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ICP Prep > CPGs > Flashcards

CPGs Flashcards

1
Q

Adrenaline Pharmacology

A

Alpha- and beta-adrenergic agonists
Beta 1: Increases HR, increases conduction velocity through AV node, increases myocardial contractility and increases irritability of the ventricles
Beta 2: Causes bronchodilatation
Alpha: Causes peripheral vasoconstriction

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2
Q

Contraindications and Precautions Adrenaline

A

Contra: Hypovolamic shock without adequate fluid replacement
Precaution: Elderly patients, pts with cardiovascular disease, pts on monoamine oxidase inhibitors, if pt beta blocked higher dosage may be required

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3
Q

Metabolism + Excretion of Adrenaline

A

By monoamine oxidase and other enzymes in the blood, in the liver and around nerve endings, and is excreted by the kidneys

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4
Q

Side Effects Adrenaline

A

Sinus tachycardia, supra-ventricular arrhythmia’s, ventricular arrhythmia’s, hypertension, papillary dilatation, may increase size of MI, anxiety / palpitations, muscle tremour

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5
Q

Aspirin Pharmacology

A

An analgesic, antipyretic, anti inflammatory and anti plate agent - which reduces platelet aggregation and inhibits synthesis of prostaglandins which has anti inflammatory actions

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6
Q

Metabolism and Excretion Aspirin

A

Converted to salicylate in the gut mucosa and liver, excreted mainly by the kidneys

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7
Q

Contraindications and Precautions Aspirin

A

Contras: hypersensitivity to aspirin / salicylates, actively bleeding peptic ulcer, bleeding disorders, suspected dissecting AAA, chest pain associated with psychostimulant overdose of BP >160
Precautions: peptic ulcer, asthma, on anticoagulants

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8
Q

Side effects aspirin

A

Heartburn, nausea, GI bleeding, increased bleeding times, hypersensitivity reactions

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9
Q

Why is aspirin contraindicated for use in active febrile illness for those under 12 years old?

A

It may lead to renal function impairment and Reye’s syndrome

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10
Q

Ceftriaxone Pharmacology

A

Cephalosporin Antibiotic

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11
Q

Ceftriaxone Metabolism and excretion

A

Excreted unchanged in urine and in bile

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12
Q

Contraindications Ceftriaxone and Precautions

A

Contra: Allergy to cephalosporin antibiotics
Precaution: Allergy to penicillin antibiotics

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13
Q

Side effects Ceftriaxone

A

Nausea and vomiting, skin rash

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14
Q

What alterations are made to ceftriaxone IM and IV administration?

A

IV: make up to 10ml per 1g and administer over 2 minutes
IM: Make up to 4ml per 1G and must be administered to lateral upper thigh.

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15
Q

Dexamethosone Pharmacology

A

A corticosteroid secreted by the adrenal cortex, it relieves inflammatory reactions and provide immunosuppresion.

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16
Q

Metabolism and excretion Dexamethasone

A

Metabolised by the liver and excreted predominantly by the kidneys

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17
Q

Contraindications and Precautions of dexamethasone

A

Contra: known hypersensitivity to dexamethasone or other corticosteroids
Precautions: usually only relevant with prolonged use and high dosages

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18
Q

Side effects Dexamethasone:

A

Except for allergens. adverse effects are usually only associated with prolonged use and high dosages

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19
Q

Diazapam Pharmacology

A

Member of the benzodiazapam family, inhibits anxiolytic, muscle relaxant and sedative effects. muscle- relaxant, a Most of these effects are thought to result from a facilitation of the action of GABA (The allosteric binding increases the frequency at which the chloride channel opens, leading to an increased conductance of chloride ions. This shift in charge leads to a hyperpolarization of the neuronal membrane and reduced neuronal excitability)

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20
Q

Metabolism / Excretion diazepam

A

Diazepam is metabolized in the liver to its active metabolite which is excreted in the urine as inactive metabolite

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21
Q

Contraindication / Precautions Diazepam

A

Contra: Known allergy to benzodiazapines and myasthenia gravis
Precaution: CNS depression or ingestion of CNS depressing agents, hypotension,
children and elderly, impaired renal or hepatic function, respiratory insufficiency

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22
Q

Define Myasthenia gravis

A

A chronic autoimmune, neuromuscular disease that causes weakness in the skeletal muscles

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23
Q

Side effects diazepam

A

Extrapyramidal reactions, drowziness, bradycardia, respiratory depression, hypotension

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24
Q

What are extra pyramidal reactions?

A

Drug-induced movement disorders aincluding dystonia, akathisia, and parkinsonism.

