Indications And Side Effects

Question 1

Adrenaline 1 mg in 10 ml (1:10,000)

Answer 1

Indications: cardiac arrest
Shockable rhythm: administer after the 3rd shock and then after alternate shocks.
Non-shockable rhythm: administer immediately and the alternate shocks

Side effects: none in jrcalc

Question 2

Adrenaline 1 mg in 1 mL

Answer 2

Indications:
Anaphylaxis.
Life threatening asthma with failing ventilation and continued deterioration despite nebuliser therapy.

Side-effects:
None listed in JRCalc

Question 3

Amiodarone hydrochloride

Answer 3

Indications: cardiac arrest - shockable rhythms: if unresponsive to defibrillation administer amiodarone after the third shock. (VF or Pulseless VT)

Side-effects:
Bradycardia.
Vasodilation causing hypotension, flushing.
Bronchospasm.
Arrhythmias - Torsades de pointes

Question 4

Aspirin

Answer 4

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

Side-effects:
Increased risk of gastric bleeding.
Wheezing in some asthmatics.

Question 5

Atropine sulfate

Answer 5

Indications: symptomatic bradycardia in the presence of any of these adverse signs:
Absolute bradycardia (pulse less than 40 bpm).
Systolic BP below expected for age.
Paroxysmal ventricular arrhythmias requiring suppression.
Inadequate perfusion causing confusion, ETC.
Bradycardia following return of spontaneous circulation.

Side-effects:
Dry mouth, visual blurring and pupil dilation.
Confusion and occasional hallucinations.
Tachycardia.
Do not use small (less than 100 µg) doses as they may cause paradoxical bradycardia.

Question 6

Benzylpenicillin sodium

Answer 6

Indications: suspected meningococcal disease in the presence of:
1. A non-blanching rash.
And/Or
2. Signs/symptoms suggestive of meningococcal septicaemia. (photophobia/stiff neck)

Side-effects:
None listed in JRCALC Plus

Question 7

Chlorphenamine

Answer 7

Indications:
Severe anaphylactic reactions after initial resuscitation.
Symptomatic allergic reactions falling short of anaphylaxis but causing patient distress (e.g. severe itching).

Side-effects: 
Sedation. 
Dry mouth. 
Headache. 
Blurred vision. 
Urinary retention. 
Psycho motor impairment. 
Gastrointestinal disturbance. 
Convulsions (rare). 

Children and older people are more likely to suffer side-effects.
Warn anyone receiving chlorphenamine against driving or undertaking any other complex psychomotor task, due to the sedative and psychomotor side-effects.
With the intravenous preparation, transient hypotension, central nervous system stimulation and irritant effects.

Question 8

Dexamethasone

Answer 8

Indications: mild/moderate/severe croup, refer to modified Taussig score, refer to respiratory illness in children.

Side-effects:
Gastrointestinal upset.
Hypersensitivity anaphylactic reaction.

Question 9

Diazepam

Answer 9

Indications:
Patients who have prolonged (lasting 5 minutes 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 minutes or if it is recurrent).
Symptomatic cocaine toxicity (severe hypertension, chest pain or convulsions).

Side-effects:
Respiratory depression may occur, especially in the presence of alcohol. Opioid drugs similarly enhance diazepams cardiac and respiratory depressive effects.
Hypotension may occur. This may be significant if the patient has to be moved from a horizontal position to allow for extrication from and address. Caution should therefore be exercised and consideration given to either removing the patient flat or, if the convulsionhas stopped and it is considered safe, allowing a 10 minute recovery period prior to removal.
Light headedness.
Unsteadiness.
Drowsiness.
Confusion.
Amnesia.

Question 10

Glucagon

Answer 10

Indications:
Hypoglycaemia, clinically suspected hypoglycaemia or unconscious patients where hypoglycaemia is considered a likely cause (BM <4.0 millimoles per litre).

Should only be given when oral glucose administration is not possible or is ineffective AND/OR when IV access to administer 10% glucose is not possible.

Side-effects:
Nausea, vomiting.
Abdominal pain in adults
Diarrhoea in children.
Hypokalaemia.
Hypotension in adults.
Acute hypersensitivity reaction, although this is rare.

Question 11

Glucose 10%

Answer 11

Indications:
Hypoglycaemia or suspected hypoglycaemia when oral administration is not possible and a rapid improvement in clinical state and blood glucose level is required.
An unconscious patient, where hypoglycaemia is considered a likely cause.
Management of hypoglycaemia in patients who have not responded to the administration of IM glucagon after 10 minutes.

