Medication Doses

Question 1

Amiodarone - Cardiac Arrest

Answer 1

300mg after the 3rd shock

150mg after the 5th shock

Question 2

CPR Interfering patient

Answer 2

Fentanyl 100mcg 1-2min (no max)
If fentanyl ineffective: 
Ketamine 50-100mg 1-2min (no max)
If no IV access:
Fentanyl 200mcg or Ketamine 200mg IM

Question 3

RSI - standard

Answer 3

Ketamine 1.5mg/kg (max 200mg)
If GCS >10 Midaz 5mg IV
Rocuronium 1mg/kg (max 100mg)

Question 4

RSI - modified (ketamine contraindicated)

Answer 4

Fentanyl 100-200mcg
Midaz 5-10mg IV
Rocuronium 1mg/kg (max 100mg)

(If serotonin syndrome use a morph/midaz combination)

Question 5

Narrow complex tachycardia (stable BP <90)

Answer 5

If BP < 90 or no reversion with valsalva

Adenosine 6mg - if no reversion after 2/60
Adenosine 12mg repeat once after 2/60

Question 6

Narrow complex tachycardia (unstable - deteriorating rapidly)

Answer 6

Synchronised Cardioversion
Midaz 1-2mg
Fentanyl 50mcg

Cardioversion 150J repeat x 1
If unsuccessful change to anterior posterior and DCCS 200J

Question 7

Wide complex tachycardia - stable

Answer 7

Amiodarone 5mg/kg (max 300mg) over 20/60 single dose

Question 8

Wide complex tachycardia - unstable

Answer 8

Synchronised cardioversion

Midaz 1-2mg
Fentanyl 50mcg

DCCS 150J repeat x 1
If unsuccessful anterior/posterior position DCCS 200J

If successful or unsuccessful continue to run the amiodarone infusion

Question 9

Inadequate Perfusion (cardiogenic) - no crackles

Answer 9

N/Saline 250ml IV repeat as required.

Question 10

Inadequate Perfusion (cardiogenic) crackles or ext poor perfusion

Answer 10

Adrenaline Infusion
- commence @ 5mcg/min (5ml/hr) titration to achieve SBP 100mmHg (max 250mcg)

If no syringe pump.
- Adrenaline 10mcg IV @ 2/60

Question 11

STEMI

Answer 11

Heparin 4000units. Repeat 1000units at 1hour

Tenectaplase

• <60kg 30mg 6000units 6ml
• 60-69kg 35mg 7000units 7mls
• 70-79kg 40mg 8000units 8mls
• 80-89kg 45mg 9000units 9mls
• 90-99kg 50mg 10000units 10mls

Question 12

Morphine - pain relief

Answer 12

IV - Up to 5mg max 20mg

IM - 10mg repeat 5mg after 15min or frail/<60kg 0.1mg/kg no repeat.

Question 13

Fentanyl - pain relief

Answer 13

IV - up to 50mcg max 200mcg
IN - 200mcg repeat 50mcg til 400mcg. If elderly/frail/<60kg 100mcg repeat 50mcg max 200mcg
IM - 100mcg repeat 50mcg after 15min or 1mcg/kg no repeat.

Question 14

Ketamine - pain relief

Answer 14

IV - 10-20mg at 5-10min. Procedural pain relief 20-30mg at 2min until dissociation
Infusion - 0.1-0.3mg/kg/hr

IN - 75mg repeat 50mg at 20min no max or
- if frail/<60kg/elderly 50mg repeat 25mg at 20min no max

Question 15

Headache

Answer 15

Prochlorperazine 12.5mg.
Paracetamol 1g
Fentanyl if pain >7 and still 15min away from hospital

Question 16

Bradycardia - unstable

Answer 16

Atropine 600mcg
Atropine 1200mcg @ 3-5min if inadequate response.

Continue 600mcg if adequate response 3-5min as required max 3mg

Question 17

Asthma - Mild/Mod

Answer 17

Salbutamol pMDI 4-12 doses at 20min intervals. 4 breaths between each puff

Question 18

Asthma - severe

Answer 18

Salbutamol 10mg (5ml) repeat at 5min 5mg (2.5ml)
Ipratropium Bromide 500mcg once
Dexamethasone 8mg IV/oral

Question 19

Asthma - Inadequate response to severe management

Answer 19

Adrenaline 500mcg IM repeat at 5-10min (max 1.5mg)

IV adrenaline if no response to IM or thunderstorm asthma consult
20mcg at 2min.

