Indications

Question 0

Adrenaline

• Indications-

Answer 0

• -Cardiac arrest
• -Ventricular fibrillation, pulseless VT, PEA, Asystole
• -Resistant symptomatic bradycardia -Anaphylaxis (for all patients with signs of systemic reaction: hypotension, laryngeal oedema or definite difficulty breathing -
• Impending upper airway obstruction due to inflammation e.g.: -Upper airway infection -Inhalation burns (With signs of stridor, cyanosis, dysphonia etc)
• -Life-threatening severe asthma
• -Severe hypotension not due to hypovolemia -Beta-blocker/calcium channel blocker toxicity -Croup (Laryngo-tracheo-bronchitis)

Question 1

Adenosine

• Indications -

Answer 1

• Stable patients with narrow-complex paroxysmal supra-ventricular tachycardia, to terminate the reentry SVT

Question 2

Amiodarone Hydrochloride

• Indications-

Answer 2

• -Defibrillation refractory
• • VF and refractory pulseless VT (i.e. unresponsive to CPR, shock and vasopressor)
• -Control of haemodynamically stable VT -Polymorphic VT with normal QT interval, if this can be determined (i.e. EXCLUDING Torsades de Pointes)
• -Narrow-complex tachycardias originating from a reentry mechanism (reentry SVT) if the rhythm remains uncontrolled by adenosine and vagal manouvers, or when these are contra-indicated

Question 3

Atropine Sulphate

• Indications-

Answer 3

• -Symptomatic bradycardia, associated with unstable signs or symptoms: (acute decreased level of consciousness, ongoing severe ischaemic chest pain, hypotension, pulmonary oedema, congestive cardiac failure)
• -Bradycardia (6/min) Ventricular Extra Systole
• -Asystolic cardiac arrest in adults -Pulseless electrical activity with bradycardia
• -Organophosphate poisoning

Question 4

Beta adrenergic stimulants

• Indications

Answer 4

• -Acute bronchospasm
• -Premature or obstructed labour -
• Suspected hyperkalaemia on ECG rhythm strip

Question 5

Calcium Chloride 10%

• Indications-

Answer 5

• Any of the following suspected cardiac arrest/pre-arrest conditions: -
  
  • Hyperkalaemia (indicated by tall peaked t-waves, flattened p-waves, broadened QRS complexes, e.g. renal failure severe tissue damage-crush syndrome)
• -Calcium channel blocker toxicity (e.g. verapamil)
• -Beta blocker toxicity (e.g. propranolol)

Question 6

Clopidogrel

• Indications-

Answer 6

• -Used as antiplatelet therapy ONLY in patients who have true aspirin allergy (who cannot tolerate aspirin) with suspected acute myocardial infarction (acute coronary syndromes)

Question 7

Corticosteroids

• Indications-

Answer 7

• -Severe allergy/anaphylaxis
• -Acute asthma attack

Question 8

Diazepam

• Indications-

Answer 8

• -Anti-convulsive therapy
• -Sedation

Question 9

Flumazenil

• Indications-

Answer 9

• -Reversal of CNS sedative effects and respiratory depression due to benzodiazepines alone

Question 10

Furosemide

• Indications-

Answer 10

• -Acute pulmonary oedema of cardiac, hepatic or renal origin

Question 11

Glucagon

• Indications-

Answer 11

• -Acute management of symptomatic hypoglycaemia (HGT < 3.5mmol/L) Only if adequate IV access of IV dextrose is not available or effective
• -Severe anaphylactic reactions if patient is unresponsive to adrenaline, and especially if the patient is taking beta blockers -
• Severe symptomatic bradycardia from beta blockade overdose not responding to other medications e.g. adrenaline
• -Calcium channel blocker OD

Question 12

Glyceryl Trinitrate

• Indications-

Answer 12

• -Angina pectoris
• -Acute myocardial infarction
• -Acute pulmonary oedema

Question 13

Lignocaine Hydrochloride (LIDOCAINE)

(Systemic) - Indications

Answer 13

• -Shock resistant ventricular fibrillation- only if amiodarone unavailable -
• Ventricular tachycardia - only if amiodarone unavailable
• -Control of ahemodynamically compromising PVCs (i.e. complex ventricular ectopy (symptomatic/unstable patient) associated with AMI/ACS -Multiform (multifocal) -Repetitive (couplets, salvos, or > 3) -R on T pattern
• -Complex ventricular ectopy in the setting of myocardial ischemia or causing haemodynamic instability should be suppressed. (Only in the setting of symptomatic, complex ectopy is lignocaine likely to benefit a patient having an AMI/ACS)
• -Torsades de pointes (evidence of prolonged QT) - use lignocaine only if magnesium sulphate (the primary drug for torsades) is not effective or is unavailable)
• -Intubation of patients with head injury, stroke, hypertensive encephalopathy or where increased intracranial pressure is detrimental.

Question 14

Lorazepam

• Indications-

Answer 14

• First line anti-convulsive therapy for status epilepticus

Question 15

Magnesium Sulphate

• Indications-

Answer 15

• -Recommended for use in cardiac arrest if torsades de pointes or suspected hypomagnesaemia is present
• -Life-threatening ventricular dysrrhythmia due to digitalis toxicity
• -Acute severe asthma unresponsive to conventional therapy
• -Control of seizures in toxaemia of pregnancy

Question 16

Metoclopramide Monohydrochloride

• Indications-

Answer 16

• -Nausea and vomiting due to:
  
  • -Stimulation of CETZ by medication (e.g.morphine)
• -Motility disorders of the GIT (e.g. gastro-enteritis)

Question 17

Midazolam

• Indications-

Answer 17

• -Sedation
• -Induction agent for intubation -
• Anticonvulsive therapy - NOT first line therapy
• -It should not be administered in a patient with persistent convulsions unless lorazepam/diazepam unavailable

Question 18

Morphine Sulphate

• Indications-

Answer 18

• -Acute severe pain
• -Indicated for patients with continuing ischaemic chest pain (ACS) that is NOT RELIEVED by Glyceryl Trinitrate -
• Cardiogenic pulmonary oedema -
• Concomitant use with benzodiazepines for synergism in induction

Question 19

Naloxone Hydrochloride

• Indications-

Answer 19

• -Only to be administered after adequate oxygenation and ventilation
• -Reversal of respiratory depression due to acute opiate usage
• -Nenonatal respiratory depression secondary to the administration of opiods to the mother in the previous 4 hours
• NOTE: The only therapeutic goal is to reverse any respiratory depression in a suspected narcotic overdose, and not to fully awaken such patients, who may become violent should acute withdrawal occur

Question 20

Promethazine

• Indicaitons-

Answer 20

• -Acute anaphylaxis/sever allergy

Question 21

Sodium Bicarbonate 8.5%

• Indications-

Answer 21

• Pre-hospital use of sodium bicarbonate is indicated in: -3 lead ECG diagnosis of suspected hyperkalaemia in protracted PEA that is not responding
• -Known OD induced cardiac arrest with protracted PEA that is not responding (e.g. tricyclic anti-depressant OD, aspirin OD, cocaine OD)
• -Severe tricyclic anti-depressant OD, with acute decompensation/unstable patient, i.e QRS complex > 100 milliseconds, or if hypotension develops
• -Prior to release of prolonged entrapment to prevent acute crush syndrome collapse

Question 22

Thiamine Hydrochloride

• Indications-

Answer 22

• -Suspected Wernicke’s encephalopathy -
• Prior to IV administration of 50% glucose, where the possibility of thiamine deficiency is suspected, e.g. alcoholism, malnourishment