Side-effects: none listed in JRCalc

Question 12

Glucose 40% oral gel

Answer 12

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

Side-effects: none

Question 13

Glyceryl trinitrate(GTN)

Answer 13

Indications:
Cardiac chest pain due to angina or myocardial infarction, when systolic blood pressure is greater than 90mmHg.

Breathlessness due to pulmonary oedema in acute heart failure when systolic blood pressure is greater than 110mmHg.

Patients with suspected cocaine toxicity presenting with chest pain.

Side-effects:
Headache.
Dizziness.
Hypotension.

Question 14

Hydrocortisone

Answer 14

Indications:
Severe or life-threatening asthma (providing cannulation is easy and does not delay transport to hospital).

Anaphylaxis - only after adrenaline (if indicated) and chlorphenamine administrated.

Adrenal crisis (including Addison crisis).

1. Established adrenal crisis (intravenous route is preferable). Ensure hydrocortisone is administered as soon as possible.
2. Suspected adrenal insufficiency or unexplained collapse in steroid dependent patients (intramuscular route is sufficient and should not delay transport).

If there is any doubt about previous steroid administration, it is better to administer further hydrocortisone.
Hydrocortisone is not indicated in the management of exacerbations of COPD.

Question 15

Ibuprofen

Answer 15

Indications:
relief of mild to moderate pain.

Pyrexia with discomfort (may help to relieve the misery and often unpleasant symptoms that often accompany fibro illness, e.g. aches and pains).

Soft tissue injuries.

Best when used as part of a balanced analgesic regimen.

Side-effects:
Nausea
Vomiting
Tinnitus.

Question 16

Intravascular fluid therapy in adults

Answer 16

Staff should continue to aim for a systolic blood pressure of 100 to 110 mmHg In head injured patients requiring fluid resuscitation as per trust guidance. Remember the basics in this patient group, focus on good airway management, ventilation, haemorrhage control, splinting and rapid removal to definitive care (considering advanced clinical support at scene).

Haemorrhagic causes:
penetrating trunk trauma - SBP less than 60 mmHg AND signs of impaired major organ perfusion.

Penetrating head and limb trauma, blunt trauma or medical haemorrhage – SBP less than 90 mmHg and signs of impaired major organ perfusion.

Question 17

Ipratropium bromide

Answer 17

indications:
Acute severe or life-threatening asthma.

Acute asthma unresponsive to salbutamol.

Exacerbation of COPD, unresponsive to salbutamol.

SIDE-effects: 
Nausea. 
Dry mouth (common).
Tachycardia/arrhythmia. 
Paroxysmal tightness of the chest.
Allergic reaction.

Question 18

Midazolam

Answer 18

Indications:
Convulsion lasting five minutes or more AND still fitting OR three or more convulsions in an hour.
convulsion continuing 10 minutes after first dose of medication.

If midozalam is prescribed for the patient the clinician must follow the prescribers instructions for its administration. If a PGD is being used the document will state the clinical situation in which the medicine can be administered.

side-effects:
Respiratory depression.
Hypotension.
Reduced level of consciousness leading to impaired airway control.
Confusion leading to increased agitation.
Amnesia in some patients.

Question 19

Morphine sulphate

Answer 19

Indications:
Pain associated with suspected myocardial infarction (analgesic of first choice).

Severe pain as a component of a balanced analgesia regime.

The decision about which analgesias and which route should be guided by clinical judgement.

Side-effects: 
Respiratory depression. 
Cardiovascular depression. 
Nausea and vomiting. 
Drowsiness. 
Pupillary constriction.

Question 20

naloxone hydrocloride

Answer 20

Indications:

The reversal of acute opiate toxicity for respiratory arrest or respiratory depression.

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

In cardiac arrest, where opioid toxicity is considered to be the likely cause.

Patients exposed to high potency veterinary or anaesthetic preparations should be given naloxone urgently if: consciousness is impaired or exposure occurred within the last 10 minutes, even if asymptomatic.
OR
If an antidote is supplied with the opioid medication, such as diprenorphine or naloxone, it should be administered immediately.

side-effects:
in patients who are physically dependent on opioids, naloxone may precipitate violent withdrawal symptoms, including cardiac arrhythmias. It is better, in these cases, to titrate the dose of the naloxone as described in the dosing charts in this guideline to affectively reverse the cardiac and respiratory depression, but still leave the patient in a groggy state with regular reassessment of ventilation and circulation.

Vomiting is a common side effect following naloxone administration, insure access to suction.

