Drugs Flashcards
Adrenaline adult IM dose for anaphylaxis or severe allergic reaction
500 microg
Repeated at 5 minute intervals
No max dose
Adrenaline adult IV dose for cardiac arrest
1 mg
Repeated at 3-5 minute intervals
No max dose
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)
500 microg
Repeated at 5 minute intervals
No maximum dose
Adrenaline Contraindications
Nil
Adrenaline Drug Class
Sympathomimetic
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
Adrenaline paediatric 1 - 5 yrs IM dose for anaphylaxis or severe allergic reaction
150 mcg
every 5 mins
no max dose
Adrenaline paediatric 6mths - 1yr IM dose for anaphylaxis or severe allergic reaction
100 mcg
every 5 mins
no max dose
Adrenaline paediatric <6mths IM dose for anaphylaxis or severe allergic reaction
50 mcg
every 5 mins
no max dose
Adrenaline paediatric ≥6yrs IM dose for anaphylaxis or severe allergic reaction
300 mcg every
5 mins
no max dose
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
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
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
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
Adrenaline Indications
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)
CCP only
Shock unresponsive to adequate fluid resuscitation
Bradycardia with poor perfusion
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
Adrenaline Paediatric Newly Born IV Dose for Cardiac Arrest
50 microg
Repeated every 3 - 5 mins
No max dose
Adrenaline Paediatric ≥10kg (≥1yr) IV Dose for Cardiac Arrest
10 microg/kg
Repeated every 3 - 5 mins
No max dose
Adrenaline Paediatric <10kg (excl newly born) IV Dose for Cardiac Arrest
100 microg
Repeated every 3 - 5 mins
No max dose
Adrenaline Precautions
Concurrent MAOI therapy
Quetiapine toxicity
Hypertension
Hypovolaemic shock
Adrenaline Paediatric NEB Dose for Croup
5 mg
Single dose only
Adrenaline Presentation
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)
Adrenaline side effects
anxiety
pupil dilation
palpitations/tacharrhythmias
hypertension
tremor
Adrenaline Timing
Onset
30 seconds IV
60 seconds IM
Duration
5 - 10 minutes
Half-Life
2 minutes
Analgesic Pain Levels
1 - 4 Mild
5 - 7 Moderate
8 - 10 Severe
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
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
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
Aspirin Drug Class
antiplatelet
Aspirin indications
Suspected ACS
Acute cardiogenic pulmonary oedema
Aspirin precautions
Possible aortic aneurysm or any other condition that may require surgery
Concurrent anticoagulant therapy (e.g. warfarin)
History of GI bleeding or peptic ulcers
Pregnancy
Aspirin Presentation
tablet (white), 300 mg aspirin
Aspirin Routes of Administration
PO
Aspirin Side Effects
NSAID induced bronchospasm
epigastric pain/discomfort
gastritis
GI bleeding
nausea and/or vomiting
Aspirin Timing
Onset
≈ 10 minutes (variable)
Duration
≈ 1 week (antiplatelet)
Half-Life
3. 2 hours (300 - 650 mg)
Calculating Volume from Dose
Calculating Volume from Dose
V required = (strength required (SR) / stock strength (SS)) x volume of stock
or; sunrise over sunset
Ceftriaxone Adult IV Dose for Suspected Meningococcal Septicaemia (with non-blanching petechial and/or purpuric rash)
2 g
Slow push over 5 minutes
Single dose only
Syringe prep: Reconstitute 2 g of ceftriaxone with 18.8 m water for injection in a 20 mL syringe to achieve a final concentration of 2 g/20 mL. Ensure syringe is appropriately labelled.
Ceftriaxone Contraindications
Absolute
- Allergy and/or adverse drug reaction to cephalosporin antibiotics
- Known immediate or severe hypersensitivity to penicillin or carbapenem based drugs
Relative (requires consultation with the QAS Clinical Consultation and Advice Line)
- Pts < 1mth
Ceftriaxone Drug Class
Antibiotic
Ceftriaxone Paediatric IM Dose for Suspected Meningococcal Septicaemia (with non-blanching petechial and/or purpuric rash)
QAS clinical consultation and advice line consultation and approval required in all Pts <1 mth
50mg/kg (rounded up to nearest 5kg)
total max dose 2g
single dose only
- Syringe prep: reconstitute 1g of ceftriaxone with 2.4mL water for injection, withdraw the required dose from the vial using a 3 mL syringe**
- Footnote For paeds over 20kg, clinicians must advising the hospital that only a partial dose has been administered*
Ceftriaxone Indications
Suspected meningococcal septicaemia (with a non-blanching petechial and/or purpuric rash)
Ceftriaxone Adult IM Dose for Suspected Meningococcal Septicaemia (with non-blanching petechial and/or purpuric rash)
2 g (2 x 1 g IM injections) Single dose only *Syringe prep: Reconstitute two separate vials each containing 1 g of ceftriaxone with 2.4mL water for injection in a 3 ml syringe to achieve a final concentraion of 1 g/3 mL*
Ceftriaxone Paediatric IV >20kgs Dose for Suspected Meningococcal Septicaemia (with non-blanching petechial and/or purpuric rash)
Single dose only
Syringe prep: Reconstitute 2 g of ceftriaxone with 18.8 mL water for injection in 20 mL syringe to achieve a concentration of 100 mg/mL (2 g/20 mL). Withdraw required dose leaving any excess ceftriaxone in the vial.
Ceftriaxone IV Paediatric ≤20kgs Dose for Suspected Meningococcal Septicaemia (with non-blanching petechial and/or purpuric rash)
QAS clinical consultation and advice line consultation and approval required in all Pts ≤1 mth.