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25
Q

Droperidol Pharmacology

A

Antipsychotic - inhibits dopamine mediated neurotransmission in the cerebrum and basal ganglia, also inhibits the chemoreceptor trigger zone in the medulla

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26
Q

Contraindications / Precautions Droperidol

A

Contras: Known allergy, parkinsons disease, previous dystonic reaction to droperidol, patients under 8 years old
Precautions: Concomitant use of CNS depressants

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27
Q

Metabolism / Excretion Droperidol

A

Hepatic metabolism with bilary / renal excretion as inactive metabolites

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28
Q

Side effects Droperidol

A

Extrapyramidal reactions,

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29
Q

Fentanyl Pharmacology

A

A synthetic narcotic analgesic. IT binds to opioid receptors, especially the mu opioid receptor, which are coupled to G-proteins. Activation of opioid receptors causes GTP to be exchanged for GDP on the G-proteins which in turn down regulates adenylate cyclase, reducing concentrations of cAMP. Reduced cAMP decreases cAMP dependant influx of calcium ions into the cell. The exchange of GTP for GDP results in hyperpolarization of the cell and inhibition of nerve activity. Decreased conduction velocity of AV node

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30
Q

Side effects Fentanyl

A

Sedation, respiratory depression, apnoea, rigidity of diaphragm and intercostal muscles, bradycardia

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31
Q

Fentanyl metabolism / excretion

A

Metabolised by the liver and excreted by the kidneys

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32
Q

Contras / Precautions Fentanyl

A

Contras: Known hypersensitivity, active labour, epistaxis or occluded nasal passages (IN admin), Patients <1 years olf
Precautions: Eldery Patients, resp depression (eg COPD), current asthma, known addiction to narcotics, Monoamine Oxidase inhibitors

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33
Q

Glucagon Pharacology

A

A hormone normally secreted by the pancreas. Causes an increase in blood glucose concentration by converting stored liver glycogen to glucose. Has weak chronitropic and inotropic effect.

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34
Q

Glucagon metabolism

A

Metabolized by the liver, the kidneys and in the plasma.

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35
Q

Contras / precaution s glucagon

A

NIL of significance

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36
Q

Side effects glucagon

A

Nausea and vomiting

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37
Q

Glucose solution 10% Pharmacology

A

A slightly hypertonic crystalloid solution composed of 10% dextrose and 90% water

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38
Q

Metabolism glucose solution 10%

A

Glucose is broken down in most tissues, and stored in the liver and muscles as glycogen

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39
Q

Contras / precautions glucose 10% solution

A

NIL of significance

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40
Q

Glyceryl trinitrate GTN pharmacology

A

A vascular smooth muscle relaxant. Venous dilatation premotes venous pooling and reduces venous return to the heart (reduces preload). Arterial dilatation reduces systemic vascular resistance and arterial pressure (reduces afterload)

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41
Q

GTN metabolism

A

In liver

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42
Q

GTN contras / precautions

A

Contras: known hypersensitivity, Sys BP <100 for buccal, sys BP <120 for IV, Viagra, levetra in past 24 hours or cialis past 4 days, HR >150, HR <50 (excluding autonomic disreflexia, VT, right ventricular infarct
Precautions: No previous admin, elderly pts, recent AMI, inferior STEMI with sys BP <160, avoid skin contact with concentrated solution, always reduce BP slowly rather than aggressively

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43
Q

Side effects GTN:

A

Tachycardia, hypotension, headache, skin flushing, bradycardia

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44
Q

Ibuprofen Pharmacology

A

Non-selective NSAID that inhibits the synthesis of prostoglandins and COX. This results in analgesia, anti-inflammatory and antipyretic effects

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45
Q

Metabolism / excretion ibuprofen

A

Metabolised by liver and excreted by the kidneys

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46
Q

Contras / Precautions Ibuprofen

A

Contras: heart failure / cardiovascular disease, pregnancy 3rd trimester, pts taking anticoags, renal disease, current bleed GI bleeding or peptic ulcer, severe renal impairment, children <3 months
Precautions: asthma, previous hx GI bleeding or peptic ulcers, dehydration / hypolvolamia / diuretic treatment, elderly, chicken pox

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47
Q

Side effects ibuprofen

A

nausea, dyspepsia, GI bleeding, dizziness

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48
Q

Ipratropium bromide Pharmacology

A

Anticholinergic bronchodilator. Allows bronchodilation by inhibiting cholinergic bronchomotot tone (blocks vagal reflexes which mediate bronchocontriction)

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49
Q

Metabolism and Excretion Ipratropium Bromide

A

Metabolised in the GI tract, excreted by the kidneys

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50
Q

Contras / Precautions Ipratropium Bromide

A

Contras: Allergies to atropine or its derivatives
Precautions: Glaucoma, avoid contact with eyes

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51
Q

Side Effects Ipratropium Bromide

A

Headache, nausea, dry mouth, skin rash, tachycardia, palpitations, acute angle closure glaucoma secondary to direct eye contact