Question 21

nitrous oxide

entonox

Answer 21

Indications:
moderate to severe pain.
Labour pains.

Side-effects:
minimal side-effects

Question 22

Ondansetron

Answer 22

indications:
adults:
prevention and treatment of opiate induced nausea and vomiting.
Treatment of nausea or vomiting.

Children:
prevention and treatment of opiate induced nausea and vomiting.
For travel associated nausea or vomiting.

Side-effects: Hiccups. Constipation. Flushing. Hypotension. Chest pain. Arrhythmias. Bradycardia. Headache. Seizures. Movement disorders. Injection site reactions.

Question 23

Oxygen

Answer 23

indications:
children:
significant illness and or injury.

Adults:
critical illnesses requiring high levels of supplemental oxygen.
Serious illnesses requiring moderate levels of supplemental oxygen if the patient is hypoxic.
COPD or other conditions requiring controlled or low-dose oxygen therapy.
Conditions for which patients should be monitored closely but oxygen therapy is not required unless the patient is hypoxaemic.

side/effects:
non-humidified O2 is drying and irritating to mucous membranes over a period of time.
In patients with COPD there is a risk that even moderately high doses of inspired oxygen can produce increased carbon dioxide levels which may cause respiratory depression and this may lead to respiratory arrest.

Question 24

paracetamol

Answer 24

indications:
oral:
relief of mild to moderate pain or high temperature with discomfort (not for high temperature alone).
intravenous:
as part of a balanced analgesic regimen for severe pain paracetamol is effective in reducing opioid requirements while improving analgesic when morphine is contraindicated.

side-effects:
side effects are extremely rare; occasionally IV paracetamol may cause hypotension if administered too rapidly.

Question 25

Salbutamol

Answer 25

Indications: acute asthma attack when normal inhaler therapy has failed to relieve symptoms.
Expiratory wheezing associated with allergy, anaphylaxis, smoke inhalation or other lower airway cause.
Exacerbation of COPD.

side-effects: 
Tremor. 
Tachycardia. 
Palpitations. 
Headache. 
Feeling of tension. 
Peripheral vasodilation. 
Muscle cramps. 
Rash.

Question 26

NaCl 0.9%

Sodium Chloride

Answer 26

INDICATIONS:

Adult fluids therapy: 
Medical conditions without haemorrhage. 
Medical conditions with haemorrhage. 
Trauma related haemorrhage. 
Burns. 
Limb crash injury.

Child fluid therapy:
Medical conditions.
Trauma related haemorrhage.
Burns.

Flush:
As a flush to confirm patency of an intravenous or intra osseous cannula.
As a flush following drug administration.

SIDE-EFFECTS:
Over infusion may precipitate pulmonary oedema and cause breathlessness.

Question 27

Syntometrine

Answer 27

indications:
postpartum haemorrhage within 24 hours of delivery of the infant where bleeding from the uterus is uncontrollable by uterine massage.
Miscarriage with life-threatening bleeding and they confirmed diagnosis (e.g. where a patient has gone home with medical management and starts to bleed).

Side-effects: 
nausea and vomiting. 
Abdominal pain. 
Headache. 
Hypertension and bradycardiac. 
Chest pain and, rarely, anaphylactic reactions.

Question 28

Tranexamic acid (EASTT Jan 2022)

Answer 28

Injured patients with traumatic injury were serious bleeding (significant internal/external haemorrhage) is suspected, within three hours of injury.

Patients aged over 18 years old with head injury and a GCS of 12 or less within three hours of injury.

Postpartum haemorrhage within three hours of delivery or onset and bleeding is estimated to be over 500 mL and continuing.

Haemorrhage due to disorders of obstetric origin e.g., anti-partum haemorrhage, suspected placental abruption.

SIDE-EFFECTS:
Common side-effects (more than one in 100 but less than one in 10): 
nausea. 
Vomiting. 
Diarrhoea.

Serious adverse affects (unknown rate of incident):
Hypersensitivity reactions including anaphylaxis have been reported.
Rapid injection may cause hypotension.
Arterial Venus embolism at any site.

Question 29

Ticagrelor

Answer 29

Indication: acute ST segment elevation myocardial infarction indicated for transfer to PPCI secondary to administration of aspirin.

Side effects: constipation, diarrhoea, dyspepsia, dyspnoea, gout, gouty arthritis, bleeding, headache, hyperuricaemia, hypotension, nausea, skin reactions, syncope, vertigo, angio-oedema, confusion, intercranial haemorrhage, tumour haemorrhage, thrombotic thrombocytopenic purpura.