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Bachelor of Paramedic Science > CPP Drugs as per Gavin's email > Flashcards

CPP Drugs as per Gavin's email Flashcards

1
Q

Adrenaline adult IM dose for anaphylaxis or severe allergic reaction

A

500 microg
Repeated at 5 minute intervals
No max dose

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2
Q

Adrenaline adult IV dose for cardiac arrest

A

1 mg
Repeated at 3-5 minute intervals
No max dose

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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

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4
Q

Adrenaline Contraindications

A

Nil

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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

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6
Q

Adrenaline Paediatric Newly Born IV Dose for Cardiac Arrest

A

50 microg
Repeated every 3 - 5 mins
No max dose

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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)

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8
Q

Fentanyl Adult Subcut Dose for Significant Pain

A

QAS clinical consultation and advice line approval required in all situations

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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)

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10
Q

Fentanyl Contraindications

A

Allergy AND/OR Adverse Drug Reaction

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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
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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

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13
Q

Fentanyl Presentation

A

ampoule, 100 microg/2 mL fentanyl

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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.

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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

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16
Q

Glucagon Contraindications

A

Allergy AND/OR adverse drug reaction

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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)

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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.

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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

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20
Q

Glucagon Presentation

A

Vials (powder and solvent), 1mg glucagon

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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

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22
Q

Midazolam Adult NAS Dose - Generalised Seizure/Focal Seizure

A

5mg
Repeat every 10 minutes
Total max dose 20mg

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23
Q

Midazolam Contraindications

A

allergy and/or adverse drug reaction

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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

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25
Q

Midazolam Paediatric IM Dose for Acute Behavioural Disturbance (with a SAT score ≥2), unresponsive to droperidol (max dose) administration

A

QAS clinical consultation and advice line approval required in all situations

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26
Q

Midazolam Paediatric IM Dose for Generalised/Focal Seizures (GCS ≤12)

A

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

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27
Q

Midazolam Presentation

A

Ampoule, 5mg/1mL, midazolam

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28
Q

Midazolam Timing

A

Onset
5-15 minutes (IM)
1-3 minutes (IV)

Duration
Variable

  • *Half Life**
    2. 5 hours
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29
Q

Morphine ≥70yrs/cachectic or frail IM adult dose for:

Significant pain

Autonomic dysreflexia (with SBP >160mmHg)

A

2.5-5mg
Repeated at up to 5mg every 10 mins
Total max dose 10 mg (or MME)

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30
Q

Morphine adult dose for significant pain via SUBCUT

A

QAS clinical consultation and advie line approval required in all situations

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31
Q

Morphine Contraindications

A

Allergy and/or adverse drug reaction

Kidney disease (renal failure)

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32
Q

Morphine Indications

A

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
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33
Q

Morphine SUBCUT paediatric dose for significant pain

A

QAS clinical consultation and advice line approval required in all situations

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34
Q

Morphine paediatric IM dose for:

Significant pain

Autonomic dysreflexia (with SBP >160mmHg)

A

≥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

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35
Q

Morphine Presentation

A

Ampoule, 10mg/1 mL morphine sulphate pentahydrate

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36
Q

Sodium Chloride 0.9% adult IV/INF dose - significant burns (TBSA > 20%)

A

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

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37
Q

Sodium Chloride 0.9% adult/paediatric IM/IV dose to dissolve and dilute drugs

A

As authorised on individual DTPs

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38
Q

Sodium Chloride 0.9% adult IV/INF dose:

hypovolaemia

A

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

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39
Q

Sodium Chloride 0.9% adult/paediatric IV dose as a flush following IV or IO drug administration

A

PRN

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40
Q

Sodium Chloride 0.9% contraindications

A

Nil

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41
Q

Sodium Chloride 0.9% Indications

A

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

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42
Q

Sodium chloride 0.9% paediatric IV/INF dose for significant burns (TBSA >10%)