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52
Q

Lignocaine Hydrochloride Pharmacology

A

A local anaesthetic agent. Prevents initiation and transmission of nerve impulses causing local anaethesia

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53
Q

Metabolism Lignocaine Hydrochloride

A

Metabolised 90% liver, excreted 10% unchanged in the kidneys

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54
Q

Contraindications / Precautions Lignocaine

A

Contras: Known hypersensitivity, bradycardia with inadequate perfusion, evidence of a second or third degree heart block
Precaution: Only IM admin due to potential CNS complications

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55
Q

Methoxyflurane pharmacology

A

Inhalational analgesic agent at low concentrations. CND depressant

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56
Q

Methoxyflurane Contras / Precautions

A

Contras: Prexisting renal disease / impairment, concurrent use of tetracycline antibiotics, exceeding total dose of 6ml in 24 hours or 15 ml in seven days, family history or anesthetic induced malignant hyperthermia
Precautions: Must be handheld by pt, preeclampsia

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57
Q

Side Effects methoxyflurane

A

Drowziness, decrease in BP and HR (rare), exceeding maximum dose may lead to renal toxicity

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58
Q

Metoclopromide Pharmacology

A

Metoclopramide is an antiemetic and dopamine receptor antagonist. Accelerates gastric emptying and peristalsis

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59
Q

Metabolism / Excretion Metoclopromide

A

Metbolised by the liver and excreted by the kidneys

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60
Q

Contras / Precautions Metoclopromide

A

Contras: GIT haemorrage, obstruction or perforation, known sensitivity or intolorance, <16 years of age
Precautions: Undiagnosed abdominal pain

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61
Q

Side Effects metoclopromide

A

Drowziness, lethargy, dry mouth, muscle tremour, hypotension / Hypertension. extrapyramidal reactions, lowers the seizure threshold

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62
Q

Midazolam Pharmacology

A

CND depressant of the benzodiazapine class. Benzodiazepines enhance the inhibitory action of the amino acid neurotransmitter gamma-aminobutyric acid (GABA). Antianxiolytic, sedative and anti-convulsant properties.

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63
Q

Contras / Precautions Midazolam

A

Contras: Known hypersensitivity to benzodiazapines
Precautions: reduced dosage may be required for the elderly, chronic renal failure, CCF or shock, The CND deppressants effects are enhanced in the presence or narcotics or alcohol, can cause severe resp depression in pts with COPD, pts with mysthenia gravis

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64
Q

Side effects midazolam

A

Depressed level of consciousness, resp depression, loss of airway control, hypotension

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65
Q

Morphine Pharmacology

A

A narcotic analgesic.
Morphine binding to opioid receptors blocks transmission of nociceptive signals, signals pain-modulating neurons in the spinal cord, and inhibits primary afferent nociceptors to the dorsal horn sensory projection cells.

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66
Q

Contraindications / Precautions Morphine

A

Contras: Known hypersensitivity, labour
Precautions: Elderly, hypotension, resp depression, current asthma, resp tract burns, known addiction to narcotics, acute alcholism, pts on monoamine oxidase inhibitors

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67
Q

Morphine metabolism / excretion

A

Metabolised by the liver and excreted by the kidneys

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68
Q

Morphine Side Effects

A

CNS effects: Drowziness, resp depression, euphoria, N+V, pin-point pupils, addiction
CV effects: Hypotension, bradycardia

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69
Q

Naloxone Pharmacology

A

A narcotic antagonist. It is a competitive inhibitor of the opioid receptor. Naloxone antagonizes the action of opioids, reversing their effects.

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70
Q

Metabolism Naloxone

A

Metabolised in the liver

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71
Q

Contras / Precautions Naloxone

A

Contras: Nil
Precautions: If pt is dependant on narcotics they may become combative after admin, neonates

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72
Q

When should naloxone not be administered?

A

Following a narcotic assoiciated cardiac arrest or following a head injury

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73
Q

Ondansatron Pharmacology

A

A seretonin 5-HT3 receptor antagonist. Effects are on both central and peripheral nerves. It reduces the activity of the vagus nerce, thereby inhibits the vomiting centre in the medulla oblongata, and also blocks serotonin receptors in the chemoreceptor trigger zone

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74
Q

Contras / Precautions Ondansatron

A

Contras: Known hypersensitivity, children <2 years old
Precautions: impaired hepatic function, elderly, pregnancy, lactation

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75
Q

Metabolism / Excretion Ondansatron

A

Metabolised by liver and excreted by the kidneys

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76
Q

Side Effects Ondansatron

A

Headache, skin flusing, extrapyramidal effects, arrhythmia

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77
Q

Pharmacology Normal Saline

A

An isotonic crystalloid solution

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78
Q

Contras / Precautions oxygen admin

A

Contras: Known paraquat poisoning, lung disease secondary to bleomycin therapy
Precautions: Prolonged admin to neonates, high concentrations given to COPD patients, FIre and or explosive hazard