Single dose only
Syringe prep: Reconstitute 1 g of ceftriaxone with 9.4 mL water for injection in 10 mL syringe to achieve a concentration of 100 mg/mL (1 g/10 mL). Withdraw required dose leaving any excess ceftriaxone in the vial.*
Ceftriaxone Precautions
any allergy or hypersenitivity to penicilin or carbapenem (isolated minor drug rash attributed to penicillin does not contrindicate the use of cefriaxone)
Ceftriaxone Presentation
Vial (powder), 1 g ceftriaxone
Ceftriaxone Routes of Administration
IM
IV
IO
Ceftriaxone Side Effects
Pain and/or inflammation at the injection site
Ceftriaxone Timing
Onset
dose/route variable
Duration
approx 1 day
Half-Life
6 - 9 hours
Common Pain Assessment Tools
number rating scale (0-10 severity)
verbal rating scales (description - mild/moderate/severe)
Dexamethasone Contraindications
Allergy AND/OR Adverse Drug Reaction
<6 months OR >8 years of age (consultation required)
Steroid administration within 4 hours
Dexamethasone Drug Class
corticosteroid
Dexamethasone Indications
Croup
Dexamethasone Paediatric PO Dose for Croup for children 6 months to 6 years
Can be repeated once if child spits it out
Dexamethasone Precautions
Nil in this setting
Dexamethasone Presentation
Vial, 8mg/2mL dexamethasone
Dexamethasone Routes of Administration
PO
Dexamethasone Side Effects
Nil
Dexamethazone Timing
**Onset** 30 mins (croup)
Duration
72 hours
Half-Life
4-5 hours (children)
Drug Checks
Right pt - Pt doesn’t have any: Allergies, Contras, Precautions, Meds that may interact, Age appropriate
Right drug - Indication - the righ drug to treat this presentation
Right dose - Right dose, expressed as mass only, e.g. “Five milligrams of midazolam”, consider also noting timing & max dose
Right route - Clearly stated, and dose must be correct for this route
Right Strength/Presentation - Mass in volume as provided in the drug kit
Right Appearance & Drug Safety Check - The ampoule is unbroken, does not leak, and the liquid is clear and free of floaties
* The drug is <drug>, <mass>, and expires <sometime></sometime></mass></drug>
E.g.: “This bag of sodium chloride 0.9% is undamaged, does not leak when squeezed, and the fluid is clear and
uncontaminated. Drug check: Sodium chloride 0.9%, 500mL bag, expires 10/2023”
* E.g.: “Ampoule is unbroken with clear liquid; adrenaline; 1mg in 1mL; expires 10/2023”
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)
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)
Fentanyl Adult Subcut Dose for Significant Pain
QAS clinical consultation and advice line approval required in all situations
Fentanyl Contraindications
Allergy AND/OR Adverse Drug Reaction
Fentanyl Drug Class
narcotic analgesic
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)
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
Fentanyl Indications
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
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)
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
Fentanyl Adult ≥70yrs/cachectic or frail NAS Dose for:
Significant Pain
Autonomic Dysreflexia (SBP >160 mmHg)
25-50 microg
Repeated up to 50 microg every 10 mins
Total max dose 100 microg (or MME)
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)
Fentanyl paediatric NAS dose for significant pain
≥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
Fentanyl Precautions
known addiction to narcotics
current MAOI therapy
respiratory tract burns
respiratory depression and/or failure
hypotension
Fentanyl Presentation
ampoule, 100 microg/2 mL fentanyl
Fentanyl Routes of Administration
IM
IV
NAS
SUBCUT
Fentanyl Side Effects
drowsiness
pin point pupils
respiratory depression
muscular rigidity (particularly muscles of respiration)
hypotension
bradycardia
nausea and/or vomiting
Fentanyl paediatric SUBCUT dose for significant pain
QAS clinical consultation and advice line approval required in all situations
Fentanyl Timing
Onset
≤3 minutes
Duration
30-60 minutes
Half-life
2-3 hours
Glucagon Adult IM Dose - Refractory anaphylaxis with persistent hypotension/shock (unresponsive to 3 x IM adrenaline injections and adequate fluid challenges)
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.
Glucagon Adult IM Dose - Symptomatic hypoglycaemia
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
Glucagon Contraindications
Allergy AND/OR adverse drug reaction
Glucagon Drug Class
Hyperglycaemic
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
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.
Glucagon Indications
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)
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
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.
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.
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
Glucagon Paediatric IM Dose for Symptomatic hypoglycaemia (with the inability to self-administer oral glucose) for children >25kg
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
Glucagon Precautions
Nil
Glucagon Presentation
Vials (powder and solvent), 1mg glucagon
Glucagon Routes of Administration
IM
IV
Glucagon Side Effects
Nil
Glucagon Timing
Onset
4-7 minutes
Duration
Variable
Half-Life
3-6 minutes
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.
Glucose 10% Adult IV Dose
15g (150mL)
Repeated at 10g (100 mL) boluses every 5 minutes until BGL >4.0mmol/L
Glucose 10% Adult INF Dose
15g (150mL)
Repeated at 10g (100 mL) boluses every 5 minutes until BGL >4.0mmol/L
Glucose 10% Contraindications
Nil
Glucose 10% Drug Class
hyperglycaemic
Glucose 10% Indications
Symptomatic hypoglycaemia (with the inability to self-administer oral glucose)
Unconscious hypoglycaemia - EACP2 only
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
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
Glucose 10% Precautions
Hyperglycaemia
Glucose 10% Presentation
Viaflex plastic container, 250 mL glucose monohydrate 10%
Glucose 10% Routes of Administration
INF
IV
Glucose 10% Side Effects
Nil
Glucose 10% Timing
