Indications

Question 1

Indications of Aspirin

Answer 1

Adults with clinical or ECG evidence suggestive of myocardial infarction or ischaemia.

Question 2

Indications of Dexamethasone

Answer 2

Moderate / Severe Croup

Question 3

Indications of Clopidogrel

Answer 3

STEMI:

• In patients not already taking clopidogrel
• Receiving thrombolytic treatment
• Anticipated thromolytic treatment
• Anticipated PPCI

Question 4

Indications of Adrenaline 1:000

Answer 4

Anaphylaxis

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

Question 5

Indications of Adrenaline 1:10,000

Answer 5

Cardiac Arrest

Question 6

Indications of Amiodarone

Answer 6

Cardiac Arrest:
Shockable rhythms: if unresponsive to defibrillation administer amiodarone after the 3rd shock and an additional bolus depending on age to unresponsive VF or pulseless VT following the 5th shock.

Question 7

Indications of Atropine

Answer 7

Symptomatic Bradycardia in the presence of ANY of these adverse signs:
- Absolute bradycardia (<40 bom)
- Systolic BP below expected for age
Paroxysmal ventricular arrhythmias requiring suppression
- Inadequate perfusion causing confusion etc.
- Bradycardia following ROSC

Nb: Hypoxia is the most common cause of bradycardia in children so interventions to support ABC with oxygen therapy should be the first-line therapy.

Question 8

Indications of Benzylpenicillin

Answer 8

Suspected meningococcal disease in the presence of:
1. Non-blanching rash
AND / OR
2. Signs/symptoms suggestive of meningococcal septicaemia

Question 9

Indications of Chlorphenamine

Answer 9

Severe anaphylactic reactions (when indicated should follow initial treatment with IM adrenaline).

Symptomatic allergic reactions falling short of anaphylaxis but causing patient distress (eg. severe itching).

Question 10

Indications of Diazepam

Answer 10

Patients who have prolonged (lasting 5 mins or more) OR repeated (3 or more in an hour) convulsions who are CURRENTLY CONVULSING - not secondary to an uncorrected hypoxic or hypoglycaemic episode.

Eclamptic Convulsions (initiate treatment if seizure lasts over 2-3 mins or if it is recurrent).

Symptomatic cocaine toxicity (severe hypertension, chest pain or convulsions).

Question 11

Indications of Entonox

Answer 11

Moderate to severe pain

Labour pains

Question 12

Indications of Furosemide

Answer 12

Pulmonary oedema secondary to left ventricular failure.

Question 13

Indications of Glucagon

Answer 13

Hypoglycaemia (BM <4.0 millimoles per litre), especially in known diabetics.

Clinically suspected hypoglycaemia where oral glucose administration is not possible.

The unconscious patient, where hypoglycaemia is considered a likely cause.

Question 14

Indications of Glucose 10%

Answer 14

Hypoglycaemia (esp in known diabetics).

Clinically suspected hypoglycaemia where oral glucose administration is not possible.

The unconscious patient, where hypoglycaemia is considered a likely cause.

Question 15

Indications of Glucose 40% Gel

Answer 15

Known or suspected hypoglycaemia in a conscious patient where there is no risk of choking or aspiration.

Question 16

Indications of Glyceryl Trinitrate (GTN)

Answer 16

Cardiac chest pain due to angina or MI.

Acute cardiogenic pulmonary oedema.

Question 17

Indications of Heparin

Answer 17

STEMI where heparin is required as adjunctive therapy with reteplase or tenecteplase to reduce the risk of re-infarction.

Question 18

Indications of Hydrocortisone

Answer 18

Severe or life-threatening asthma.

Anaphylaxis.

Adrenal crisis (including Addisonian crisis) - which is a time-critical medical emergency with an associated mortality.

Question 19

Indications of Ibuprofen

Answer 19

Relief of mild to moderate pain and/or high temperature.

Soft tissue injuries.

Best when used as part of a balanced analgesic regimen.

Question 20

Indications of Ipratropium Bromide (Atrovent)

Answer 20

Acute severe or life-threatening asthma.

Acute asthma unresponsive to salbutamol.

EXacerbation of COPD unresponsive to salbutamol.

Question 21

Indications of Metaclopramide

Answer 21

Nausea or vomiting in adults aged 20 and over.

Prevention and treatment of nausea and vomiting following administration of morphine.

Question 22

Indications of Midazolam

Answer 22

Convulsion lasting 5 mins or more and STILL FITTING.