79
Q

Paracetamol Pharmacology

A

An analgesic aand antipyretic agent. Exact mechanism unclear but thought to inhibit prostaglandin synthesis in the CNS

80
Q

Metabolism / Excretion Paracetamol

A

Metabolised by the liverand excreted by the kidneys

81
Q

Contras / Precautions Paracetamol

A

Contras: Known hypersensitivity, children <1 month of age, paracetamol admin within past 4 hours, Total paracetamol within past 24 hours >4G adult of 60mg/kg child, chest pain in suspected ACS
Precautions: Hepatic or renal dysfunction, elderly / frail, malnourised

82
Q

Side Effects Paracetamol

A

Hypersensitivity reactions or hematological reactions (both rare)

83
Q

Prochlorperazine Pharmacology

A

Antiemetic which acts on several central neuro-transmitter systems.

84
Q

Metabolism / Excretion Prochlorperazine

A

Metabolised by the liver and excreted by the kidneys

85
Q

Contras / Precautions Prochlorperazine

A

Contras: Circulatory collapse, CNS depression, previous hypersensitivity, children <2 years of age
Precautions: Hypotension, epilepsy, Pts effected by alchohol or on anti-depressants

86
Q

Side Effects prochlorperazine

A

Drowzinessm blurred vision, hypotension, sinus tach, skin rash, extrapyramidal reactions, tardic dyskinesia may develop in pts on antipsychotic drugs

87
Q

Salbutamol Pharmacology

A

A synthetic beta-adrenergic stimulant, with primarily beta 2 effects

88
Q

Salbutamol Metabolism / Excretion

A

Metabolised by the liver and excreted by the kidneys

89
Q

Salbutamol contras / Precautions

A

Contras: Nil
Precautions: Diabetes, cardiac disease, pregnancy / lactating mothers, between doses oxygen must be administered continuously, large doses of IV salbutamol have been reported to cause metabolic acidosis

90
Q

Salbutamol Side Effects

A

SInus tachycardia, muscle tremour

91
Q

Weight ranges for igels (5,4,3,2.5,2,1.5,1

A

5: >90 kg
4: 50 -90kg
3: 30-60kg
2.5: 25-35kg
2: 10-25kg
1.5: 5-12kg
1: 2-5kg

92
Q

Contraindications igel

A

 Intact gag reflex or resistance to insertion.
 Strong jaw tone and/or Trismus.
 Suspected epiglottitis or upper airway obstruction

93
Q

Precautions iGel

A

 Inability to prepare the patient with the external auditory meatus aligned with
the sternal notch.
 Patients who require high airway pressures e.g. morbid obesity, pregnancy,
decreased pulmonary compliance (stiff lungs due to pulmonary fibrosis) or
increased airway resistance (severe asthma).
 Significant volume of vomit in airway

94
Q

Indications iGel

A

 Cardiac Arrest.
 Unconscious patients without gag reflex.
 Ineffective oxygenation with bag valve mask and basic airway management.
 Unable to intubate/difficult intubation.
 Assisted ventilation required for > 10 minutes.

95
Q

Indications Modified Valsalva

A

Haemodynamically stable Supraventricular Tachyarrhythmia’s i.e. SVT in line
with CPG A0403

96
Q

Contraindications Modified Valsalva

A

 Haemodynamically unstable requiring immediate synchronised cardioversion
(Systolic BP <90 mmHg)
 AF/A Flutter
 Third Trimester Pregnancy
 AMI
 Aortic stenosis
 Coronary artery stenosis

97
Q

Precautions Modified Valsalva

A

 Syncope
 Prolonged hypotension may occur

98
Q

What occurs in 4 phases of modified Valsalva

A

o Phase one – a transient increase in aortic pressure and a compensatory decrease in heart rate, due to increased intrathoracic pressure generated during forced exhalation against resistance.
o Phase two – the end of the transient period, with a decrease in aortic pressure as a consequence of reduced venous return and hence cardiac output, with baroreceptor response leading to increased heart
rate.
o Phase three – the end of the strain phase of the Valsalva manoeuvre, with further decrease in aortic pressure and compensatory rise in heart rate.
o Phase four – increased venous return accentuated by raising legs leading to increasing aortic pressure and compensatory decrease in heart rate, with subsequent return to resting heart rate.

99
Q

Effects of modified valsalva

A

The Valsalva manoeuvre increases vagal tone, slow conduction through the
atrioventricular (AV) node and prolongs the AV nodal refractory period,
leading to a reduction in heart rate and reversion of supraventricular
tachycardia.