Onset
Rapid
Duration
N/A
Half-Life
N/A
Glucose Gel Adult PO Dose
15g
Repeated once at 15 minutes if BGL ≤ 4mmol/L
Total maximum dose 30g
Glucose Gel Contraindications
Unconsciousness
Patients with difficulty swallowing
Patients < 2 years
Glucose Gel Drug Class
hyperglycaemic
Glucose Gel Indications
Symptomatic hypoglycaemia (with the ability to self-administer oral glucose)
Glucose Gel Paediatric PO Dose
≥2 yrs - 15 g
Repeated once at 15 mins if BGL ≤4 mmol/L
Total max dose 30 g
Glucose Gel Precautions
Nil
Glucose Gel Presentation
Tube, 15g Glucose (Glutose 15)
Glucose Gel Routes of Administration
PO
Glucose Gel Side Effects
nausea and/or vomiting
diarrhoea
Glucose Gel Timing
Onset
≈ 10 mins
Duration
Variable
Half-Life
N/A
Glyceryl Trinitrate (GTN) Adult Subling Dose - Acute Cardiogenic Pulmonary Oedema
400 microg
Repeated at 5 min intervals
No maximum dose
Glyceryl Trinitrate (GTN) Adult Subling Dose - Suspected ACS (with pain)
400 microg
Repeated at 5 min intervals
No maximum dose
Glyceryl Trinitrate (GTN) Adult Subling Dose:
Autonomic Dysreflexia (SBP >160 mmHG)
400 microg
Repeated at 5 min intervals
No maximum dose
Glyceryl Trinitrate (GTN) Adult Subling Dose:
Irukandji Syndrome (SBP > 160 mmHG)
400 microg
Repeated at 5 min intervals
No maximum dose
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
Glyceryl Trinitrate (GTN) Drug Class
Vasodilator
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)
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
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
Glyceryl Trinitrate (GTN) Precautions
cerebral vascular disease
risk of hypotension and/or syncope
inferior AMI
intoxication (GTN effects are enhanced)
Phosphodiesterase 5 inhibitor medication administration (eg tadalafil, sildenafil, vardenafil) administration in the previous 4 days
Glyceryl Trinitrate (GTN) Presentation
Spray (sublingual), 400 microg/dose, 200 doses, nitrolingual pump spray
Ampoule, 50 mg/10mL glyceryl trinitrate
Glyceryl Trinitrate (GTN) Routes of Administration
SUBLING
Glyceryl Trinitrate (GTN) Side Effects
vascular headaches
dizziness
syncope
hypotension
reflex tachycardia
Glyceryl Trinitrate (GTN) Timing
Onset
≤2 minutes
Duration
20 - 30 minutes
- *Half Life**
5. 5 minutes
Hydrocortisone Drug Class
corticosteroid
Hydrocortisone Adult IM Dose for:
Suspected, or at risk of, an acute adrenal insufficiency (adrenal crisis)
100 mg
Single dose only
Hydrocortisone Adult IM Dose for:
Asthma (excluding mild)
100 mg
Single dose only
Hydrocortisone Adult IM Dose for:
Acute Exacerbation of COPD
100 mg
Single dose only
Hydrocortisone Adult IM Dose for Refractory Anaphylaxis with Persistent Wheeze
200 mg
Single dose only
Hydrocortisone Contraindications
Allergy AND/OR Adverse Drug Reaction
Hydrocortisone IV Adult Dose for:
Asthma (excluding mild)
100 mg
Slow push over 1 minute
Single dose only
Hydrocortisone IV Adult Dose for:
Acute Exacerbation of COPD
100 mg
Slow push over 1 minute
Single dose only
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
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)
Hydrocortisone Adult IV Dose for Refractory Anaphylaxis with Persistent Wheeze
200mg
Slow push over 1 minute
Single dose only
Hydrocortisone Paediatric IV Dose for:
Asthma (excluding mild)
4 mg/kg
Slow push over 1 minute
Single dose only
Not to exceed 100 mg
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
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
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
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
Hydrocortisone Paediatric IM Dose for:
Asthma (excluding mild)
4 mg/kg
Single dose only, not to exceed 100 mg
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
Hydrocortisone Paediatric >10yrs IM Dose for:
Suspected, or at risk of, an acute adrenal insufficiency (adrenal crisis)
100 mg
Single dose only
Hydrocortisone Paediatric 5 - 10yrs IM Dose for:
Suspected, or at risk of, an acute adrenal insufficiency (adrenal crisis)
50 mg
Single dose only
Hydrocortisone Paediatric 0 - 4yrs IM Dose for:
Suspected, or at risk of, an acute adrenal insufficiency (adrenal crisis)
25 mg
Single dose only
Hydrocortisone Precautions
Hypertension
(retains Na+ in kidneys, inc blood and plasma fluid)
Hydrocortisone Presentation
Vial (powder) - 100mg,
Hydrocortisone Routes of Administration
IM
IV
Hydrocortisone Side Effects
Nil
Hydrocortisone Timing
Onset (IV)
1 - 2 hours
Duration (IV)
6 - 12 hours
Half-Life
1 - 2 hours
Ibuprofen Adult PO Dose
200 - 400 mg
Must not be administered within 6 hours of previous ibuprofen administration
Ibuprofen contraindications
- Pts <13yrs or >65yrs
- Allergy AND/OR known severe adverse reaction (KSAR) to any NSAID OR aspirin
- Concurrent NSAID therapy
- NSAID induced asthma
- Heart failure
- Angiotensin-converting enzyme (ACE) inhibitor OR Angiotensin II receptor blocker (ARB)
- Anticoagulant medications
- Current GI bleeding or peptic ulcers
- Dehydration AND/OR hypovolaemia
- Pregnancy
- Renal impairment
- Diuretic treatment
Ibuprofen Drug Class
Non-steroidal anti-inflammatory drug (NSAID)
Ibuprofen indications
Moderate pain due to acute inflammation & tissue injury
Ibuprofen paediatric dose
QAS officers are NOT authorised to dminister ibuprofen to paediatric pts
Ibuprofen precautions
Asthma
Hepatic dysfunction
History of GI bleeding or peptic ulcers
Ibuprofen presentation
tablet, 200 mg
Ibuprofen Routes of Administration
PO
Ibuprofen side effects
dizziness
dyspepsia
nausea
GI bleeding
Ibuprofen Timing
Onset
≈ 15 mins
Duration
4 - 6 hours
Half-Life
2 hours
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
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
Ipratropium bromide Contraindications
Allergy and/or Adverse Drug Reaction
Patients less than 1 year of age
Ipratropium Bromide Drug Class
anticholinergic agent
Ipratropium bromide Indications
Moderate bronchospasm (unresponsive to initial QAS salbutamol NEB)
Severe bronchospasm
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
