CPP Drugs as per Gavin's email Flashcards
(178 cards)
1
Q
Adrenaline adult IM dose for anaphylaxis or severe allergic reaction
A
500 microg
Repeated at 5 minute intervals
No max dose
2
Q
Adrenaline adult IV dose for cardiac arrest
A
1 mg
Repeated at 3-5 minute intervals
No max dose
3
Q
Adrenaline adult IM dose for severe life-threatening bronchospasm or silent chest (Pt must only be able to speak in single words and/or have haemodynamic compromise and/or ALOC)
A
500 microg
Repeated at 5 minute intervals
No maximum dose
4
Q
Adrenaline Contraindications
A
Nil
5
Q
Adrenaline Indications
A
Cardiac arrest
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)
Croup (moderate to severe)
Shock unresponsive to adequate fluid resuscitation - CCP only
Bradycardia with poor perfusion - CCP only
6
Q
Adrenaline Paediatric Newly Born IV Dose for Cardiac Arrest
A
50 microg
Repeated every 3 - 5 mins
No max dose
7
Q
Adrenaline Presentation
A
Ampoule, 1 mg/1 mL (1:1,000) adrenaline
Ampoule, 1 mg/10 mL (1:10,000) adrenaline
Prefilled syringe EpiPen auto-injector, 300 microg adrenaline (yellow)
Prefilled syringe Epi Pen auto-injector, 150 microg adrenaline (green)
8
Q
Fentanyl Adult Subcut Dose for Significant Pain
A
QAS clinical consultation and advice line approval required in all situations
9
Q
Fentanyl Adult ≥70yrs/cachectic or frail NAS Dose for:
Significant Pain
Autonomic Dysreflexia (SBP >160 mmHg)
A
25-50 microg
Repeated up to 50 microg every 10 mins
Total max dose 100 microg (or MME)
10
Q
Fentanyl Contraindications
A
Allergy AND/OR Adverse Drug Reaction
11
Q
Fentanyl Indications
A
significant pain
autonomic dysreflexia (with SBP > 160 mmHg)
Sedation - CCP only
Induction for rapid sequence intubation - CCP only
Note: Morphine is the preferred narcotic agent except:
- allergy and or KSAR to morphine
- haemodynamic instability
- known/suspected kidney disease
- when NAS narcotic administration is preferred
- suspected ACS
12
Q
Fentanyl paediatric NAS dose for significant pain
A
≥1yr - 1.5 microg/kg
Single max dose 50 microg
Repeated once at 1 microg/kg at 10 mins
Total max dose 100 microg (or MME)
<1yr - QAS clinical consultation and advice line approval required in all situations
13
Q
Fentanyl Presentation
A
ampoule, 100 microg/2 mL fentanyl
14
Q
Glucagon Adult IM Dose - Refractory anaphylaxis with persistent hypotension/shock (unresponsive to 3 x IM adrenaline injections and adequate fluid challenges)
A
May be administered when paramedics are unable to achieve IV access.
1mg
Single dose only.
Syringe preparation: Reconstitute 1 mg of glucagon with 1 ml of water for injection in a 3 ml syringe to achieve a final concentration of 1 mg/ 1 ml.
15
Q
Glucagon Adult IM Dose - Symptomatic hypoglycaemia
A
1mg
Single dose only
Syringe preparation: reconstitute 1 mg glucagon with 1 mL of water for injection in a 3 mL syringe to achieve a final concentration of 1 mg/1 mL
16
Q
Glucagon Contraindications
A
Allergy AND/OR adverse drug reaction
17
Q
Glucagon Indications
A
Symptomatic hypoglycaemia (with the inability to self-administer oral glucose)
Refractory anaphylaxis with persistent hypotension/shock (unresponsive to 3 x IM adrenaline injections and adequate fluid challenges)
18
Q
Glucagon Paediatric IM Dose for refractory anaphylaxis with persistent hypotension/shock (unresponsive to 3 x IM adrenaline injections and adequate fluid) for children >25kg
A
May be administered when paramedics are unable to achieve IV access
1 mg
Single dose only
Syringe Prep: Reconstitute 1 mg of glucagon with 1 mL water for injection in a 3 mL syringe to achieve a final concentration of 1 mg/1 mL.