100
Q

Indications and sites IO

A

For adult and paediatric (>1y) patients in cardiac arrest where vascular access
is difficult to obtain or there will be a delay in obtaining.
o Adult insertion sites: Proximal humerus, proximal tibia or distal tibia.
o Paediatric insertion sites: Proximal humerus, proximal tibia, distal tibia or distal
femur.

101
Q

Contraindications IO

A
  • Fracture of the targeted bone.
  • Previous, significant orthopaedic procedures at insertion site (e.g. prosthetic limb or joint).
  • IO in the targeted bone within the past 48 hours.
  • Infection at area of insertion.
  • Excess tissue or absence of adequate anatomical landmarks.
102
Q

What landmarks do you align pelvic binder with

A

Align the top edge of the Belt at the level of the iliac crest.
Alternatively the Belt can be cantered at the level of the
greater trochanters.

103
Q

Contras CT7

A
  • Knee or ankle/foot trauma: May increase pain and worsen other injuries.
104
Q

Precautions CT7

A
  • Pelvic trauma: Pelvic splinting is a higher clinical priority than splinting of limb factures.
    Traction splints may apply pressure on the pelvis in order to achieve traction, potentially
    worsening an injury. Legs should be realigned as part of open book fracture management.
    Splinting can still be used in pelvic trauma/fracture without gross deformity though anatomical
    splinting may be better depending on pelvic injury and severity.
  • Compound fractures: Open fractures with exposed bone should be irrigated with a sterile
    isotonic solution prior to realignment and splinting.
105
Q

Define Primary and Secondary Post Partum haemorrage

A

Primary: 600ml within the first 24 hours
Secondary: Excessive haemorrhage from 1 day to 6 weeks post partum

106
Q

Signs and Symptoms of Preeclampsia

A

Hypertension BP sys >140 and dias >90
headache
visual disturbances
nausea and or vomiting
dizziness

107
Q

At what temperature is cardiac arrhythmia associated with hypothermia

A

33 degrees and below

108
Q

How to handle and position hypothermic patients

A

Handle gently and position flat or lateral. Avoid head up position

109
Q

Warmed fluid for hypothermia should be what temperature

A

Between 37 and 42 degrees

110
Q

Temperatures for mild, moderate and severe hypothermia

A

Mild:32-35
Moderate: 28-32
Severe: <28

111
Q

Fluid therapy for hypothermia patients <32 degrees

A

Warmed fluids 10ml/kg to max of 40ml/kg

112
Q

Drug dosages alterations for hypothermic cardiac arrest

A

> 32 normal
30-32 double dosage intervals + do not warm above 33 if ROSC
<30 continue CPR and warming until tempt >30, one defib and one adrenaline only

113
Q

BP and HR aims in fluid therapy for hypovolaemia

A

HR <100 BP >100

114
Q

Fluid therapy for pts with isolated neurogenic shock

A

500ml Normal saline bolus only

115
Q

Aim of fluid therapy for pt with penetrating trunk injury, suspected AA or uncontrolled haemorrage

A

Accept palpable carotid pulse with adequate conscious state

116
Q

Fluid dosage for hypovolamic patient with either isolated tachycardia or hypotension BP <100

A

HR>100: 20ml/kg
BP<100: 20ml/kg

117
Q

What is the narcotic drug of choice for traumatic brain injury

A

Fentanyl

118
Q

Fluid dosage for partial of full thickness burns >10%

A

2ml/kg x % burn over first 8 hours

119
Q

Wallace rule of 9s burns

A

Head and Neck: 9% (Front and back of the head each account for 4.5%)
Upper Limbs (Each Arm): 9% (Front and back of each arm each account for 4.5%)
Chest: 18% (Front of the chest and abdomen each account for 9%)
Back: 18%
Lower Limbs (Each Leg): 18% (Front and back of each leg each account for 9%)
Genitalia: 1%

120
Q

Crush syndrome management less than 30 mins and over 30 mins

A

Less than 30 mins or involving torso and head immediately remove
More than 30 mins establish IV access 500ml normal saline and cardiac monitor prior to removal

121
Q

Barotrauma / Gas Embolis

A

Arrises from gas expansion in body cavities
Assess for CAGE (Cerebral Artery Gas Embolis) - sudden LOC or other CNS symptoms after rapid ascent

122
Q

Decompression Sickness

A

More gradual onset usually post dive. 0-36 hours post diving
Symptoms: generalsied aches, headache. SON, rash, joint pain, parethesia, paralysis, seizures, unconcious

123
Q

Management diving emergency

A

Keep pt supine, normal saline 1000ml then medical consult, tx avoid high altitudes.