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
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
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
Ipratropium bromide Precautions
Glaucoma
Ipratropium bromide Presentation
Nebule, 250 microg/1 mL ipratropium bromide monohydrate
Ipratropium bromide Routes of Administration
NEB
Ipratropium bromide Side Effects
dilated pupils
dry mouth
palpitations
Ipratropium bromide Timing
- *Onset**
1. 5 - 3 minutes (peak 1.5 - 2 hours)
Duration
4 - 6 hours
Half-life
3 hours
Loratadine Contraindications
allergy and/or adverse drug reaction
anaphylaxis
pts less than 8 years
Loratadine Drug Class
antihistamine (less sedating)
Loratadine Indications
Symptomatic urticaria (without evidence of anaphylaxis)
Loratadine adult PO dose for symptomatic urticaria (without evidence of anaphylaxis)
10 mg
Single dose only
Not to be administered within 24 hours of previous antihistamine administration unless QAS approval
Loratadine paediatric PO dose for symptomatic urticaria (without evidence of anaphylaxis) for children 8 years and older
10 mg
Single dose only
Not to be administered within 24 hours of previous antihistamine administration unless QAS approval
Loratadine Precautions
Increased risk of sedation and anticholinergic effects in older people
Severe hepatic impairment
Loratadine presentation
tablet, 10 mg
Loratadine Routes of Administration
PO
Loratadine Side Effects
fatigue
drowsiness
headache
dry mouth
nausea
Loratadine Timing
Onset
1-2 hrs
Duration
≈ 24 hrs
Half-Life
≈ 8 hrs
Methoxyflurane Adult INH Dose
3 mL - Repeated once after 20 minutes
Total maximum dose 6 mL
Total weekly dose should not exceed 15 mL with administration on consecutive days not recommended
Methoxyflurane Contraindications
Allergy and/or Adverse Drug Reaction
Patients <1 year
Hx of signigicant liver or renal disease
Hx of malignant hyperthermia
Methoxyflurane Drug Class
analgesic (at low doses)
Methoxyflurane Indications
Pain
Methoxyflurane Paediatric INH Dose for children 1 yr and older
3 mL
Single dose only
Methoxyflurane precautions
ALOC
Intoxicated or drug affected patients
cardiovascular instability
respiratory depression
Methoxyflurane presentation
bottle, 3 mL
Methoxyflurane Routes of Administration
INH
Methoxyflurane side effects
ALOC
cough
renal/hepatic failure (following repeated high dose exposure)
Methoxyflurane Timing
Onset (INH)
1 - 3 minutes
Duration (INH)
5 - 10 minutes
Half-Life
Not available
Midazolam Adult IM Dose - Acute Behavioural Disturbance (SAT score ≥2) unresponsive to droperidol (max dose) administration
QAS Clinical Consultation and Advice Line approval required in all situations
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
Midazolam Adult NAS Dose - Generalised Seizure/Focal Seizure
5mg
Repeat every 10 minutes
Total max dose 20mg
Midazolam Adult IM Dose - Generalised Seizure/Focal Seizure
5mg
Repeat every 10 minutes
Total max dose 20mg
Midazolam Contraindications
allergy and/or adverse drug reaction
Midazolam Drug Class
Benzodiazepine (short acting)
Midazolam Indications
Generalised seizure/focal seizure (GCS ≤12)
Acute behaviour disturbance (SAT score ≥2) unresponsive to droperidol (max dose) administration
Sedation - CCP only
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
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
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
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
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
Midazolam Precautions
- Reduced dosages must be considered in:
- low body weight, older or cachectic Pts
- Pts with chronic renal failure, congestive heart failure or shock
- can cause severe respiratory depression in Pts with COPD
- myasthenia gravis
- multiple sclerosis
Midazolam Presentation
Ampoule, 5mg/1mL, midazolam
Midazolam Routes of Administration
NAS
IM
IV
Midazolam Side Effects
hypotension
respiratory depression particularly when associated with other CNS depressants incl alcohol and narcotics
Midazolam Timing
Onset
5-15 minutes (IM)
1-3 minutes (IV)
Duration
Variable
- *Half Life**
2. 5 hours
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)
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)
Morphine adult dose for significant pain via SUBCUT
QAS clinical consultation and advie line approval required in all situations
Morphine Contraindications
Allergy and/or adverse drug reaction
Kidney disease (renal failure)
Morphine Drug Class
Narcotic analgesic
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)
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)
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
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
Morphine Milligram Equivalent (MME)
100 microg fentanyl = 10 mg morphine
Morphine SUBCUT paediatric dose for significant pain
QAS clinical consultation and advice line approval required in all situations
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
Morphine Precautions
concurrent MAOI therapy
known addiction to narcotics
respiratory tract burns
respiratory depression and/or failure
cardiac chest pain
hypotension
Morphine Presentation
Ampoule, 10mg/1 mL morphine sulphate pentahydrate
Morphine Routes of Administration
IM
IO
IV
SUBCUT
Morphine Side Effects
drowsiness
pin point pupils
respiratory depression
bradycardia
hypotension
nausea and/or vomiting
Morphine Timing
Onset
5-10 mins IM (peak 20-30 mins)
2-5 mins IV (peak 20 mins)
Duration
1 - 2 hours
Half-Life
2 hours
Non-pharmacological Pain Management Options
Reassurance, empathy and information
Comfort
Parents presence
Choice and control
Laughter and fun
Hot/cold
Diversion
Positioning
Splinting
Ondansetron Adult PO Dose for Significant Nausea and/or Vomiting
4 - 8 mg
Total maximum dose 8 mg
Must not be given within 8 hours of previous ondansetron administration
Ondansetron Adult IM Dose for Significant Nausea and/or Vomiting
4 - 8 mg
Total maximum dose 8 mg
Must not be given within 8 hours of previous ondansetron administration