19
Q
Glucagon Paediatric IM Dose for Symptomatic hypoglycaemia (with the inability to self-administer oral glucose) for children >25kg
A
1 mg
Single dose only
Syringe preparation: Reconstitute 1 mg of glucagon with 1 mL of water for injection in a 3 mL syringe to achieve a final concentration of 1 mg/1 mL
20
Q
Glucagon Presentation
A
Vials (powder and solvent), 1mg glucagon
21
Q
Midazolam Adult IM Dose - Acute Behavioural Disturbance (SAT score ≥2) unresponsive to droperidol (max dose) administration
A
QAS Clinical Consultation and Advice Line approval required in all situations
22
Q
Midazolam Adult NAS Dose - Generalised Seizure/Focal Seizure
A
5mg
Repeat every 10 minutes
Total max dose 20mg
23
Q
Midazolam Contraindications
A
allergy and/or adverse drug reaction
24
Q
Midazolam Indications
A
Generalised seizure/focal seizure (GCS ≤12)
Acute behaviour disturbance (SAT score ≥2) unresponsive to droperidol (max dose) administration
Sedation - CCP only
25
Midazolam Paediatric IM Dose for Acute Behavioural Disturbance (with a SAT score ≥2), unresponsive to droperidol (max dose) administration
QAS clinical consultation and advice line approval required in all situations
26
Midazolam Paediatric IM Dose for Generalised/Focal Seizures (GCS ≤12)
200 microg/kg
Single dose not to exceed 5 mg
Repeated at half initial dose every 10 min (max 2.5 mg)
Total max dose 10 mg
27
Midazolam Presentation
Ampoule, 5mg/1mL, midazolam
28
Midazolam Timing
**Onset**
5-15 minutes (IM)
1-3 minutes (IV)
**Duration**
Variable
* *Half Life**
2. 5 hours
29
Morphine ≥70yrs/cachectic or frail IM adult dose for:
Significant pain
Autonomic dysreflexia (with SBP >160mmHg)
2.5-5mg
Repeated at up to 5mg every 10 mins
Total max dose 10 mg (or MME)
30
Morphine adult dose for significant pain via SUBCUT
QAS clinical consultation and advie line approval required in all situations
31
Morphine Contraindications
Allergy and/or adverse drug reaction
Kidney disease (renal failure)
32
Morphine Indications
Significant pain
Autonomic dysreflexia (with SBP \>160mmHg)
Sedation - CCP Only
Is the preferred narcotic agent except when:
* allergy or KSAR to morphine
* haemodynamic instability
* known/suspected kidney disease
* when NAS narcotic admin is preferred
* suspected ACS
33
Morphine SUBCUT paediatric dose for significant pain
QAS clinical consultation and advice line approval required in all situations
34
Morphine paediatric IM dose for:
Significant pain
Autonomic dysreflexia (with SBP \>160mmHg)
≥1yr - 100-200 microg/kg
Single max dose 5 mg
Total max dose 200 microg/kg (or MME)
<1yr - QAS clinical consultation and advice line approval required in all situations
35
Morphine Presentation
Ampoule, 10mg/1 mL morphine sulphate pentahydrate
36
Sodium Chloride 0.9% adult IV/INF dose - significant burns (TBSA \> 20%)
mL/hr to be infused = 15 mL/hr x TBSA (nearest 10%)
if \> 100 kg administer additional 200 mL/hr
Re-assess Pt after every 250-500 mL fluid administration
For burns management: use PHIFTEEN B (15-B) formula in adults to identify the hourly parenteral fluid rate goal to be administered for the time of injury
37
Sodium Chloride 0.9% adult/paediatric IM/IV dose to dissolve and dilute drugs
As authorised on individual DTPs
38
Sodium Chloride 0.9% adult IV/INF dose:
hypovolaemia
PRN - titrate according to the indication and the pt's physiological response to treatment
Re-assess Pt after every 250-500 mL fluid administration
In uncontrolled haemorrhage administer the minimum amount of IV/IO fluid required to maintain a radial pulse
39
Sodium Chloride 0.9% adult/paediatric IV dose as a flush following IV or IO drug administration
PRN
40
Sodium Chloride 0.9% contraindications
Nil
41
Sodium Chloride 0.9% Indications
Inadequate tissue perfusion/shock
Hypovolaemia
Significant burns (Total Body Surface Area \> 20% for adults or\> 10% for paediatrics)
