg/30 seconds slowly IVI

Titrate to effect

55
Q

Adrenaline

Pt with obstructing laryngeal oedema

A

Nebulization:

Initiate with 1 ml of 1 : 1000 + 4 ml of N/S

If necessary increase

2 - 4 mg adrenaline diluted with 5 ml N/S

Paramedic Drugs (South Africa) (7 decks)

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