Indication/Diagnosis

Question 1

Amiodarone Hydrochloride

Answer 1

• Cardiac Arrest with shockable rhythms:
  
  • unresponsive VF
  • pulseless VT
• If unresponsive to defibrillation administer after 3rd shock

Question 2

Aspirin

Answer 2

• Cardiac chest pain
• Adults with clinical/ECG evidence suggestive of myocardial infarction or ischaemia

Question 3

Atropine Sulfate

Answer 3

• Symptomatic bradycardia in presence of ANY of these adverse signs:
  
  • absolute bradycardia (pulse <40 beats/min)
  • systolic BP below expected for age
  • paroxysmal ventricular arrhythmias requiring suppression
  • inadequate perfusion causing confusion, etc
  • bradycardia following ROSC

NB - hypoxia is most common cause of bradycardia in paediatrics, therefore support ABC and O₂ should be first-line therapy

Question 4

Benzylpenicillin Sodium

Answer 4

• Suspected meningococcal disease in the presence of:
  
  • a non-blanching rash (classic, haemorrhagic, non-blanching rash(may be petechial or purpuric)
  • signs/symptoms suggestive of meningococcal septicaemia (stiff neck, photophobia, etc)

Question 5

Adrenaline 1:1000

Answer 5

• Anaphylaxis
• Life-threatening asthma with failing ventilation and continued deterioration despite nebuliser therapy

Question 6

Adrenaline 1:10,000

Answer 6

• Cardiac arrest

Question 7

Chlorphenamine

Answer 7

• Severe Anaphylactic reactions after initial resuscitation
• Symptomatic allergic reactions falling short of anaphylaxis but causing pt distress (eg, sever itching)

Question 8

Dexamethasone

Answer 8

• Mild/moderate/severe croup
• refer to modified Taussig Score

Question 9

Diazepam

Answer 9

• Pt who have prolonged (>5mins) OR repeated (>3/hour) convulsions who are currently convulsing - not secondary to hypoxic/hypoglycaemic episode
• Eclamptic convulsions (initiate if seizure lasts over 2-3 mins or is recurrent)
• Symptomatic cocaine toxicity (severe hypertension, chest pain or convulsions)

Question 10

Glucose 40% (oral gel)

Answer 10

• Known or suspected hypoglycaemia in a conscious pt with no risk of choking/aspiration

Question 11

Glucagon

Answer 11

• Clinically suspected hypoglycaemia
• Unconscious pt where hypoglycaemia is considered likely cause (BM <4.0mmol/l)

NB - Glucagon only to be administered when oral glucose administration is not possible or is ineffective, AND/OR when IV access to administer 10% glucose is not possible

Question 12

Glucose 10%

Answer 12

• Hypoglycaemia (BM <4.0mmol/l) or suspected, when oral administration is not possible and a rapid improvement in clinical state and blood glucose level is required
• Unconscious pt where hypoglycaemia is considered likely cause
• Management of hypoglycaemia in pt who have not responded to administration of IM glucagon after 10 mins

Question 13

Glyceryl Trinitrate (GTN)

Answer 13

• Cardiac chest pain due to angina or MI, when systolic BP is >90mmHg
• Breathlessness due to pulmonary oedema in acute heart failure when systolic BP >110mmHg
• Pt with suspected cocaine toxicity presenting with chest pain

Question 14

Hydrocortisone

Answer 14

• Severe/Life-threatening Asthma - provided IV access is easy and administration does not delay transport to hospital
• Anaphylaxis - only after adrenaline (if indicated) and chlorphenamine administration
• Adrenal Crisis:
  
  • established adrenal crisis, administer ASAP (IV route preferable)
  • suspected adrenal insufficiency or unexplained collapse in steroid dependant pt (IM is sufficient, do not delay transport)

NB - if there is any doubt about previous steroid administration, better to administer further hydrocortisone

Question 15

Ibuprofen

Answer 15

• relief of mild to moderate pain
• Pyrexia with discomfort (might relieve unpleasant aches/pains that often accompany febrile illness)
• Soft tissue injury