124
Q

Treatment for N+V associated with cardiac chest pain, Iatrogenic secondary to narcotic analgesia, severe gastroenterteritis or previously diagnosed migraine

A

Metoclopromide 10mg IV/IM, repeat at 10 mins
AND/OR
Ondansatron 4mg IV/IM, repeat at 10 mins

125
Q

Treatment prophylaxis for potential motion sickness or planned aeromedical evacuation

A

Prochlorperazine 12.5mg IM and Ondansatron 4mg IV

126
Q

Treatment prophylaxis for eye trauma or patients with suspected spinal injuries who are immobilised

A

Ondansatron 4mg , repeat 10mins

127
Q

Treatment BGL<4

A

If responding to comands 15G oral glucose
If not responding to commands or no response to oral glucose large bore cannula 15G / 150ml glucose with 10ml saline flush, repeat 10G / 100ml every 10 mins until BGL>4
OR Glucagon 1mg IU IM

128
Q

What is DKA charactorized by

A

Hyperglycaemia
Ketosis
Metabolic acidosis

129
Q

What is HHS characterized by

A

Hyperglycaemia
Hyperosmolarity
Severe Dehydration

130
Q

What is euglycemic ketoacidosis

A

A condition where a patient blood glucose is normal but they have elevated ketones. Most likely to occur in pregnant patients, patients on low carb diets or patients taking SGLT2i medications (anti-hyperglycamic - dapagliglozin, empagliflozin, ertugliflozin).

131
Q

Management of hyperglycemia

A

If ketones <0.6 - 20ml/kg fluid if pt is dehydrated, if ketones >0.6 - 20ml/kg fluid if pt is dehydrated. Pt with ketones over 0.6 must be transported.

132
Q

Exclusion criteria for nonconvey diabetic emergencies

A

Post hypo and alone, unable / unwilling to eat post hypo, pregnancy, moderate/severe dehydration, no diagnosed hx diabetes, pt taking steroids, chronic alcoholics, blood ketone level >0.6

133
Q

Blood ketone assessment guide

A

Normal <0.6
Normal 0.6-1.5
Moderate 1.6-3.0
Severe >3.0

134
Q

Management continuous .recurrent seizures

A

> 60 years old: Midazolam 0.05mg/kg max single dose 10mg IM
<60 years old: Midazolam 0.1mg/kg max single dose 10mg IM

Repeat initial dose at 10 mins

135
Q

Preferred location for IM admin of adrenaline in anaphylaxis?

A

Antereo-lateral mid-thigh due to improved absorption

136
Q

Treatment for pts persistantly unresponsive to adrenaline (especially if taking beta blockers)

A

Consult for 1-2 IU of Glucagon IM or IV

137
Q

Treatment for anaphylaxis

A

500mcg Adrenaline IM at 5 min intervals
10mg salbutamol neb with repeat 5mg @ 5 mins if required for bronchospasm
20ml/kg normal saline IV fluid resus
5mg nebulised adrenaline for upper airway oedema

138
Q

What are the SIRs criteria

A

2 or more of:
Temp>38 or <36
HR>90
RR>20
BP<90

139
Q

Suspected Sepsis Inadequate perfusion Treatment

A

Normal Saline 20ml/kg if poor perfusion
If prolonged transport time exists, consult for ceftriaxone and dexamethasone (dosage on consult)

140
Q

Criteria for admin of ABX in Meningococcal disease

A

History suggestive of infection and any of:
Altered level of conciousness
Meningeal irritation (neck stiffness, photophobia)
Non blanching petechial rash

141
Q

Treatment suspected meningococcal disease

A

If IV access: 2G Ceftriaxone administered over 2 mins (each G made up into 9.5ml of normal saline)
If no IV access: 2G Ceftriaxone (each G made up into 3.5ml Lignocaine HCl) admin into the upper lateral thigh or large muscle mass

142
Q

What are the two goal vita sign targets for treating narcotic overdose

A

GCS>12 and RR>8 (with adequate tidal volume)

143
Q

Treatment Narcotic OD

A

Partial reversal (preferred unless imminent arrest)
Naloxone 100mcg bolus IV every 60 seconds titrated to response (maximum 2mg)
Complete reversal
800mcg IM
Repeat 800mcg IV/IM at 5 mins if no response Repeat 400mcg IV/IM at 5 mins (max 2mg)

144
Q

ECG changes indicated TCA overdose

A

Positive R wave in aVR >3mm, prolonged PR, QRS and QT intervals. If QRS widening over 0.12 secs - severe toxicity. QTc >500msec indicates toxicity

145
Q

Treatment TCA overdose

A

Hyperventilate with 100% O2 at rate 20-24

146
Q

What are the 4 general categories of ABD

A

Psychiatric disorders, substance related, organic disorders, situational

147
Q

When may paramedics sedate and place a patient in protective custody?