A

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

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43
Q

Sodium chloride 0.9% IV/INF paediatric dose for:

hypovolaemia

A

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

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44
Q

Sodium Chloride 0.9% presentation

A

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

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45
Q

Sodium chloride 0.9% Timing

A

Onset
Immediate

Duration
Variable

Half-Life
N/A

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46
Q

Glucose 10% Indications

A

Symptomatic hypoglycaemia (with the inability to self-administer oral glucose)
Unconscious hypoglycaemia - EACP2 only

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47
Q

Glucose 10% Timing

A

Onset
Rapid

Duration
N/A

Half-Life
N/A

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48
Q

Glucose 10% Adult IV Dose

A

15g (150mL)
Repeated at 10g (100 mL) boluses every 5 minutes until BGL >4.0mmol/L

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49
Q

Glucose 10% Contraindications

A

Nil

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50
Q

Glucose 10% Presentation

A

Viaflex plastic container, 250 mL glucose monohydrate 10%

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51
Q

Glucose 10% Paediatric IV Dose

A

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

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52
Q

Glucose Gel Indications

A

Symptomatic hypoglycaemia (with the ability to self-administer oral glucose)

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53
Q

Glucose Gel Timing

A

Onset
≈ 10 mins

Duration
Variable

Half-Life
N/A

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54
Q

Glucose Gel Adult PO Dose

A

15g
Repeated once at 15 minutes if BGL ≤ 4mmol/L
Total maximum dose 30g

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55
Q

Glucose Gel Contraindications

A

Unconsciousness

Patients with difficulty swallowing

Patients < 2 years

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56
Q

Glucose Gel Presentation

A

Tube, 15g Glucose (Glutose 15)

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57
Q

Glucose Gel Paediatric PO Dose

A

≥2 yrs - 15 g
Repeated once at 15 mins if BGL ≤4 mmol/L
Total max dose 30 g

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58
Q

Glucose Gel Drug Class

A

hyperglycaemic

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59
Q

Glucose 10% Drug Class

A

hyperglycaemic

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60
Q

Fentanyl paediatric IV dose for significant pain

A

≥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

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61
Q

Fentanyl paediatric SUBCUT dose for significant pain

A

QAS clinical consultation and advice line approval required in all situations

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62
Q

Glucagon Adult IV Dose - Refractory anaphylaxis with persistent hypotension/shock (unresponsive to 3 x IM adrenaline injections and adequate fluid challenges)

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.

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63
Q

Glucagon Paediatric IV Dose for refractory anaphylaxis with persistent hypotension/shock (unresponsive to 3 x IM adrenaline injections and adequate fluid) for children >25kg

A

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.

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64
Q

Morphine ≥70yrs/cachectic or frail IV adult dose for:

Significant pain

Autonomic dysreflexia (with SBP >160mmHg)

A

2.5mg
Repeated at up to 2.5mg every 5 mins
Total max dose 10 mg (or MME)

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65
Q

Adrenaline adult NEB dose for anaphylaxis or severe allergic reaction

A

5mg
Single dose only

May be administered for upper airway obstruction that is refractory to 3 X IM adrenaline injections

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66
Q

Fentanyl Adult ≥70yrs/cachectic or frail IM dose for:
Significant Pain
Autonomic Dysreflexia (with SBP >160 mmHg)

A

25-50 microg
Repeated up to 50 microg every 10 mins
Total max dose 100 microg (or MME)

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67
Q

Fentanyl Adult ≥70yrs/cachectic or frail IV dose for:

significant pain

autonomic dysreflexia (with SBP >160 mmHg)

A

25 microg
Repeated up to 25 microg every 5 mins
Total max dose 100 microg (or MME)

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68
Q

Morphine paediatric IV dose for:

Significant pain

Autonomic dysreflexia (with SBP >160mmHg)

A

≥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

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69
Q

Midazolam Adult IV Dose - Generalised Seizure/Focal Seizure (GCS 12 or less)

A

If IV already there
5mg
Repeat every 5 minutes
Total max dose 20mg

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70
Q

Fentanyl adult <70yrs IM dose for:
Significant Pain
Autonomic Dysreflexia (with SBP >160 mmHg)