Ondansetron Contraindications
Absolute
Allergy AND/OR Adverse Drug Reaction
Congenital long QT syndrome
Current apomorphine therapy (used in severe Parkinson’s disease)
Patients less than 2 years of age
Relative
1st trimester pregnancy (only use if uncontrolled hyperemesis present)
Ondansetron Drug Class
Antiemetic
Ondansetron Paediatric IM Dose for Significant Nausea and/or Vomiting
Must not be given within 8 hours of previous dose
Ondansetron Indications
Significant nausea AND/OR vomiting
Ondansetron Adult IV Dose for Significant Nausea and/or Vomiting
4 - 8 mg
Slow push over 2 - 3 minutes
Total maximum dose 8 mg
Must not be given within 8 hours of previous dose
Ondansetron Paediatric IV Dose for Significant Nausea and/or Vomiting for children 2 years and older
100 microg/kg
Slow push over 2 - 3 mins
Single dose only
Total max dose 4mg
Must not be administered within 8 hours of previous dose
Ondansetron Paediatric PO Dose for Significant Nausea and/or Vomiting for children 2 to 4 years
2 mg
Single dose only
Ondansetron Paediatric PO Dose for Significant Nausea and/or Vomiting for children 5 yrs and older
4 mg
Single dose only
Ondansetron Precautions
elderly Pts
Pts with risk factors for QT interval prolongation or cardiac arrhythmias
hepatic impairment
intestinal obstruction
Ondansetron Presentation
Ampoule, 4 mg/2 mL ondansetron
Orally Disintegrating Tablet (ODT), 4 mg ondansetron
Ondansetron Routes of Administration
PO
IM
IV
Ondansetron Side Effects/Adverse Events
Common >1%
headache
constipation
Rare <0.1%
hypersensitivity reactions (including anaphylaxis)
ECG changes (dysrhythmias)
Ondansetron Timing
Onset (IV)
5 minutes
Duration (IV)
Several hours
Half-Life (IV)
3 - 4 hours
Oxygen Adult/Paediatric INH Dose for:
Intra-arrest
Administer 100% O2
Oxygen Adult/Paediatric INH Dose for:
CO poisoning
Administer 100% O2
Oxygen Adult/Paediatric INH Dose for:
Cyanide poisoning
Administer 100% O2
Oxygen Adult/Paediatric INH Dose for:
Preoxygenation for RSI
Administer 100% O2
Oxygen adult/paediatric INH dose - All other presentations
Titrate oxygen to achieve SpO2 92-96%
Oxygen adult/paediatric INH dose for:
Paraquat toxicity
Titrate oxygen to achieve SpO2 88-92%
Oxygen adult/paediatric INH dose for:
Bleomycin treatment
Titrate oxygen to achieve SpO2 88-92%
Oxygen adult/paediatric INH dose for:
Obesity
Titrate oxygen to achieve SpO2 88-92%
Oxygen adult/paediatric INH dose for:
COPD
Titrate oxygen to achieve SpO2 88-92%
Oxygen adult/paediatric INH dose for:
Cystic fibrosis
Titrate oxygen to achieve SpO2 88-92%
Oxygen adult/paediatric INH dose for:
Neuromuscular Disease
Titrate oxygen to achieve SpO2 88-92%
Oxygen Contraindications
Known paraquat poisoning with SpO2 ≥ 88%
Hx of bleomycin therapy with SpO2 ≥ 88%
Oxygen Drug Class
Gas
Oxygen Indications
A wide range of conditions resulting in, or potentially resulting in systematic and/or localised hypoxia
Oxygen Precautions
Patients with paraquat poisoning or bleomycin lung injury may be harmed by supplemental oxygen. Avoid oxygen unless the patient is hypoxaemic - target 88-92%
Prolonged administration to premature neonates
Neborns will have low Sp02 for the first 10 minutes following birth - refer to CPG: Resuscitation - Newly born
Patients with cyanotic heart disease may have saturation targets between 75°/o to 85%. Ascertain optimal target saturation levels for these patients from carers or HCP
A BVM will not supply adequate oxygen unless IPPV is provided
Using high flow oxygen to protect against subsequent hypoxaemia in the event of deterioration may delay the recognition of such a deterioration. This may provide a false reassurance that the patient is stable.
Oxygen Presentation
Size C cylinder, 450 L medical oxygen (in kit)
Size D cylinder, 1600 L medical oxygen (in van)
Oxygen Side Effects
Hypoventilation in some COPD Pts with hypoxic drive
Drying of airway mucous membranes
Oxygen Timing
Onset
Immediate
Duration
N/A
Half-Life
N/A
Oxytocin Adult IM Dose for active management of the third stage of labour (following confirmed delivery of all foetuses) AND the prevention of primary post partum haemorrhage (PPH)
10 international units
single dose only
Oxytocin Adult IV Dose for management of uncontrolled primary or secondary post partum haemorrhage (PPH)
Loading dose - 10 international units
slow push over 2-5 minutes
May be given in addition to a dose that may have been administered for active management of the third stage of labour/the prevention of primary post partum haemorrhage (PPH)
Oxytocin Contraindications
allergy and/or adverse drug reaction
undelivered foetuses
Oxytocin Drug Class
oxytocic
Oxytocin Indications
active management of the third stage of labour (following confirmed delivery of all foetuses) AND the prevention of primary post partum haemorrhage (PPH)
management of uncontrolled primary or secondary post partum haemorrhage (PPH)
Oxytocin Precautions
myocardial ischaemia
may potentiate hypotension when administered with analgesia
Oxytocin Presentation
ampoule, 10 international units (IU)/1 mL
Oxytocin Side Effects
headache
bradycardia
tachycardia
nausea and/or vomiting
Oxytocin Timing
Onset
2-4 minutes
Duration
30-60 minutes
Half Life
N/A
Paracetamol Adult PO Dose for:
mild to moderate pain
0.5g - 1g
Must not be administered within 4 hours of previous dose
Repeated every 4 hours
Total max dose 4g in 24 hours
Paracetamol Adult PO Dose for:
fever (causing distress)
0.5g - 1g
Must not be administered within 4 hours of previous dose
Repeated every 4 hours
Total max dose 4g in 24 hours
Paracetamol contraindications
Allergy/known severe adverse reaction (KSAR)
Patients <1 month old
Paracetamol Drug Class
analgesic and antipyretic
Paracetamol indications
Mild to moderate pain
Fever (causing distress)
Paracetamol Paediatric PO Dose for children 1 month and older for:
mild to moderate pain
15 mg/kg
Single dose only
Must not be administered within 4 hours of previous dose
Paracetamol Paediatric PO Dose for children 1 month and older for:
fever (causing distress)