To dissolve and dilute drugs (for the purpose of IM, IV or 10 administration)
As a flush following IV or 10 drug administration
42
Sodium chloride 0.9% paediatric IV/INF dose for significant burns (TBSA \>10%)
QAS clinical consultation and advice line consultation and approval required in all situations
Paediatric pts must be re-assessed after every 10 mL/kg of fluid administration
43
Sodium chloride 0.9% IV/INF paediatric dose for:
hypovolaemia
QAS clinical consultation and advice line approval required in all situations
10-20mL/kg
May be repeated twice following Pt assessment
Total max dose 60mL/kg
Paediatric pts must be re-assessed after every 10 mL/kg of fluid administration
44
Sodium Chloride 0.9% presentation
Ampoule, 10 mL sodium chloride 0.9%
Viaflex plastic container, 100 mL sodium chloride 0.9%
Viaflex plasitc container, 500 mL sodium chloride 0.9%
BD PosiFlush 10 mL pre-filled sodium chloride 0.9% syringe
45
Sodium chloride 0.9% Timing
**Onset**
Immediate
**Duration**
Variable
**Half-Life**
N/A
46
Glucose 10% Indications
Symptomatic hypoglycaemia (with the inability to self-administer oral glucose)
Unconscious hypoglycaemia - EACP2 only
47
Glucose 10% Timing
**Onset**
Rapid
**Duration**
N/A
**Half-Life**
N/A
48
Glucose 10% Adult IV Dose
15g (150mL)
Repeated at 10g (100 mL) boluses every 5 minutes until BGL >4.0mmol/L
49
Glucose 10% Contraindications
Nil
50
Glucose 10% Presentation
Viaflex plastic container, 250 mL glucose monohydrate 10%
51
Glucose 10% Paediatric IV Dose
0.25 g/kg (2.5 mL/kg)
Repeated at 0.1 g/kg (1 mL/kg) boluses every 5 mins until BGL > 4.0 mmol/L
52
Glucose Gel Indications
Symptomatic hypoglycaemia (with the ability to self-administer oral glucose)
53
Glucose Gel Timing
**Onset**
≈ 10 mins
**Duration**
Variable
**Half-Life**
N/A
54
Glucose Gel Adult PO Dose
15g
Repeated once at 15 minutes if BGL ≤ 4mmol/L
Total maximum dose 30g
55
Glucose Gel Contraindications
Unconsciousness
Patients with difficulty swallowing
Patients < 2 years
56
Glucose Gel Presentation
Tube, 15g Glucose (Glutose 15)
57
Glucose Gel Paediatric PO Dose
≥2 yrs - 15 g
Repeated once at 15 mins if BGL ≤4 mmol/L
Total max dose 30 g
58
Glucose Gel Drug Class
hyperglycaemic
59
Glucose 10% Drug Class
hyperglycaemic
60
Fentanyl paediatric IV dose for significant pain
≥1yr - 1 microg/kg
Single max dose 25 microg
Repeated every 5 mins at 0.5 microg/kg (max 25 microg)
Total max dose 2 microg/kg (or MME)
<1yr - QAS clinical consultation and advice line approval required in all situations
61
Fentanyl paediatric SUBCUT dose for significant pain
QAS clinical consultation and advice line approval required in all situations
62
Glucagon Adult IV Dose - Refractory anaphylaxis with persistent hypotension/shock (unresponsive to 3 x IM adrenaline injections and adequate fluid challenges)
1 mg
Single dose only.
*Syringe preparation: Reconstitute 1 mg of glucagon with 1 ml of water for injection in a 3 ml syringe to achieve a final concentration of 1 mg/1 ml.*
63
Glucagon Paediatric IV Dose for refractory anaphylaxis with persistent hypotension/shock (unresponsive to 3 x IM adrenaline injections and adequate fluid) for children \>25kg
1 mg
Single dose only
*Syringe Prep: Reconstitute 1 mg of glucagon with 1 mL water for injection in a 3 mL syringe to achieve a final concentration of 1 mg/1 mL.*
64
Morphine ≥70yrs/cachectic or frail IV adult dose for:
Significant pain
Autonomic dysreflexia (with SBP \>160mmHg)
2.5mg
Repeated at up to 2.5mg every 5 mins
Total max dose 10 mg (or MME)
65
Adrenaline adult NEB dose for anaphylaxis or severe allergic reaction
5mg
Single dose only
May be administered for upper airway obstruction that is refractory to 3 X IM adrenaline injections
66
Fentanyl Adult ≥70yrs/cachectic or frail IM dose for:
Significant Pain
Autonomic Dysreflexia (with SBP \>160 mmHg)
25-50 microg