3 or more focal or generalised convulsions in an hour.

Convulsion continuing 10 mins after first dose of medication.

Traumatic brain injury with combativeness or agitation where sedation is required to facilitate effective oxygenation.

Question 23

Indications of Misoprostol

Answer 23

Post-partum haemorrhage within 24 hours or delivery where bleeding from the uterus is uncontrollable by uterine massage.

Miscarriage with life-threatening bleeding and a confirmed diagnosis (e.g. patient has gone home with medical management and starts to bleed).

Both syntometrine and ergometrine are contra-indicated in hypertension; in this case misoprostol should be administered instead.

In all other circumstances misoprostol should only be used if syntometrine or other oxytocics are unavailable or if they have been ineffective at reducing haemorrhage after 15 mins.

Question 24

Indications of Morphine Sulphate

Answer 24

Pain associated with suspected MI (analgaesic of first choice).

Severe pain as a component of a balanced analgesia regimen.

Question 25

Indications of Naloxone Hydrochloride (Narcan)

Answer 25

Opioid overdose producing respiratory, cardiovascular and CNS depression.

Overdose of either an opioid analgaesic (e.g. dextropropoxyphene, codeine), or a compound analgaesic (e.g. co-codamol).

Unconsciousness, associated with respiratory depression of unknown cause, where opioid overdose is a possibility.

Question 26

Indications of Ondansetron

Answer 26

Adults:

• Prevention and treatment of opiate-induced nausea and vomiting (e.g. morphine)
• Treatment of nausea or vomiting

Children:

• Prevention and treatment of opiate-induced nausea and vomiting (e.g. morphine)
• For travel associated nausea or vomiting

Question 27

Indications of Oxygen

Answer 27

Hypoxaemia

Cardiac Arrest

Major trauma:

• Abdo
• Burns
• Electrocution
• Head
• Limb
• Spinal
• Pelvic
• Immersion
• Thoracic
• Trauma in pregnancy

Critical illnesses:

• Anaphylaxis
• Decompression illness
• Major pulmonary haemorrhage
• Sepsis
• Shock
• Drowning
• Active convulsion
• Hypothermia

Question 28

Indications of Paracetamol

Answer 28

Oral: Relief of mild to moderate pain or high temperature with discomfort.

IV: Severe pain (…)

Question 29

Indications of Reteplase

Answer 29

STEMI 12 hours of symptom onset where PPCI is NOT readily available.

Question 30

Indications of Salbutamol

Answer 30

Acute asthma attack where normal inhaler therapy has failed to relieve symptoms.

Expiratory wheezing associated with allergy, anaphylaxis, smoke inhalation or other lower airway cause.

Exacerbation of COPD.

SOB in patients with severe breathing difficulty due to LVF.

Question 31

Indications of 0.9% Sodium Chloride

Answer 31

Medical conditions with or without haemorrhage.

Trauma-related haemorrhage.

Burns.

Limb crush injury in adults.

As a flush.

Question 32

Indications of Sodium Lactate Compound (Hartmann’s/Ringer’s Lactate)

Answer 32

Blood and fluid loss, to correct hypovolaemia and improve tissue perfusion if sodium chloride 0.9% is NOT available.

Dehydration.

Question 33

Indications of Syntometrine

Answer 33

Post-partum haemorrhage within 24 hours of delivery where bleeding from the uterus is uncontrollable by uterine massage.

Miscarriage with life-threatening bleeding and a confirmed diagnosis (e.g. patient has gone home with medical management and starts to bleed).

Question 34

Indications of Tenecteplase

Answer 34

STEMI within 6 hours of symptom onset where PPCI is NOT readily available.

Question 35

Indications of Tetracaine 4%

Answer 35

Venepuncture in non-urgent situation in individuals believed to be needle-phobic.

Question 36

Indications of Tranexamic Acid (TXA)

Answer 36

Patients with TIME CRITICAL injury where significant internal/external haemorrhage is suspected.

Injured patients fulfilling local step 1 or step 2 trauma triage protocol.

Women suffering from post-partum haemorrhage. use TXA alongside uterotonic drugs such as syntometrine and misoprostol.

Question 37

Indications of Activated Charcoal

Answer 37

Emergency treatment of acute oral poisoning and oral drug overdose.

• Adults and children aged 1 or over who have ingested toxins less than 1 hour before arrival of an ambulance clinician.

OR

• Adults and children irrespective or time of ingestion and have ingested toxins where Toxbase has been contacted and has advised administration of activated charcoal. (…)