15 mg/kg
Single dose only
Must not be administered within 4 hours of previous dose
Paracetamol precautions
Hepatic or renal dysfunction
Soluble tablets:
- Pts with sodium restriction (heart failure, chronic kidney disease)
- Phenylketonuria
Paracetamol presentation
elixir - 120 mg/5 mL
tablet - 500 mg
Paracetamol side effects
nausea
Paracetamol Timing
Onset (PO)
10 - 60 minutes
Duration (PO)
4 hours
Half-Life
≈ 2 hours
Salbutamol Adult MDI Dose for Bronchospasm
12 (1.2 mg) MDI inhalations
Repeat at 10 minutes
No max dose
Salbutamol Contraindications
Allergy AND/OR adverse drug reaction
Patients less than 1 year
Salbutamol Drug Class
Beta-adrenergic agonist
Salbutamol Indications
Bronchospasm
Suspected hyperkalaemia (with QRS widening and/or AV dissociation) - CCP only
Salbutamol Adult NEB Dose for Bronchospasm
5 mg
Repeated PRN
No max dose
Salbutamol paediatric NEB dose for bronchospasm for children 6 years and older
5mg
Repeated PRN
No max dose
Salbutamol paediatric NEB dose for bronchospasm for children 1 to 5 years
2.5mg
Repeated PRN
No max dose
Salbutamol paediatric MDI dose for bronchospasm for children 6 years and older
12 (1.2 mg) MDI inhalations
Repeated every 10 minutes
No max dose
Salbutamol paediatric MDI dose for bronchospasm for children 1 to 5 years
6 (600 microg) MDI inhalations
Repeated every 10 mins
No max dose
Salbutamol Precautions
Acute pulmonary oedema
lschaemic heart disease
Salbutamol Presentation
Metered Dose Inhaler - 100 microg/puff, salbutamol
Nebule - 2.5mg/2.5mL
Nebule - 5mg/2.5mL
Ampoule - 500mcg/1mL
Salbutamol Side Effects
anxiety
tachyarrhythmias
tremors
hypokalaemia and metabolic acidosis
Salbutamol Timing
Onset
2 - 5 minutes
Duration
16 - 60 minutes
- *Half-Life**
1. 6 hours
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
Sodium Chloride 0.9% adult/paediatric IM/IV dose to dissolve and dilute drugs
As authorised on individual DTPs
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
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
Sodium Chloride 0.9% adult/paediatric IV dose as a flush following IV or IO drug administration
PRN
Sodium Chloride 0.9% contraindications
Nil
Sodium Chloride 0.9% Drug Class
isotonic crystalloid solution
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
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
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
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
Sodium Chloride 0.9% precautions
acute or Hx of heart failure
pre-existing renal failure
uncontrolled haemorrhage (unless associated with severe head injury)
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
Sodium Chloride 0.9% side effects
excessive administration will result in fluid overload
Sodium chloride 0.9% Timing
Onset
Immediate
Duration
Variable
Half-Life
N/A
Steps in Paediatric Drug Calculations
Estimated weight = (age x 3) + 7
eg (4 x 3) + 7 = 19kg
Work out dose
eg (15mg/kg) = 15 x 19 = 285mg
Confirm using right unit of measurement
(mg)
Do conversion if required
eg, mg to microgram
Calculate dose
Stock required x volume
Stock strength
Sucrose 24% Contraindications
Patients greater than 12 months of age
Sucrose intolerance - Congenital sucrase-isomaltase deficiency (CSID)
Fructose intolerance
Glucose-galactose malabsorption
Concurrent muscle relaxant/paralysis therapy
Sucrose 24% Drug Class
N/A
Sucrose 24% Paediatric PO Dose for:
Distress Due to Pain
0 - 1 month
0.1 mL (2 drops)
May be repeated once at 5 minutes
2 - 12 months
0.5 mL (10 drops)
May be repeated once at 5 minutes
Sucrose 24% Paediatric PO Dose for:
Short Term Procedural Pain Management
0 - 1 month
0.1 mL (2 drops)
May be repeated once at 5 minutes
2 - 12 months
0.5 mL (10 drops)
May be repeated once at 5 minutes
Sucrose 24% Precautions
Nil
Sucrose 24% Presentation
Twist-tip vial, 2 mL 24% sucrose
Sucrose 24% Side Effects
hyperglycaemia
Sucrose 24% Timing
Onset
minutes
Duration
5-8 minutes
Half-life
N/A
Sucrose 24% Indications
Short term procedural pain management (e.g. IV cannulation)
Distress due to pain
Tips for paediatric drug administration
Be honest - explain what you are doing and what you need them to do before,
during and after the procedure
Use clear and simple language that is tailored to the child’s developmental level
Use positive language: ‘Keep your arm nice and relaxed for me’
Avoid negative terms: ‘Don’t move’, ‘Sting’
Ensure the child is positioned comfortably where they are able to see, hear and/or touch their carer during the procedure
Try to have one person at a time talk to the child
To go from big units to small
multiply
To go from gram to kilogram
divide by 1000
To go from gram to milligram
multiply by 1000
To go from kilogram to gram
multiply by 1000
To go from microgam to milligram
divide by 1000
To go from milligram to gram
divide by 1000
To go from milligram to microgram
multiply by 1000
To go from small units to big
divide
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
Tranexamic Acid (TXA) Contraindications
Allergy and/or adverse drug reaction
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)
Tranexamic Acid (TXA) Precautions
Nil
Tranexamic Acid (TXA) Presentation
1gm/10mL
Tranexamic Acid (TXA) Side Effects
Headache
Seizures
Hypotension
Nausea and/or vomiting
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)
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)
Tranexamic Acid (TXA) Drug Class
Antifibrinolytic
Water for injection IM/IV adult/paediatric dose
As authorised on individual DTPs
Water for injection contraindications
Nil
Water for Injection Drug Class
N/A
Water for injection indications
To dissolve AND/OR dilute drugs for the purpose of IM, IV or IO administration
Water for injection precautions
Nil
Water for injection presentation
Ampoule 20 mL water for injection
Water for injection side effects
nil
Water for injection timing
Onset
N/A
Duration
N/A
Half Life
N/A
What influences pain?
culture
beliefs
mood
coping ability
previous pain experiences
What is the weight calculation formula?