A

25-100 microg
Repeated up to 50 microg every 10 mins
Total max dose 200 microg (or MME)

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71
Q

Fentanyl adult <70yrs IV dose for:
Significant Pain
Autonomic Dysreflexia (with SBP >160 mmHg)

A

25-50 microg
Repeated up to 50 microg every 5 mins
Total max dose 200 microg (or MME)

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72
Q

Fentanyl Adult <70 NAS Dose for:

Significant Pain

Autonomic Dysreflexia (SBP >160 mmHg)

A

50-100 microg
Repeated up to 100 microg every 10 mins
Total max dose 200 microg (or MME)

73
Q

Morphine <70yrs IM adult dose for:

Significant pain

Autonomic dysreflexia (with SBP >160mmHg)

A

2.5 - 10mg
Repeated at up to 5mg every 10mins
Total max dose 20mg (or MME)

74
Q

Morphine <70 IV adult dose for:

Significant pain

Autonomic dysreflexia (with SBP >160mmHg)

A

2.5 - 5mg
Repeated at up to 5mg every 5mins
Total max dose 20mg (or MME)

75
Q

Adrenaline Paediatric NEB Dose for Anaphylaxis or Severe Allergic Reaction

A

5mg Single dose only

May be administered for upper airway obstruction that is refractory to 3 x IM adrenaline injections

76
Q

Adrenaline Paediatric NEB Dose for Croup

A

5 mg

Single dose only

77
Q

Fentanyl paediatric IM dose for significant pain

A

≥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
Q

Adrenaline paediatric 1 - 5 yrs IM dose for anaphylaxis or severe allergic reaction

A

150 mcg
every 5 mins
no max dose

79
Q

Adrenaline paediatric 6mths - 1yr IM dose for anaphylaxis or severe allergic reaction

A

100 mcg
every 5 mins
no max dose

80
Q

Adrenaline paediatric <6mths IM dose for anaphylaxis or severe allergic reaction

A

50 mcg
every 5 mins
no max dose

81
Q

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)

A

150 mcg
every 5 mins
no max dose

82
Q

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)

A

100 mcg
every 5 mins
no max dose

83
Q

Adrenaline paediatric ≥6yrs IM dose for anaphylaxis or severe allergic reaction

A

300 mcg every
5 mins
no max dose

84
Q

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)

A

50 mcg
every 5 mins
no max dose

85
Q

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)

A

300 mcg
every 5 mins
no max dose

86
Q

Adrenaline Paediatric ≥10kg (≥1yr) IV Dose for Cardiac Arrest

A

10 microg/kg
Repeated every 3 - 5 mins
No max dose

87
Q

Adrenaline Paediatric <10kg (excl newly born) IV Dose for Cardiac Arrest

A

100 microg
Repeated every 3 - 5 mins
No max dose

88
Q

Glucagon Paediatric IM Dose for Symptomatic hypoglycaemia (with the inability to self-administer oral glucose) for children ≤25kg

A

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
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

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
Q

Glucagon Paediatric IV Dose for refractory anaphylaxis with persistent hypotension/shock (unresponsive to 3 x IM adrenaline injections and adequate fluid) for children ≤25kg

A

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
Q

Sodium Chloride 0.9% adult IV/INF dose:

inadequate tissue perfusion/shock

A

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
Q

Sodium chloride 0.9% IV/INF paediatric dose for:

inadequate tissue perfusion/shock

A

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
Q

Morphine Routes of Administration

A

IM

IO

IV

SUBCUT

94
Q

Midazolam Routes of Administration

95
Q

Midazolam Adult IM Dose - Generalised Seizure/Focal Seizure

A

5mg
Repeat every 10 minutes
Total max dose 20mg

96
Q

Midazolam Adult IV 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

97
Q

Midazolam Paediatric NAS Dose for Generalised/Focal Seizures (GCS ≤12)

A

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
Q

Midazolam Paediatric IV Dose for Acute Behavioural Disturbance (with a SAT score ≥2), unresponsive to droperidol (max dose) administration