Repeated up to 50 microg every 10 mins
Total max dose 100 microg (or MME)
67
Fentanyl Adult ≥70yrs/cachectic or frail IV dose for:
significant pain
autonomic dysreflexia (with SBP >160 mmHg)
25 microg
Repeated up to 25 microg every 5 mins
Total max dose 100 microg (or MME)
68
Morphine paediatric IV dose for:
Significant pain
Autonomic dysreflexia (with SBP \>160mmHg)
≥1yr - 100 microg/kg
Single max dose 2.5mg
Repeated at 50 microg/kg (max 2.5mg) every 5 mins
Total max dose 200 microg/kg (or MME)
<1yr - QAS clinical consultation and advice line approval required in all situations
69
Midazolam Adult IV Dose - Generalised Seizure/Focal Seizure (GCS 12 or less)
**If IV already there**
5mg
Repeat every 5 minutes
Total max dose 20mg
70
Fentanyl adult <70yrs IM dose for:
Significant Pain
Autonomic Dysreflexia (with SBP >160 mmHg)
25-100 microg
Repeated up to 50 microg every 10 mins
Total max dose 200 microg (or MME)
71
Fentanyl adult <70yrs IV dose for:
Significant Pain
Autonomic Dysreflexia (with SBP >160 mmHg)
25-50 microg
Repeated up to 50 microg every 5 mins
Total max dose 200 microg (or MME)
72
Fentanyl Adult <70 NAS Dose for:
Significant Pain
Autonomic Dysreflexia (SBP \>160 mmHg)
50-100 microg
Repeated up to 100 microg every 10 mins
Total max dose 200 microg (or MME)
73
Morphine <70yrs IM adult dose for:
Significant pain
Autonomic dysreflexia (with SBP >160mmHg)
2.5 - 10mg
Repeated at up to 5mg every 10mins
Total max dose 20mg (or MME)
74
Morphine <70 IV adult dose for:
Significant pain
Autonomic dysreflexia (with SBP >160mmHg)
2.5 - 5mg
Repeated at up to 5mg every 5mins
Total max dose 20mg (or MME)
75
Adrenaline Paediatric NEB Dose for Anaphylaxis or Severe Allergic Reaction
5mg Single dose only
May be administered for upper airway obstruction that is refractory to 3 x IM adrenaline injections
76
Adrenaline Paediatric NEB Dose for Croup
5 mg
Single dose only
77
Fentanyl paediatric IM dose for significant pain
≥1yr - 1-2 microg/kg
Single max dose 50 microg
Total max dose 2 microg/kg (or MME)
Less than 1yr - QAS clinical consultation and advice line approval required in all situations
78
Adrenaline paediatric 1 - 5 yrs IM dose for anaphylaxis or severe allergic reaction
150 mcg
every 5 mins
no max dose
79
Adrenaline paediatric 6mths - 1yr IM dose for anaphylaxis or severe allergic reaction
100 mcg
every 5 mins
no max dose
80
Adrenaline paediatric <6mths IM dose for anaphylaxis or severe allergic reaction
50 mcg
every 5 mins
no max dose
81
Adrenaline Paediatric 1 - 5yrs IM Dose for Severe Life-threatening Bronchospasm or Silent Chest (pts must only be able to speak in single words and/or have haemodynamic compromise and/or ALOC)
150 mcg
every 5 mins
no max dose
82
Adrenaline Paediatric 6mths - 1yr IM Dose for Severe Life-threatening Bronchospasm or Silent Chest (pts must only be able to speak in single words and/or have haemodynamic compromise and/or ALOC)
100 mcg
every 5 mins
no max dose
83
Adrenaline paediatric ≥6yrs IM dose for anaphylaxis or severe allergic reaction
300 mcg every
5 mins
no max dose
84
Adrenaline Paediatric <6mths IM Dose for Severe Life-threatening Bronchospasm or Silent Chest (pts must only be able to speak in single words and/or have haemodynamic compromise and/or ALOC)
50 mcg
every 5 mins
no max dose
85
Adrenaline Paediatric ≥6yrs IM Dose for Severe Life-threatening Bronchospasm or Silent Chest (pts must only be able to speak in single words and/or have haemodynamic compromise and/or ALOC)
300 mcg
every 5 mins
no max dose
86
Adrenaline Paediatric ≥10kg (≥1yr) IV Dose for Cardiac Arrest
10 microg/kg
Repeated every 3 - 5 mins
No max dose
87
Adrenaline Paediatric <10kg (excl newly born) IV Dose for Cardiac Arrest
100 microg
Repeated every 3 - 5 mins
No max dose
88
Glucagon Paediatric IM Dose for Symptomatic hypoglycaemia (with the inability to self-administer oral glucose) for children ≤25kg