(Age x 3) + 7 = weight in kilograms
Oxytocin Routes of Administration
IM
IV
Water for Injection Routes of Administration
IM
IV
Tranexamic Acid Routes of Administration
INF
IV
Sucrose 24% Routes of Administration
PO
Sodium Chloride 0.9% Routes of Administration
INF
IV
Salbutamol Routes of Administration
MDI
NEB
Paracetamol Routes of Administration
PO
Oxygen Routes of Administration
NC
NEB
SFM
NRBM
BVM
SAD
ETT
CPAP
Amiodarone Indications
- Cardiac arrest (if refractory to three DCCS)
- Sustained conscious VT (CCP only)
Amiodarone Contraindications
For Pts in cardiac arrest:
TCA overdose
Amiodarone Side Effects
hypotension
bradycardia
nausea and/or vomiting
peripheral paraesthesia
Amiodarone Drug Class
Anti-arrhythmic
Amiodarone Timing
Onset (IV)
5 minutes
Duration (IV)
30 minutes
Half-Life
14 - 110 days (with chronic dosing)
Amiodarone Routes of Administration
IV
IO (CCP only)
IV INF (CCP only)
Amiodarone Presentation
Ampoule, 150mg/3mL
Amiodarone adult IV dose for cardiac arrest (refractory to 3 DCCS)
300 mg
Slow push over 1-2 minutes
Repeated once at 150 mg if refractory to 5 DCCS
Total max dose 450 mg
Syringe Preparation: draw up and administer neat - first dose = 2 undiluted ampoules, second dose 1 undiluted ampoule
Amiodarone paediatric dose for cardiac arrest (refractory to 3 DCCS)
CCP only
Atropine Indications
CCP only
* bradycardia (with poor perfusion)
* envenomation (with increased parasympathetic activity)
* hypersalivation (secondary to ketamine administration)
* organophosphate toxicity (with cardiac and/or respiratory compromise)
Atropine Presentation
1.2mg/1mL
Atropine Side Effects
reduces airway secretions
mydriasis (pupil dilation/blown pupils)
Naloxone Drug Class
opioid antagonist
Naloxone Indications
Respiratory depression (secondary to the administration of narcotic drugs)
Naloxone Contraindications
allergy/KSAR
newly born pts
Naloxone Precautions
Use with caution on patients with pre-existing cardiac disease
Naloxone Side Effects
Narcotic reversal can cause combativeness, vomiting, sweating, tachycardia and hypertension
May produce acute withdrawal convulsions in the chronic narcotic user
Pulmonary oedema
Naloxone Presentation
Ampoule, 400 microg/mL
Naloxone Routes of Administration
IM
Naloxone Adult IM dose for Respiratory depression (secondary to the administration of narcotic drugs)
1.6 mg
Single dose only
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
Naloxone Timing
Onset
3–5 minutes (IM)
1–3 minutes (IV)
Duration
≈ 60 minutes
Half-Life
60 minutes
Droperidol Drug Class
antipsychotic
Droperidol Indications
Acute behavioural disturbances (with a SAT Score ≥ 2)
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
Droperidol Precautions
Hypoperfused state
Concurrent use of CNS depressants
Droperidol side Effects
Vasodilation/hypotension
Extrapyramidal effects e.g. dystonic reactions (rare)
Droperidol Presentation
Vial, 10 mg/2 mL
Droperidol Timing
Onset
5-15 minutes
Duration
4-6 hours
Half-Life
N/A
Droperidol Routes of Administration
IM
IV
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
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
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
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
Box Jellyfish Antivenom Drug Class
antivenom
Box Jellyfish Antivenom Indications
Box jellyfish (chironex fleckeri) envenomation associated with any of the following:
* a Pt currently in cardiac arrest
* decreased level of consciousness
* cardiac and/or respiratory distress or collapse
* total surface area affected greater than half the surface area of one limb
* intractable pain unrelieved by icepacks, methoxyflurane and/or narcotic analgesia
Box Jellyfish Antivenom Contraindications
Allergy and/or KSAR
Box Jellyfish Antivenom Precautions
a foreign protein that can cause allergic reaction, anaphylaxis or sensitisation
Box Jellyfish Antivenom Side Effects
allergic reaction including anaphylaxis and delayed serum sickness
intense stinging sensation on injection
Box Jellyfish Antivenom Presentation
20,000 units/1.5 - 4 mL
Box Jellyfish Antivenom Timing
Onset
N/A
Duration
N/A
Half-Life
N/A
Box Jellyfish Antivenom Routes of Administration
IM
IV (preferred)
Box Jellyfish Antivenom Adult/Paediatric IM dose for Box jellyfish (chironex fleckeri) envenomation associated with any of the following:
* decreased level of consciousness
* cardiac and/or respiratory distress or collapse
* total surface area affected greater than half the surface area of one limb
* intractable pain unrelieved by icepacks, methoxyflurane and/or narcotic analgesia
60,000 units
single dose only
(3 injection sites)
Box Jellyfish Antivenom Adult/Paediatric IV dose for Box jellyfish (chironex fleckeri) envenomation associated with any of the following:
* decreased level of consciousness
* cardiac and/or respiratory distress or collapse
* total surface area affected greater than half the surface area of one limb
* intractable pain unrelieved by icepacks, methoxyflurane and/or narcotic analgesia
20,000 units
infusion over 20 minutes
administer via springfusor 30mL
single dose only
Syringe Preparation: mix 20,000 units of antivenom with sodium chloride 0.9% in a 30 mL springfusor syringe to achieve a final concentration of 20,000 units/20 mL at a rate of 60 mL/hour (over 20 minutes)
Box Jellyfish Antivenom Adult/Paediatric IV dose for Box jellyfish (chironex fleckeri) envenomation associated with a patient currently in cardiac arrest
20,000 units
Slow push over 2-5 minutes
Repeated immediately up to 2 times
Total max dose 60,000 units
Syringe Preparation: mix 20,000 units of antivenom with sodium chloride .9% to achieve a final concentration of 20,000 units/20 mL
Magnesium Sulphate Drug Class
electrolyte
Magnesium Sulphate Indications
- Irukandji syndrome (with intractable pain unrelieved by narcotic analgesia and/or SBP > 160mmHg)
- Box jellyfish (chironex fleckeri) envenomation (unresponsive to antivenom therapy)
CCP Only:
* Eclampsia
* Torsades de Pointes
* Severe life-threatening (asthma (only in Pts who have required IM/IV adrenaline (epinephrine))
Magnesium Sulphate Contraindications
- Allergy AND/OR Adverse Drug Reaction
- Atrioventricular (AV) block
- Renal failure
Magnesium Sulphate Precautions
Renal impairment
Magnesium Sulphate Side Effects
- Pain at the cannulation site
- Magnesium toxicity
- hypotension/respiratory depression
- loss of deep tendon reflexes
Magnesium Sulphate Presentation
Ampoule, 10 mmol (2.5 g)/5 mL
Magnesium Sulphate Timing
Onset
Immediate
Duration
30 minutes
Half-Life
Variable
Magnesium Sulphate Routes of Administration
IV
INF
Magnesium Sulphate Adult IV dose for Irukandji syndrome (with intractable pain unrelieved by narcotic analgesia AND/OR systolic BP > 160 mmHg)
10 mmol over 20 minutes
Repeated once at 20 minutes.
Total maximum dose 20 mmol.
Administer via SPRINGFUSOR® 30 mL
Syringe preparation: Mix 10 mmol (5 mL) of magnesium sulphate with 15 mL sodium chloride 0.9% in a 30 mL SPRINGFUSOR® syringe to achieve a final concentration of 10 mmol/20 mL. Ensure syringe is appropriately labelled. Administer infusion via the SPRINGFUSOR® at a rate of 60 mL/hour (over 20 mins).