A

QAS clinical consultation and advice line approval required in all situations

99
Q

Glucose 10% Routes of Administration

100
Q

Glucose 10% Adult INF Dose

A

15g (150mL)
Repeated at 10g (100 mL) boluses every 5 minutes until BGL >4.0mmol/L

101
Q

Glucose 10% Paediatric INF Dose

A

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
Q

Glucose Gel Routes of Administration

103
Q

Glucagon Routes of Administration

104
Q

Fentanyl Routes of Administration

A

IM

IV

NAS

SUBCUT

105
Q

What is the IV fentanyl dose for hypotensive pts SBP <90mmHg?

A

25 mcgs if CCP backup

106
Q

What is the IM fentanyl dose for hypotensive pts SBP <90mmHg?

A

Consult for 50 mcgs

107
Q

Tranexamic Acid (TXA) Drug Class

A

Antifibrinolytic

108
Q

Tranexamic Acid (TXA) Indications

A

Recent traumatic injuries (3 hours or less) with a COAST score ≥3

Management of uncontrolled primary post-partum haemorrhage (3 hours or less)

109
Q

Tranexamic Acid (TXA) Contraindications

A

Allergy and/or adverse drug reaction

110
Q

Tranexamic Acid (TXA) Presentation

111
Q

Tranexamic Acid Paediatric IV Dose for:

Recent traumatic injuries (<3 hours) with a COAST score _>_3

A

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
Q

Tranexamic Acid Adult INF Dose for:

Recent traumatic injuries (<3 hours) with a COAST score >3

A

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
Q

Tranexamic Acid Adult INF Dose for:

Management of uncontrolled primary post-partum haemorrhage (≤3 hours)

A

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
Q

Naloxone Drug Class

A

opioid antagonist

115
Q

Naloxone Indications

A

Respiratory depression (secondary to the administration of narcotic drugs)

116
Q

Naloxone Contraindications

A

allergy/KSAR
newly born pts

117
Q

Naloxone Presentation

A

Ampoule, 400 microg/mL

118
Q

Naloxone Routes of Administration

119
Q

Naloxone Adult IM dose for Respiratory depression (secondary to the administration of narcotic drugs)

A

1.6 mg
Single dose only

120
Q

Naloxone paediatric IM dose for Respiratory depression (secondary to the administration of narcotic drugs)

A

20 microg/kg
Single dose only, not to exceed 800 microg

121
Q

Glyceryl Trinitrate (GTN) Adult Subling Dose - Acute Cardiogenic Pulmonary Oedema

A

400 microg
Repeated at 5 min intervals
No maximum dose

122
Q

Glyceryl Trinitrate (GTN) Adult Subling Dose - Suspected ACS (with pain)

A

400 microg
Repeated at 5 min intervals
No maximum dose

123
Q

Glyceryl Trinitrate (GTN) Adult Subling Dose:
Autonomic Dysreflexia (SBP >160 mmHG)

A

400 microg
Repeated at 5 min intervals
No maximum dose

124
Q

Glyceryl Trinitrate (GTN) Contraindications

A

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
Q

Glyceryl trinitrate (GTN) Indications

A

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
Q

Glyceryl Trinitrate (GTN) Paediatric Subling Dose for:

Irukandji syndrome (with a SBP >160mmHg)

A

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
Q

Hydrocortisone Adult IM Dose for:

Suspected, or at risk of, an acute adrenal insufficiency (adrenal crisis)

A

100 mg
Single dose only

128
Q

Hydrocortisone Adult IM Dose for Refractory Anaphylaxis with Persistent Wheeze

A

200 mg
Single dose only

129
Q

Hydrocortisone Contraindications

A

Allergy AND/OR Adverse Drug Reaction

130
Q

Hydrocortisone Indications

A

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
Q

Hydrocortisone Paediatric >10yrs IM Dose for:

Suspected, or at risk of, an acute adrenal insufficiency (adrenal crisis)