A

They may sedate a pt in protective custody when: they consider it necessary and prudent to do so, they have exhausted all other means of getting the pt to hospital in a less restrictive manner
They may place a person into protective custody if they reasonable believe that: the persona has a mental illness, the person needs to be assessed against assessment or treatment criteria, the persons safety or other persons is likely to be at risk if the person is not taken into protective custody.

148
Q

ABD Sedation treatment

A

SAT +1
10mg oral diazapam (5mg if age>60 years), may be repeated at 60 min intervals to max of 40mg).
SAT +2 - +3 NO IV access
Droperidol 10 mg IM (5mg in age>60 or weight <50kg) Repeat once at 15 mins if SAT >0
SAT +2 - +3 IV access
Droperidol 5mg IV, may repeat same dosage at 10 mins if SAT>0
Max dose drop 20mg or 10mg if age>60 or weight under 50kg

149
Q

What is the key word to look for on labels in suspected organophosphate poisoning?

A

Anticholinesterase

150
Q

Treatment Autonomic dysreflexia

A

Treat possible cause (unkink catheter, manage pain ect)
400mcg GTN if BP >160 repeat 10 mins until symptoms resolve or onset of side effects or BP<160

151
Q

How can shock be defined / identified (sepsis)

A

Septic shock defined as “a subset of sepsis with profound circulatory, cellular and metabolic abnormalities”
Shock can be identified by a vasopressor requirement to maintain systolic BP>100 if unresponsive to at least 1L of saline

152
Q

qSOFA Criteria

A

2 of more of HAT:
Hypotension - sys BP<100
Altered concious state - any decrease from baseline
Tachypnoea - RR>22

153
Q

Criteria for ABX admin in sepsis

A

Provisional diagnosis of sepsis, a positive qSOFA score + tranport time >60 mins

154
Q

Fluid admin in sepsis

A

500ml IV repeated until BP >100 sys (max 3L

155
Q

Treatment Bronchoconstriction

A

Mild or moderate:
Salbutamol pDMI 6 puffs at 5 mins or if no spacer 10mg salbutamol nebulised, repeat 5mg at 5 mins

Severe: Salbutamol pDMI 6 puffs at 5 minutes and Ipatropium bromide pDMI 8 x puffs no repeat or 10mg salbutamol nebulised, repeat 5mg at 5 mins and 500mcg ipatropium bromide no repeat

If requiring ventilation 5-8p/mi allowing for prolonged expiratory phase with gentle lateral chest pressure if required

If imminent arrest 300mcg adrenaline IM repeat at 20 minutes as required

156
Q

Treatment COPD

A

Irrespective of severity: 10mg salbutamol nebulised, repeat 5mg at 5 mins and 500mcg ipatropium bromide no repeat nebulise titrate oxygen to 88-92%

If requiring ventilation 5-8p/mi allowing for prolonged expiratory phase with gentle lateral chest pressure

157
Q

Management No cardiac output COPD / Asthma

A

Apnoea for 1 minutes

158
Q

What are the specific indications for fentanyl?

A

Contraindication to morphine, short duration of action desired (e.g dislocations), hypotension, nausea and vomiting secondary to previous morphine admin

159
Q

Pain relief for mild pain

A

1000mg Paracetamol oral AND OR 400mg Ibuprofen

160
Q

Pain relief for moderate pain

A

Consider Paracetamol and Ibuprofen
Morphine 0.05mg/kg up to 5mg IV repeat up to no less than 5 mins or Fentanyl .50mcg/kg max 50 mcg repeat up to no less than 5 mins
Or if unable to gain IV access or delayed >10 mins
3ml methoxyflurane repeat 3 ml as required only once
OR
Fentanyl up to 100mcg IN repeat 50mcg at no less than 5 minutes max 400mcg
OR
Morphine 0.1mg/kg max 10 mg IM/SC or Fentanyl 1mcg/kg max 100mcg IM/SC Repeat dose once only at 20 minutes

161
Q

Pain relief for severe pain

A

Morphine 0.05mg/kg up to 5mg IV repeat up to no less than 5 mins or Fentanyl .50mcg/kg max 50 mcg repeat up to no less than 5 mins

162
Q

Treatment ACS

A

Aspirin 300mcg
GTN 400mcg 5 min intervals as long as systolic BP >100
Pain relief as per pain management
GTN for hypertension +/- symptoms 400mcg Evenry 5 minutes until Systolic BP<160 or diastrolic BP<100

163
Q

Treatment SVT

A

If maintaining BP >100mg Valsalva maneuver

164
Q

Treatment Acute Pulmonary Odema

A

Posture pt sitting upright
If systolic BP over 100 GTN 400mcg, repeat 400mcg at 5 mins as required