0.5 mg
Single dose only
*Syringe preparation: Reconstitute 1 mg of glucagon with 1 mL of water for injection in a 3 mL syringe to achieve a final concentration of 1 mg/1 mL. Decant 0.5 mL of the prepared solution to achieve a final concentration of 0.5 mg/1 mL*
89
Glucagon Paediatric IM Dose for refractory anaphylaxis with persistent hypotension/shock (unresponsive to 3 x IM adrenaline injections and adequate fluid) for children ≤25kg
May be administered when paramedics are unable to achieve IV access
0.5 mg
Single dose only
*Syringe prep: Reconstitute 1 mg of glucagon with 1 mL water for injection in 3 mL syringe to achieve final concentration of 1 mg/1 mL. Decant 0.5 mL of the prepared solution to achieve a final concentration of 0.5 mg/0.5mL.*
90
Glucagon Paediatric IV Dose for refractory anaphylaxis with persistent hypotension/shock (unresponsive to 3 x IM adrenaline injections and adequate fluid) for children ≤25kg
0.5 mg
Single dose only
*Syringe prep: Reconstitute 1 mg of glucagon with 1 mL water for injection in 3 mL syinge to achieve final concentration of 1 mg/1 mL. Decant 0.5 mL of the prepared solution to achieve a final concentration of 0.5 mg/0.5mL.1 mg*
91
Sodium Chloride 0.9% adult IV/INF dose:
inadequate tissue perfusion/shock
PRN - titrate according to the indication and the pt's physiological response to treatment
Re-assess Pt after every 250-500 mL fluid administration
In uncontrolled haemorrhage administer the minimum amount of IV/IO fluid required to maintain a radial pulse
92
Sodium chloride 0.9% IV/INF paediatric dose for:
inadequate tissue perfusion/shock
QAS clinical consultation and advice line approval required in all situations
10-20mL/kg
May be repeated twice following Pt assessment
Total max dose 60mL/kg
Paediatric pts must be re-assessed after every 10 mL/kg of fluid administration
93
Morphine Routes of Administration
IM
IO
IV
SUBCUT
94
Midazolam Routes of Administration
NAS
IM
IV
95
Midazolam Adult IM Dose - Generalised Seizure/Focal Seizure
5mg
Repeat every 10 minutes
Total max dose 20mg
96
Midazolam Adult IV Dose - Acute Behavioural Disturbance (SAT score ≥2) unresponsive to droperidol (max dose) administration
QAS Clinical Consultation and Advice Line approval required in all situations
97
Midazolam Paediatric NAS Dose for Generalised/Focal Seizures (GCS ≤12)
200 microg/kg
Single dose not to exceed 5 mg
Repeated at half initial dose every 10 min (max 2.5 mg)
Total max dose 10 mg
98
Midazolam Paediatric IV Dose for Acute Behavioural Disturbance (with a SAT score ≥2), unresponsive to droperidol (max dose) administration
QAS clinical consultation and advice line approval required in all situations
99
Glucose 10% Routes of Administration
INF
IV
100
Glucose 10% Adult INF Dose
15g (150mL)
Repeated at 10g (100 mL) boluses every 5 minutes until BGL >4.0mmol/L
101
Glucose 10% Paediatric INF Dose
0.25 g/kg (2.5 mL/kg)
Repeated at 0.1 g/kg (1 mL/kg) boluses every 5 mins until BGL > 4.0 mmol/L
102
Glucose Gel Routes of Administration
PO
103
Glucagon Routes of Administration
IM
IV
104
Fentanyl Routes of Administration
IM
IV
NAS
SUBCUT
105
What is the IV fentanyl dose for hypotensive pts SBP <90mmHg?
25 mcgs if CCP backup
106
What is the IM fentanyl dose for hypotensive pts SBP <90mmHg?
Consult for 50 mcgs
107
Tranexamic Acid (TXA) Drug Class
Antifibrinolytic
108
Tranexamic Acid (TXA) Indications
Recent traumatic injuries (3 hours or less) with a COAST score ≥3
Management of uncontrolled primary post-partum haemorrhage (3 hours or less)
109
Tranexamic Acid (TXA) Contraindications
Allergy and/or adverse drug reaction
110
Tranexamic Acid (TXA) Presentation
1gm/10mL
111
Tranexamic Acid Paediatric IV Dose for:
Recent traumatic injuries (\<3 hours) with a COAST score _\>_3
QAS Clinical Consultation and Advice Line approval required in all situations.