A

100 mg
Single dose only

132
Q

Hydrocortisone Presentation

A

Vial (powder) - 100mg,

133
Q

Hydrocortisone Timing

A

Onset (IV)
1 - 2 hours

Duration (IV)
6 - 12 hours

Half-Life
1 - 2 hours

134
Q

Ipratropium bromide Adult NEB Dose for:

Moderate bronchospasm (unresponsive to initial QAS salbutamol NEB)

A 
500 microg (2 x 250 microg vials)
Repeated at 20 minute intervals
Total maximum dose - 1.5 mg
135
Q

Ipratropium bromide Contraindications

A

Allergy and/or Adverse Drug Reaction

Patients less than 1 year of age

136
Q

Ipratropium bromide Indications

A

Moderate bronchospasm (unresponsive to initial QAS salbutamol NEB)

Severe bronchospasm

137
Q

Ipratropium Bromide Paediatric NEB dose for children 6 yrs and older for:

Severe Bronchospasm

A 
500 microg (2 x 250 microg vials)
Repeated at 20 min intervals
Total max dose 1.5 mg
138
Q

Ipratropium bromide Presentation

A

Nebule, 250 microg/1 mL ipratropium bromide monohydrate

139
Q

Aspirin indications

A

Suspected ACS

Acute cardiogenic pulmonary oedema

140
Q

Aspirin Presentation

A

tablet (white), 300 mg aspirin

141
Q

Aspirin Adult PO Dose for:

Suspected ACS

A

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
Q

Aspirin contraindications

A

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
Q

Hydrocortisone Adult IV Dose for Refractory Anaphylaxis with Persistent Wheeze

A

200mg
Slow push over 1 minute
Single dose only

144
Q

Hydrocortisone IV Adult Dose for:

Asthma (excluding mild)

A

100 mg
Slow push over 1 minute
Single dose only

145
Q

Hydrocortisone Paediatric IV Dose for:

Asthma (excluding mild)

A

4 mg/kg
Slow push over 1 minute
Single dose only
Not to exceed 100 mg

146
Q

Hydrocortisone Paediatric >10yrs IV Dose for Suspected, or at risk of, an acute adrenal insufficiency (adrenal crisis)

A

100 mg
Slow push over 1 minute
Single dose only

147
Q

Glyceryl Trinitrate (GTN) Presentation

A

Spray (sublingual), 400 microg/dose, 200 doses, nitrolingual pump spray

Ampoule, 50 mg/10mL glyceryl trinitrate

148
Q

Hydrocortisone Paediatric IM Dose for:

Asthma (excluding mild)

A

4 mg/kg

Single dose only, not to exceed 100 mg

149
Q

Ipratropium Bromide Paediatric NEB dose for children 1 to 5 yrs for:

Moderate Bronchospasm (unresponsive to initial QAS salbutamol NEB)

A 
250 microg (1 x 250 microg vial)
Repeated at 20 min intervals
Total max dose 750 microg
150
Q

Ipratropium Bromide Paediatric NEB dose for children 6 yrs and older for:

Moderate Bronchospasm (unresponsive to initial QAS salbutamol NEB)

A 
500 microg (2 x 250 microg vials)
Repeated at 20 min intervals
Total max dose 1.5 mg
151
Q

Ipratropium Bromide Paediatric NEB dose for children 1 to 5 yrs for:

Severe Bronchospasm

A 
250 microg (1 x 250 microg vial)
Repeated at 20 min intervals
Total max dose 750 microg
152
Q

Ipratropium bromide Adult NEB Dose for:

Severe bronchospasm

A 
500 microg (2 x 250 microg vials)
Repeated at 20 minute intervals
Total maximum dose - 1.5 mg
153
Q

Hydrocortisone Adult IM Dose for:

Asthma (excluding mild)

A

100 mg
Single dose only

154
Q

Hydrocortisone Adult IM Dose for:

Acute Exacerbation of COPD

A

100 mg
Single dose only

155
Q

Hydrocortisone IV Adult Dose for:

Acute Exacerbation of COPD

A

100 mg
Slow push over 1 minute
Single dose only

156
Q

Hydrocortisone IV Adult Dose for:

Suspected, or at risk of, an acute adrenal insufficiency (adrenal crisis)

A

100 mg
Slow push over 1 minute
Single dose only

157
Q

Hydrocortisone Paediatric IM Dose for:

Refractory anaphylaxis with persistent wheeze (and unresponsive to 3 x IM adrenaline)

A

4 mg/kg
Single dose only
Not to exceed 100 mg

158
Q

Hydrocortisone Paediatric IV Dose

Refractory anaphylaxis with persistent wheeze (and unresponsive to 3 x IM adrenaline)

A

4 mg/kg
Slow push over 1 minute
Single dose only
Not to exceed 100

159
Q

Hydrocortisone Paediatric 5 - 10yrs IV Dose for Suspected, or at risk of, an acute adrenal insufficiency (adrenal crisis)

A

50 mg
Slow push over 1 minute
Single dose only

160
Q

Hydrocortisone Paediatric 0 to 4yrs IV Dose for Suspected, or at risk of, an acute adrenal insufficiency (adrenal crisis)

A

25 mg
Slow push over 1 minute
Single dose only

161
Q

Hydrocortisone Paediatric 5 - 10yrs IM Dose for:

Suspected, or at risk of, an acute adrenal insufficiency (adrenal crisis)

A

50 mg
Single dose only

162
Q

Hydrocortisone Paediatric 0 - 4yrs IM Dose for:

Suspected, or at risk of, an acute adrenal insufficiency (adrenal crisis)

A

25 mg
Single dose only

163
Q

Glyceryl Trinitrate (GTN) Adult Subling Dose:

Irukandji Syndrome (SBP > 160 mmHG)

A

400 microg
Repeated at 5 min intervals
No maximum dose

164
Q

Glyceryl Trinitrate (GTN) Paediatric Subling Dose for:

Autonomic dysreflexia (with a SBP >160 mmHg)

A

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
Q

Aspirin Adult PO Dose for:

Acute cardiogenic pulmonary oedema

A

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
Q

Droperidol Indications

A

Acute behavioural disturbances (with a SAT Score ≥ 2)

167
Q

Droperidol Contraindications

A

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
Q

Droperidol Presentation

A

Vial, 10 mg/2 mL

169
Q

Droperidol Adult 13-15 years IM or IV dose for Acute behavioural disturbances (with a SAT Score ≥ 2)

A

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
Q

Droperidol Adult 65 and older years IM or IV dose for Acute behavioural disturbances (with a SAT Score ≥ 2)

A

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
Q

Droperidol Adult 16 - 65 years IM or IV dose for Acute behavioural disturbances (with a SAT Score ≥ 2)

A

10 mg
Repeated once at 15 minutes
Total max dose 20 mg

172
Q

Droperidol Paediatric 8 - 12 years IM or IV dose for Acute behavioural disturbances (with a SAT Score ≥ 2)

A

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
Q

What are the non-invasive ventilation - CPAP indications?

A

acute pulmonary oedema

174
Q

Non-Invasive Ventilation - CPAP O2 Concentration

A

8L/min 5.0cm H20 54% O2
12L/min 10.0cm H2O 62% O2
15L/min 15.0cm H2O 67% O2

175
Q

Non-Invasive Ventilation - CPAP Sizes

A

Red Harness Connector
size 4 - small adult mask

Blue Harness Connector
size 5 - large adult mask

176
Q

Non-Invasive Ventilation - CPAP Procedure

A
  • 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
Q

What are the non-invasive ventilation - CPAP contraindications?

A

pts <16 years
GCS ≤ 8
hypotension (SBP <90 mmHg)
facial trauma
epistaxis
inadequate ventilatory drive
pneumothorax

178
Q

What are the non-invasive ventilation - CPAP complications?

A

corneal drying
aspiration
barotrauma
hypotension
gastric distension

Bachelor of Paramedic Science (19 decks)

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