MICA
If no response to IM
50-100mcg IV at 2-5min if infusion not available or whilst infusion being set up

Infusion 2-15mcg/min (2-15ml/hr)

Question 20

COPD

Answer 20

Salbutamol 10mg repeat 5mg at 5min
Ipratropium Bromide 500mcg
Dexamethasone 8mg

MICA
Severe resp distress and RR >24
CPAP @ 7.5cm H20 increase to 10cm if nil improvement

Question 21

Upper Airway Obstruction

Answer 21

5 back blows moving to 5 chest thrust repeat.

Unconscious manually remove obstruction. Commence chest compressions if unable to remove.

Question 22

Upper Airway Obstruction - all other stridor

Answer 22

Adrenaline 5mg Nebulised. Consult for further

Dexamethasone 8mg IV/IM

Question 23

Nausea and Vomiting - Adult

Answer 23

Ondasertron 8mg IV or 4mg oral. Repeat 4mg once after 10min.

IM can be administered using 4mg. If severe a further 4mg can be given.

The preferred treatment for N+V in pregnant patients with signs of dehydration is fluid rehydration

Question 24

Hypoglycaemia

Answer 24

Responding to commands:
- 15g oral glucose (max 30g)

Not responding to commands or glucose ineffective:

• Dextrose 10% 15g (150ml) IV 10ml N/Saline flush before and after.
• After 5-10min no return to normal further 10g (100ml) titration to effect.
• If IV unable IM glucagon 1IU.

Question 25

Hyperglycaemia

Answer 25

N/Saline 20ml/kg IV titration to perfusion. | Consider antiemetic.

Question 26

Seizures - adult

Answer 26

- Midazolam 10mg IM repeat 10mg after 10min - Elderly/frail/<60kg Midaz 5mg repeat 5mg after 5min - IV Midaz 5mg - Elderly/Frail/<60kg 2mg No response after 5min - 2-5mg IV repeat after 2-5min (Max 30mg with IM+IV) - elderly/frail/<60kg 2mg IV repeat at 2-5min - Consult for further - Endotracheal intubation if no improvement

Question 27

Anaphylaxis - Adult

Answer 27

Adrenaline 500mcg IM repeat @ 5/60 Oxygen 15lt NRB - Stridor Adrenaline 5mg nebulised consult for further - Bronchospasm Salbutamol 5mg neb or pMDI 4-12 repeat at 20min. Ipratropium bromide 500mcg. Dexamethasone 8mg IV/oral - BP <90 N/Saline 20ml/kg (max 40ml/kg) - Inadequate response with hx of heart failure or taking beta blockers Glucagon 1mg IV/IM repeat once at 5min Inadequate response after 2 doses of IM Adrenaline infusion 5mcg/min increase 5mcg @ 2/60 Extremely poor perfusion or impending cardiac arrest Adrenaline 10mcg at 2/60. Or if poor response Adrenaline 50-100mcg IV as required

Question 28

Inadequate Perfusion (non-cardiogenic/Non-hypovolaemic)

Answer 28

Inadequate or extremely poor perfusion and chest clear: - N/Saline 20ml/kg over 30min No change: - Adrenaline infusion 5mcg/min (5ml/hr) increase 5mcg @ 2/60 - If no infusion available 10mcg @ 2/60 - If poor response 50-100mcg as required.

Question 29

Meningococcal Septicaemia - Adult

Answer 29

1g Ceftriaxone IV dilute with 9.5ml water administered over 2min IM dilute with 3.5ml lidocaine into upper lateral thigh.

Question 30

Heroin OD - Adult

Answer 30

Naloxone 1-6mg-2mg IM single dose only

Question 31

Opioid OD other

Answer 31

Naloxone 100mcg IV. Repeat every 2/60 until pt self ventilating (max 2mg) Draw up into 5ml syringe with 3ml N/saline = 100mcg/ml If no IV 400mcg IM single dose.

Question 32

TCA OD

Answer 32

Sodium Bicarbonate 8.4% 100ml IV given over 3/60. Repeat 100ml after 10/60. Consult for further. Consider ETT if pt GCS<10 after mx RR - 20-24 Fi02 - 100% ETC02 - 20-25mmHg A more alkaline environment will de-activate the medication.