15mg/kg
Slow push over 10 minutes
Single dose only
Total maximum dose 1g
112
Tranexamic Acid Adult INF Dose for:
Recent traumatic injuries (\<3 hours) with a COAST score \>3
1gm over 10 minutes
Single dose only
*Infusion preparation: Mix 1g of tranexamic acid in a 100 mL bag of sodium chloride 0.9%. Ensure bag is appropriately labelled. Administer over 10 minutes (approx 3 drops per second)*
113
Tranexamic Acid Adult INF Dose for:
Management of uncontrolled primary post-partum haemorrhage (≤3 hours)
1gm over 10 minutes
Single dose only
*Infusion preparation: Mix 1g of tranexamic acid in a 100 mL bag of sodium chloride 0.9%. Ensure bag is appropriately labelled. Administer over 10 minutes (approx 3 drops per second)*
114
Naloxone Drug Class
opioid antagonist
115
Naloxone Indications
Respiratory depression (secondary to the administration of narcotic drugs)
116
Naloxone Contraindications
allergy/KSAR
newly born pts
117
Naloxone Presentation
Ampoule, 400 microg/mL
118
Naloxone Routes of Administration
IM
119
Naloxone Adult IM dose for Respiratory depression (secondary to the administration of narcotic drugs)
1.6 mg
Single dose only
120
Naloxone paediatric IM dose for Respiratory depression (secondary to the administration of narcotic drugs)
20 microg/kg
Single dose only, not to exceed 800 microg
121
Glyceryl Trinitrate (GTN) Adult Subling Dose - Acute Cardiogenic Pulmonary Oedema
400 microg
Repeated at 5 min intervals
No maximum dose
122
Glyceryl Trinitrate (GTN) Adult Subling Dose - Suspected ACS (with pain)
400 microg
Repeated at 5 min intervals
No maximum dose
123
Glyceryl Trinitrate (GTN) Adult Subling Dose:
Autonomic Dysreflexia (SBP >160 mmHG)
400 microg
Repeated at 5 min intervals
No maximum dose
124
Glyceryl Trinitrate (GTN) Contraindications
allergy and/or adverse drug reaction
acute CVA
head trauma
heart rate < 50 or > 150 beats per minute
systolic BP < 100 mmHg
phosphodiesterase 5 inhibitor medication administration:
- sildenafil OR vardenafil in the previous 24 hours
- tadalafil in the previous 48 hours
125
Glyceryl trinitrate (GTN) Indications
Suspected ACS (with pain)
Acute cardiogenic pulmonary oedema
Autonomic dysreflexia (with a systolic BP >160 mmHg)
Irukandji syndrome (with a systolic BP >160 mmHg)
126
Glyceryl Trinitrate (GTN) Paediatric Subling Dose for:
Irukandji syndrome (with a SBP \>160mmHg)
QAS clinical consultation and advice line approval required in all situations
**Note:** In all other instances, QAS officers are NOT authorised to administer GTN to paediatric Pts
127
Hydrocortisone Adult IM Dose for:
Suspected, or at risk of, an acute adrenal insufficiency (adrenal crisis)
100 mg
Single dose only
128
Hydrocortisone Adult IM Dose for Refractory Anaphylaxis with Persistent Wheeze
200 mg
Single dose only
129
Hydrocortisone Contraindications
Allergy AND/OR Adverse Drug Reaction
130
Hydrocortisone Indications
Asthma (excluding mild)
Acute exacerbation of COPD (with evidence of respiratory distress)
Refractory anaphylaxis with persistent wheeze (and unresponsive to 3 x IM adrenaline (epinephrine))
Suspected, or at risk of, an acute adrenal insufficiency (adrenal crisis)
131
Hydrocortisone Paediatric >10yrs IM Dose for:
Suspected, or at risk of, an acute adrenal insufficiency (adrenal crisis)
100 mg
Single dose only
132
Hydrocortisone Presentation
Vial (powder) - 100mg,
133
Hydrocortisone Timing
**Onset (IV)**
1 - 2 hours
**Duration (IV)**
6 - 12 hours
**Half-Life**
1 - 2 hours
134
Ipratropium bromide Adult NEB Dose for:
Moderate bronchospasm (unresponsive to initial QAS salbutamol NEB)
```
500 microg (2 x 250 microg vials)
Repeated at 20 minute intervals
Total maximum dose - 1.5 mg
```
135
Ipratropium bromide Contraindications
Allergy and/or Adverse Drug Reaction
Patients less than 1 year of age
136
Ipratropium bromide Indications
Moderate bronchospasm (unresponsive to initial QAS salbutamol NEB)