Question 16

Ipratromium Bromide

Answer 16

• Acute, severe or life-threatening asthma
• Acute asthma unresponsive to salbutamol
• Exacerbation of COPD, unresponsive to salbutamol

Question 17

Morphine Sulfate

Answer 17

• Pain associated with suspected MI
• Severe pain as part of a balanced analgesia regimen
• Pain management for adults in EOLC if:
  
  • contact palliative care team
  • medication has not been prescribed
  • medication has been prescribed but is not yet available/has run out
  • medicines are in place without a pt specific document signed by an independant prescriber

Question 18

Naloxone Hydrochloride (Narcan)

Answer 18

• Reversal of acute opioid or opiate toxicity for respiratory arrest/depression
• Unconsciousness associated with respiratory depression of unknown cause, where opioid overdose is a possibility
• Cardiac arrest where opioid toxicity is considered the likely cause
• Pt exposed to high-potency veterinary/anaesthetic preparations should be given Naloxone urgently if:
  
  • consciousness is impaired
  • exposure occurred within the last 10 mins, even if asymptomatic

NB - if an antidote is supplied with an opioid medication, such as diprenorphine (Revivon) or naloxone, administer immediately

Question 19

Nitrous Oxide (Entonox)

Answer 19

• Moderate to severe pain
• Labour pain

Question 20

Ondansetron

Answer 20

Adults:

• Prevention & treatment of opiate-induced nausea & vomiting (eg. morphine)
• Treatment of nausea & vomiting

Children:

• Prevention & treatment of opiate-induced nausea & vomiting (eg. morphine)
• For travel associated nausea & vomiting

Question 21

Paracetamol

Answer 21

Oral:

• Relief of mild to moderate pain or high temperature with discomfort (not for pyrexia alone)

IV:

• As part of a balanced analgesic regimen for severe pain. Paracetamol is effective in reducing opioid requirements while improving analgesic efficacy
• Alternative analgesic when morphine is contraindicated

Question 22

Salbutamol

Answer 22

• Acute asthma where normal inhaler therapy fails to relieve symptoms
• Expiratory wheezing associated with allergy, anaphylaxis, smoke inhalation or other lower airway cause
• Exacerbation of COPD

Question 23

Sodium Chloride 0.9%

Answer 23

Adult fluid therapy:

• medical conditions with/without haemorrhage
• trauma related haemorrhage
• burns
• limb crush injury

Child fluid therapy:

• medical conditions
• trauma related haemorrhage
• burns

Flush:

• to confirm patency of IV/IO cannula
• to follow drug administration

Question 24

Syntometrine

Answer 24

• Post-partum haemorrhage within 24hrs of delivery where bleeding from the uterus is uncontrollable by uterine massage
• Miscarriage with life-threatening bleeding and a confirmed diagnosis (eg. where pt has gone home with medical management and bleeding begins)

Question 25

Tranexamic Acid

Answer 25

• Prevention and treatment of significant haemorrhage following trauma
• Pt aged >12 with TIME CRITICAL injury where significant internal/external haemorrhage is suspected/known
• Injured pt aged >12 fulfilling step 1 or 2 of the LAS Major Trauma Decision Tool & believed to be at risk of significant haemorrhage

Question 26

Oxygen

Answer 26

Children:

• Significant illness and/or injury

Adults:

• Critical illness requiring high levels of supplemental O₂
• Serious illness requiring moderate levels of supplemental O₂ if pt is hypoxaemic
• COPD & other conditions requiring controlled or low dose O₂ therapy
• Conditions for which pt should be monitored closely but O₂ therapy is not required unless pt is hypoxaemic

Question 27

Midazolam (pt own)

Answer 27

• Convulsions lasting >5 mins & still fitting, or >3 convulsions in 1 hr
• Convulsions continuing 10 mins after first dose of medication

NB - when midazolam is prescribed for a pt the clinician MUST follow the prescriber’s instructions for its administration.