165
Q

12-lead ECG STEMI Criteria

A

≥2.5mm ST elevation in leads V2-V3 Men under 40
≥2mm ST evelation in men over 40
≥1.5mm ST evelation in women
or
≥1mm ST evelation in other leads
≥0.5mm ST evelation in V7-V9

166
Q

Where does a supraglottic airway sit

A

Low pressure seal around the posterior perimiter of the larynx, superior to the oesophageal sphrincter

167
Q

Treatment VT / VF arrest

A

Defib 200J every 2 mins
Normal Saline TKVO
Adrenaline 1mg every 4 mins

168
Q

Treatment PEA arrest

A

Normal saline TKVO
Adrenaline 1mg every 4 mins
If PEA persist Normal sALINE 20ML/kg

169
Q

RSA Criteria

A

General appearance, speech, breath sounds, resp rate, resp rhythm, breathing effort, pulse rate, skin, concious state, oxygen sats

170
Q

PSA Criteria

A

Skin, pulse, BP, concious state, cap refil

171
Q

Paediatric ages and weight calc

A

Newborn: Birth to first few hours to life. 3.5kg.
Infant: First few hours to one year. 5 moths 7kg, 1 year 10kg
Young child: 1-9 years. Age x 2 + 8kg
Older child 9-12 years. Age x 3.3kg

172
Q

When to commence chest compressions paeds

A

No palpable pulse or
HR<60 infrants
HR< 40 children

173
Q

Newborn non effective breathing treatment

A

Dry, stimulate, warm
If pulse<100 of inadequate breathing commence IPPV on room air (for 10 mins)
If after 30 seconds breathing remains inadequate and pulse <60 commence CPR 1:3

174
Q

Defibrillation paeds calculation

A

4J/kg

175
Q

Pain relief dosages paediatrics

A

Paracetamol 15mg/kg
Fentanyl IN small child (10-24kg): 25mcg 3 dosages @ 5 mins, large child(>25kg): 50mcg 3 x dosages 5 mins
Ibuprofen 10mg/kg
Methoxyflurane 3 ml repeat 3 ml as required max 6ml
Morphine IM 0.1mg/kg max 5mg. Medical consult for further dosage

176
Q

When is nebulised adrenaline indicated for croup

A

Signs of agitation, distress, cyanosis, SPO2<92% on RA, marked use of accessory muscles

177
Q

Adrenaline neb dosage paed upper airway obstruction

A

5mg/5ml neb. Repeat as required

178
Q

Asthma treatment paeds

A

Sabulatamol pDMI 6 puffs every 5 mins
IB for <6 years 4 puffs, >6 yewars 8 puffs no repeat
Salbutamol ned 5mg and IB 500mch, repeat 5mg salbutamol @ 5 mins

179
Q

Ventilation rates asthma paeds

A

Infant 15-20
Small child 10-15
Large child 8-12
all 7ml/kg

180
Q

Treatment impending arrest asthma paed

A

Adrenaline 10mcg/kg IM repeat at 20 mins as required (total max 30mcg/kg)

181
Q

Immediate treatment loss of cardiac output in asthma paeds

A

30 seconds apnoea with gentle lateral chest pressure

182
Q

Hypoglycaemia paeds treatment dosages

A

15g oral gel
GLucose 10% 5ml/kg (500mg/kg)
Glucagon <25kg 0.5 IU >25kg 1IU

183
Q

Hyperglycaemia treatment paediatrics

A

Normal saline 10ml/kg

184
Q

Continuous / recurrent seizures paeds treatment

A

0.15mg/kg IM max dose 10mg repeat once at 10 mins if required

185
Q

Adrenaline dosage paeds in anaphylaxis

A

10mcg/kg to max 500mcg @ 5 minutes

186
Q

Ceftriaxone dosage meningococcal disease paeds

A

50mg/kg max dose 2G

187
Q

Paeds sepsis fluid resus dose

A

Normnal saline 10ml/kg bolus, repeated once at 15mins max dose 20ml/kg

188
Q

Naloxone dosage paeds

A

10mcg/kg (max 400mcg per dose) IM, repeat at 10 mins to max of 400mcg

189
Q

Inadequate perfusion fluid dose paed

A

20ml/kg IV

190
Q

Paeds isolated neurogenic shock fluid resus

A

5ml/kg nomral saline single bolus

191
Q

Paediatric HR values

A

Newborn: 120-160
Infant: 100-160
Small Child: 80-120
Large Child: 80-100

192
Q

Paediatric RR Values

A

Newborn: 40-60
Infant: 20-50
Small Child: 20-35
Large Child: 15-25

193
Q

Paediatric BP vaules

A

Newborn: NA
Infant: >70sys
Small Child: >80sys
Large Child: >90 sys

ICP Prep (4 decks)

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