Severe bronchospasm
137
Ipratropium Bromide Paediatric NEB dose for children 6 yrs and older for:
Severe Bronchospasm
```
500 microg (2 x 250 microg vials)
Repeated at 20 min intervals
Total max dose 1.5 mg
```
138
Ipratropium bromide Presentation
Nebule, 250 microg/1 mL ipratropium bromide monohydrate
139
Aspirin indications
Suspected ACS
Acute cardiogenic pulmonary oedema
140
Aspirin Presentation
tablet (white), 300 mg aspirin
141
Aspirin Adult PO Dose for:
Suspected ACS
300 mg
Chewed and followed by a small sip of water (where possible)
Pts who have had <300mg in the prev 24hrs should be administered a dose totaling 300-450mg
142
Aspirin contraindications
Allergy AND/OR Adverse Drug Reaction to aspirin OR any non-steroidal anti-inflammatory drug (NSAID)
Bleeding OR clotting disorders (e .g. haemophilia)
Current GI bleeding OR peptic ulcers
Patient < 18 years
143
Hydrocortisone Adult IV Dose for Refractory Anaphylaxis with Persistent Wheeze
200mg
Slow push over 1 minute
Single dose only
144
Hydrocortisone IV Adult Dose for:
Asthma (excluding mild)
100 mg
Slow push over 1 minute
Single dose only
145
Hydrocortisone Paediatric IV Dose for:
Asthma (excluding mild)
4 mg/kg
Slow push over 1 minute
Single dose only
Not to exceed 100 mg
146
Hydrocortisone Paediatric \>10yrs IV Dose for Suspected, or at risk of, an acute adrenal insufficiency (adrenal crisis)
100 mg
Slow push over 1 minute
Single dose only
147
Glyceryl Trinitrate (GTN) Presentation
Spray (sublingual), 400 microg/dose, 200 doses, nitrolingual pump spray
Ampoule, 50 mg/10mL glyceryl trinitrate
148
Hydrocortisone Paediatric IM Dose for:
Asthma (excluding mild)
4 mg/kg
Single dose only, not to exceed 100 mg
149
Ipratropium Bromide Paediatric NEB dose for children 1 to 5 yrs for:
Moderate Bronchospasm (unresponsive to initial QAS salbutamol NEB)
```
250 microg (1 x 250 microg vial)
Repeated at 20 min intervals
Total max dose 750 microg
```
150
Ipratropium Bromide Paediatric NEB dose for children 6 yrs and older for:
Moderate Bronchospasm (unresponsive to initial QAS salbutamol NEB)
```
500 microg (2 x 250 microg vials)
Repeated at 20 min intervals
Total max dose 1.5 mg
```
151
Ipratropium Bromide Paediatric NEB dose for children 1 to 5 yrs for:
Severe Bronchospasm
```
250 microg (1 x 250 microg vial)
Repeated at 20 min intervals
Total max dose 750 microg
```
152
Ipratropium bromide Adult NEB Dose for:
Severe bronchospasm
```
500 microg (2 x 250 microg vials)
Repeated at 20 minute intervals
Total maximum dose - 1.5 mg
```
153
Hydrocortisone Adult IM Dose for:
Asthma (excluding mild)
100 mg
Single dose only
154
Hydrocortisone Adult IM Dose for:
Acute Exacerbation of COPD
100 mg
Single dose only
155
Hydrocortisone IV Adult Dose for:
Acute Exacerbation of COPD
100 mg
Slow push over 1 minute
Single dose only
156
Hydrocortisone IV Adult Dose for:
Suspected, or at risk of, an acute adrenal insufficiency (adrenal crisis)
100 mg
Slow push over 1 minute
Single dose only
157
Hydrocortisone Paediatric IM Dose for:
Refractory anaphylaxis with persistent wheeze (and unresponsive to 3 x IM adrenaline)
4 mg/kg
Single dose only
Not to exceed 100 mg
158
Hydrocortisone Paediatric IV Dose
Refractory anaphylaxis with persistent wheeze (and unresponsive to 3 x IM adrenaline)
4 mg/kg
Slow push over 1 minute
Single dose only
Not to exceed 100
159
Hydrocortisone Paediatric 5 - 10yrs IV Dose for Suspected, or at risk of, an acute adrenal insufficiency (adrenal crisis)
50 mg
Slow push over 1 minute
Single dose only
160
Hydrocortisone Paediatric 0 to 4yrs IV Dose for Suspected, or at risk of, an acute adrenal insufficiency (adrenal crisis)
25 mg
Slow push over 1 minute
Single dose only
161
Hydrocortisone Paediatric 5 - 10yrs IM Dose for:
Suspected, or at risk of, an acute adrenal insufficiency (adrenal crisis)
50 mg
Single dose only
162
Hydrocortisone Paediatric 0 - 4yrs IM Dose for:
Suspected, or at risk of, an acute adrenal insufficiency (adrenal crisis)
25 mg
Single dose only
163
Glyceryl Trinitrate (GTN) Adult Subling Dose:
Irukandji Syndrome (SBP _\>_ 160 mmHG)
400 microg
Repeated at 5 min intervals
No maximum dose
164
Glyceryl Trinitrate (GTN) Paediatric Subling Dose for:
Autonomic dysreflexia (with a SBP \>160 mmHg)
QAS clinical consultation and advice line approval required in all situations
**Note:** In all other instances, QAS officers are NOT authorised to administer GTN to paediatric Pts
165
Aspirin Adult PO Dose for:
Acute cardiogenic pulmonary oedema
300 mg
Chewed and followed by a small sip of water (where possible)
Pts who have had <300mg in the prev 24hrs should be administered a dose totaling 300-450mg
166
Droperidol Indications
Acute behavioural disturbances (with a SAT Score ≥ 2)
167
Droperidol Contraindications
**Absolute**:
Allergy AND/OR KSAR
Parkinson’s disease
Known Lewy body dementia
Previous dystonic reaction to droperidol
Patients less than 8 years of age
**Relative** (requires consultation with the QAS Clinical Consultation & Advice Line)
suspected sepsis
168
Droperidol Presentation
Vial, 10 mg/2 mL
169
Droperidol Adult 13-15 years IM or IV dose for Acute behavioural disturbances (with a SAT Score ≥ 2)
QAS Clinical Consultation and Advice Line consultation and approval required in all patients 65 or older and 13-15 yrs
0.1–0.2 mg/kg
Single max dose 10 mg
Repeated once at 15 minutes
Total max dose 20 mg
170
Droperidol Adult 65 and older years IM or IV dose for Acute behavioural disturbances (with a SAT Score ≥ 2)
QAS Clinical Consultation and Advice Line consultation and approval required in all patients 65 or older and 13-15 yrs
5 mg
Repeated once at 15 minutes
Total max dose 10 mg
171
Droperidol Adult 16 - 65 years IM or IV dose for Acute behavioural disturbances (with a SAT Score ≥ 2)
10 mg
Repeated once at 15 minutes
Total max dose 20 mg
172
Droperidol Paediatric 8 - 12 years IM or IV dose for Acute behavioural disturbances (with a SAT Score ≥ 2)
QAS Clinical Consultation and Advice Line consultation and approval required in all situations
0.1 - 0.2 mg/kg
Single max dose 10 mg
Repeated once at 15 minutes
Total max dose 20 mg
173
What are the non-invasive ventilation - CPAP indications?
acute pulmonary oedema
174
Non-Invasive Ventilation - CPAP O2 Concentration
8L/min 5.0cm H20 54% O2
12L/min 10.0cm H2O 62% O2
15L/min 15.0cm H2O 67% O2
175
Non-Invasive Ventilation - CPAP Sizes
**Red Harness Connector**
size 4 - small adult mask
**Blue Harness Connector**
size 5 - large adult mask
176
Non-Invasive Ventilation - CPAP Procedure
* Place pt in seated position
* Explain procedure to the pt (their understanding and cooperation is essential for successful CPAP)
* Prepare equipment
* Select the appropriate size face mask ensuring the inner circumference of the air cushion encompasses the bridge of the nose, side of the mouth and inferior border of the bottom lip (with mouth slightly open)
* Size 4 - small adult (red)
* Size 5 - large adult (blue)
* Attach the vectored flow valve to the mask and the oxygen tubing, ensuring harness connector remains in place
* Connect the oxygen tubing to a standard 15 L/min oxygen flow metre
* Adjust oxygen flow rate to L/min to generate 5cm H2O continuous positive airway pressure
* Monitor patient's response to treatment (resp rate, SpO2, BP, chest sound & WOB) and increase airway pressure every 3-5 mins to a maxiumum of 15 cm H2O
* If the pt shows evidence of deterioration, discontinue CPAP immediately and treat in accordance with appropriate CPG
177
What are the non-invasive ventilation - CPAP contraindications?
pts \<16 years
GCS ≤ 8
hypotension (SBP \<90 mmHg)
facial trauma
epistaxis
inadequate ventilatory drive
pneumothorax
178
What are the non-invasive ventilation - CPAP complications?
corneal drying
aspiration
barotrauma
hypotension
gastric distension
