ICP Drugs

Question 1

Adenosine
Uses

Answer 1

Treatment of SVT.

Not for the treatment of atrial flutter or fibrillation.

Question 2

Adenosine
Contraindications

Answer 2

1. 2nd or 3rd degree heart block
2. known hypersensitivity.

Question 3

Amiodarone
Uses

Answer 3

Effective for both supraventricular and ventricular arrhythmias.
1. To slow the ventricular rate in atrial fibrillation and flutter
2. to treat VF or VT

Question 4

Amiodarone
Contraindications

Answer 4

1. Known hypersensitivity
2. Cross sensitivity to iodine

Question 5

Calcium Chloride
Uses

Answer 5

1. Emergency treatment for hyperkalaemia
2. cardiac arrest (secondary to hyperkalaemia - suspected cause of arrest)
3. Prolonged hypotension post-magnesium administration, if unresponsive to fluid.

Question 6

Calcium Chloride
Contraindications

Answer 6

1. Known hypersensitivity
2. Digoxin overdose

Question 7

Heparin
Uses

Answer 7

Patients with an acute ST elevation myocardial infarction who meet the requirements for early percutaneous coronary intervention (PCI) procedure

Contraindications as per heparin checklist

Question 8

Hydrocortisone
Uses

Answer 8

1. Moderate to severe respiratory distress due to asthma or exacerbation of COPD
2. Patients with a diagnosed adrenal insufficiency who experience a stress response and exhibit altered conscious state and/or refractory hypotension

Question 9

Hydrocortisone
Contraindications

Answer 9

Known previous reaction to corticosteroids

Question 10

Ketamine
Uses (ICP)

Answer 10

1. Pain management, especially in patients who are hypotensive or unable to have narcotics, and if no other alternative is available.
2. particularly useful for trapped patients with limb injuries, especially if BP is borderline for narcotics.
3. Adjunct to morphine or fentanyl, with alternating doses.
4. Pharmacological intervention for combative/agitated patients, especially with suspected psycho-stimulant use
5. sedation to manage airway, RSI, sedation of a previously intubated patient.

Question 11

Lignocaine
Uses

Answer 11

1. Local anaesthetic effects
2. VT with cardiac output, in patients who cannot have amiodarone
3. Flushing of a painful IO in an aware patient.

Question 12

Magnesium
Uses

Answer 12

1. Torsades de pointes/polymorphic VT
2. Refractory VF (3rd drug)
3. Seizures due to eclampsia
4. Symptomatic pre-eclampsia - hypertension pregnant patients (>20/40 to 6/52 post partum) presenting as unwell (ALOC, headache, abdominal pain, visual disturbances, etc)

Question 13

Magnesium
Contraindications

Answer 13

1. AV block
2. Renal failure
3. Hepatic failure

Question 14

Midazolam
Uses (ICP)

Answer 14

1. Adjunct to analgesia for injuries where significant muscle spasm is present
2. mild sedation to permit basic airway management
3. post intubation sedation (as an adjunct to ketamine)
4. To assist in the management of agitated and combative patients.

Contra: known hypersensitivity.

Question 15

Sodium Bicarbonate
Uses

Answer 15

1. Cardiac arrest secondary to cardioactive drug overdose (e.g. tricyclic antidepressant, beta blocker, digoxin) or hyperkalaemia.
2. prolonged cardiac arrest (>15minutes)
3. for emergency treatment of hyperkalaemia
4. for treatment of arrhythmias, seizures or coma in overdose of cardioactive medications (e.g. tricyclic antidepressants, Beta blocker, digoxin)
5. to combat acidosis and hyperkalaemia in crush syndrome.

Contraindications: known hypersensitivity