Magnesium Sulphate Adult IV dose for Box jellyfish (Chironex fleckeri ) envenomation (unresponsive to antivenom therapy)
10 mmol over 20 minutes
Repeated once at 20 minutes
Total maximum dose 20 mmol
Administer via SPRINGFUSOR® 30 mL
Syringe preparation: Mix 10 mmol (5 mL) of magnesium sulphate with 15 mL sodium chloride 0.9% in a 30 mL SPRINGFUSOR® syringe to achieve a final concentration of 10 mmol/20 mL. Ensure syringe is appropriately labelled. Administer infusion via the SPRINGFUSOR® at a rate of 60 mL/hour (over 20 mins).
Magnesium Sulphate Paediatric IV dose for:
* Irukandji syndrome (with intractable pain unrelieved by narcotic analgesia AND/OR systolic BP > 160 mmHg)
* Box jellyfish (Chironex fleckeri ) envenomation (unresponsive to antivenom therapy)
0.1 mmol/kg over 15 minutes
(rounded up to the nearest 0.5 mmol)
Administer via SPRINGFUSOR® 30 mL
Single dose not to exceed 5 mmol
Repeated once at 15 minutes
Total maximum dose 10 mmol
Syringe preparation: Mix 0.1 mmol/kg of magnesium sulphate with sodium chloride 0.9% in a 30 mL SPRINGFUSOR® syringe to achieve a final concentration of 0.1 mmol/kg in 15 mL. Ensure syringe is appropriately labelled. Administer infusion via the SPRINGFUSOR®. at a rate of 60 mL/hour (over 15 mins)
Hydroxocobalamin Drug Class
antidote
Hydroxocobalamin Indications
Life-threatening cyanide toxicity (e.g. shock, respiratory failure, seizure, ALOC or myocardial ischaemia)
Hydroxocobalamin Contraindications
Allergy AND/OR Adverse Drug Reaction
Hydroxocobalamin Precautions
hypertension
pregnancy
Hydroxocobalamin Side Effects
Headache
Anaphylaxis
Hypertension
Renal failure
Nausea and/or vomiting
Pain at infusion site
Chromaturia
Erythema
Rash (acne like)
Hydroxocobalamin Presentation
Vial, 5g
Hydroxocobalamin Timing
Onset
Immediate
Duration
several days
Half-Life
26-31 hours
Hydroxocobalamin Routes of Administration
IV
INF
Hydroxocobalamin Adult IV/INF dose for Life-threatening cyanide toxicity (e.g. shock, respiratory failure, seizure, ALOC or myocardial ischaemia)
5g over 5 minutes
Amiodarone precautions
For Pts in cardiac arrest
Nil
Levetiracatem indications?
CCP only
convulsive status epilepticus continuing >20 mins post first midazolam administration
Calcium gluconate indications
CCP only
Following pre-hospital blood product transfusion
Hypotension associated with a magnesium infusion
Hydrofluoric acid inhalation
Suspected hyperkalaemic cardiac arrest
Severe hyperkalaemia
Verapamil AND/OR diltiazem toxicity
Calcium gluconate presentation
vial 2.2mmol/10mL
pre-filled syringe 4.4mmol/25mL
Clopidogrel Drug Class
Antiplatelet
Clopidogrel Indications
Pts with STEMI and
- have been accepted for pPCI (as an adjunct medication to aspirin and heparin) and the receiving interventional cardiologist is requesting clopidogrel administration; OR
- who have received tenecteplase (and have been administered aspirin and enoxaparin)
Clopidogrel contraindications
Patients less than 18 years of age
Allergy AND/OR Adverse Drug Reaction
Patients contraindicated for pre-hospital fibrinolysis administration
Prior intracranial haemorrhage
Current clopidogrel OR ticagrelor therapy
Active bleeding (excluding menses)
Clopidogrel precautions
severe renal impairment
Clopidogrel side effects
haemorrhage
Clopidogrel presentation
tablet (pink), 75mg
Clopidogrel Timing
Onset
~ 30 mins
Duration
7-10 days
Half-Life
8 hours
Clopidogrel routes of administration
PO
Clopidogrel adult dose for Pts with STEMI who have been accepted for pPCI and receiving interventional cardiologist is requesting clopidogrel administration
600mg
swallowed with a small quantity of water
Clopidogrel adult dose for Pts with STEMI who have received tenecteplase (and have been administered aspirin and enoxaparin)
300 mg
swallowed with a small quantity of water
Enoxaparin drug class
anticoagulant
Enoxaparin indications
Patients with STEMI who have received QAS tenecteplase (as an adjunct medication to aspirin and clopidogrel)
Enoxaparin contraindications
Allergy AND/OR Adverse Drug Reaction
Patients contraindicated for pre-hospital fibrinolysis administration
Enoxaparin precautions
Renal/hepatic impairment
Low bodyweight (women < 45 kg and men < 57 kg)
Older people
Enoxaparin side effects
harmorrhage
thrombocytopenia
Enoxaparin presentation
Injection, 60 mg/0.6 mL enoxaparin sodium
Injection, 100 mg/1 mL enoxaparin sodium
Enoxaparin timing
Onset
immediate
Duration
12-24 hours
Half-Life
4.4 hours for 40mg dose
Enoxaparin routes of administration
IV
subcut
Enoxaparin adult IV dose fore Patients with STEM who have received QAS tenecteplase (as an adjunct medication to aspirin and clopidogrel)
loading dose 30mg
to be administered 15 mins prior to subcut maintenance dose
Enoxaparin adult SUBCUT dose fore Patients with STEM who have received QAS tenecteplase (as an adjunct medication to aspirin and clopidogrel)
maintenace dose
1mg/kg
single dose only not to exceed 100 mg
to be administered 15 mins after IV loading dose
What pain assessment tool is used in children aged 3 and above?
wong baker faces
What pain assessment tool is used in infants who are unalbe to speak, comprehend or use self-reporting tools?
FLACC behavioural assessment scale
What are the components of the FLACC behavioural assessment scale?
Face
Legs
Activity
Cry
Consolability
Sodium Bicarbonate Drug Class
Alkalising agent
Sodium Bicarbonate Indications
CCP Only
* Cardiac arrest:
- secondary to suspected hyperkalaemia (e.g. chronic renal failure)
- secondary to tricyclic antidepressant (TCA) OR propranolol overdose
* Significant injury with potential for crush syndrome
* TCA poisoning (with QRS > 0.14 AND terminal R wave in aVR)
* Sodium channel blockade due to non-TCA poisoning (with QRS > 0.14 AND terminal R wave in aVR)
* Suspected hyperkalaemia (with QRS widening AND/OR AV dissociation)
Sodium Bicarbonate Presentation
Vial 100mL
Sodium Bicarbonate
