Contraindications

Question 1

Adrenaline

Answer 1

Hypovolaemic shock without adequate fluid replacement

Question 2

Aspirin

Answer 2

1. Hypersensitivity to aspirin / salicylates
2. Actively bleeding peptic ulcers
3. Bleeding disorders
4. Suspected dissecting aortic aneurysm
5. Chest pain associated with psychostimulant OD if SBP >160 mmHg

Question 3

Dexamethasone

Answer 3

1. Known hypersensitivity

Question 4

Fentanyl

Answer 4

1. History of hypersensitivity

2. Late second stage of labour

Question 5

Glucagon

Answer 5

1. Nil of significance in the above indication

Question 6

GTN

Answer 6

1. Known hypersensitivity
2. Systolic blood pressure < 110 mmHg tablet
3. Systolic blood pressure < 90 mmHg patch
4. Sildenafil Citrate (Viagra) or Vardenafil (Levitra) administration in the previous
   24 hr or Tadalafil (Cialis) administration in the previous 4 days (PDE5 inhibitors)
5. Heart rate > 150 bpm
6. Bradycardia HR < 50 bpm (excluding autonomic dysreflexia)
7. VT
8. Inferior STEMI with systolic BP < 160 mmHg
9. Right ventricular MI

Question 7

Ipratropium Bromide

Answer 7

1. Known hypersensitivity to Atropine or its derivatives

Question 8

Methoxyf lurane

Answer 8

1. Pre-existing renal disease / renal impairment
2. Concurrent use of tetracycline antibiotics
3. Exceeding total dose of 6 mL in a 24 hour period
4. Personal or family history of malignant hyperthermia
5. Muscular dystrophy

Question 9

Midazolam

Answer 9

1. Known hypersensitivity to benzodiazepines

Question 10

Morphine

Answer 10

1. History of hypersensitivity
2. Renal impairment / failure
3. Late second stage of labour

Question 11

Naloxone

Answer 11

1. Nil of significance in the above indication

Question 12

Ondansetron

Answer 12

1. Known hypersensitivity
2. Concurrent Apomorphine use
3. Known Long Q-T syndrome
4. Hypokalaemia or hypomagnesaemia

Question 13

Paracetamol

Answer 13

1. Hypersensitivity to paracetamol
2. Children < 1 month of age
3. Paracetamol already administered within past 4 hours
4. Total paracetamol intake within past 24 hours exceeding 4 g (adults) or 60 mg/kg
   (children)
5. Chest pain in suspected acute coronary syndrome

Question 14

Prochlorperazine (Stemetil)

Answer 14

1. Circulatory collapse (cool, pale, clammy skin, tachycardia, hypotension)
2. CNS depression
3. Previous hypersensitivity
4. Patients < 21 years of age
5. Pregnancy

Question 15

Salbutamol

Answer 15

1. Nil of significance in the above indications