Medications Flashcards
Adrenaline Presentation
1mg in 1ml
Adrenaline Introduction
A naturally occurring sympathomimetic agent
Causes:
- Peripheral Vasoconstriction
- Stimulation of cardiac conduction system —> increased contractions
- Bronchodilaton
- Dilation of muscle blood vessels
Adrenaline Onset
IV/IO: Onset 30 seconds, half-life 5 minutes, duration 5-10 minutes
IM: Onset 60 seconds, half-life 5 minutes, duration 5-10 minutes
Adrenaline Indications
- Anaphylaxis
- Life-threatening asthma
- Cardiac Arrest
- Post-ROSC
- Severe croup
Adrenaline Contraindications
Nil
Adrenaline Precautions/Notes
- Ischaemic Heart Disease
- Hypertension
- Hypovolaemia
- Do not walk patient pre or post IM adrenaline administration in anaphylaxis - usually min of 1 hour after 1x dose and 4 hours if >1 dose
- If given IV into a peripheral vein, follow each dose with a sodium chloride flush
Amiodarone Presentation
150mg in 3mL
Amiodarone Introduction
Primarily Class III antidysrhythmic agent
Prolongs action potential duration and hence refractory period of atrial, nodal and ventricular tissue
Has characteristics of all Vaughn-Williams classifications
Amiodarone Onset
Immediate onset
Peak <10 minutes
Duration 30-60 minutes
Amiodarone Indications
Cardiac Arrest with persistent/shock resistant VF/pulseless VT, post 3rd shock
Amiodarone Contraindications
No contraindications in cardiac arrest
Not compatible with Saline (if infusion dose is advocated by a specifically authorised person)
Amiodarone Precautions
- Heart Failure
- Thyroid dysfunction
- Amiodarone is only indicated for shock resistant or recurrent VF / pulseless VT
- MUST NOT be diluted into NaCl (e.g. if infusion doses are advised via ASMA / CSP)
Amiodarone Special Considerations
Bradycardia
Hypotension
Polymorphic tachycardias
Nausea
Tremor
Phlebitis
Dizziness
Paraesthesia
Headaches
Adrenaline Special Considerations
Tachyarrhythmias, palpitations
Hypertension
Pupil dilation
Tremor
Anxiety
Aspirin Presentation
300mg tablet
Aspirin Introduction
- Analgesic
- Antipyretic
- Anti-inflammatory
- Anti-platelet aggregation agent
Reduces mortality significantly in AMI by minimising platelet aggregation and thrombus formation to retard the progression of coronary artery thrombosis.
Aspirin Indications
Chest pain / discomfort of presumed cardiac origin
Aspirin Contraindications
Known hypersensitivity to aspirin / salicylates
Children < 16 years of age
Aspirin Precautions
Actively bleeding peptic ulcers
Suspected AAA
Aspirin / salicylate-sensitive asthmatics
Aspirin Special Considerations
- Heart burn, nausea, GI bleeding
- Increased bleeding time
- Anaphylactic reaction
(some patients, especially asthmatics) exhibit notable sensitivity to aspirin, which may provoke various hypersensitivity / allergic reactions)
Atropine Presentation
1.2mg in 1ml
Atropine Introduction
- Anticholinergic agent:
Inhibits acetylcholine at post-ganglionic nerves at neuroeffector site —> blocks vagal stimulation —> sympathetic response —> increase pulse rate by increasing SA node firing rate and increasing conduction velocity through the AV node - Antidote to reverse the effects of cholinesterase inhibitors eg organophosphate poisoning
Atropine Indications
- Symptomatic Bradycardia, haemodynamically unstable due to the bradycardia and associated with poor signs of perfusion, including:
- Hypotension
- Altered conscious state
- Diaphoresis
- Shortness of breath, and/or cyanosis
- Syncope - Organophosphate poisoning with cholinergic effects
Atropine Contraindications
Known hypersensitivity
Patients with cardiac transplant
Atropine Precautions
- May not be effective with 3rd degree heart block
- Isolated Bradycardia or link to traumatic cause is not an indication for atropine. All reversible causes should be addressed prior to consideration of Atropine.
- 12 lead ECG prior to rule out STEMI and 3rd degree
- Bradycardia in children is usually a result of hypoxia or vagal stimulation. Look at reversible causes
- May affect glaucoma
- Max effective dose is 3mg for bradycardia. For organophosphate repeat doses may be required and is achieved when with an increased HR, dilated pupils and decreased secretion, do not delay transport as atropinisation might not be achievable in the pre-hospital setting.
Atropine Special Considerations
Tachycardia and/or palpitations
Dilated pupils and/or blurred vision
Dry mouth and/or urinary retention
Confusion, restlessness (large doses)
Hot, dry skin (large doses)
Cophenylcaine Introduction
Topical pump spray containing:
Lignocaine hydrochloride 50mg/ml
Phenylephrine 5mg/ml
A topical local anaesthetic and haemorrhage control agent for the relief of surface pain, nasal and oral bleeding
Cophenylcaine Indications
Local pain: abrasions, small cuts and wounds
Relief of mild and moderate epistaxis
Post tonsillectomy haemorrhage
Intra-oral haemorrhage
Cophenylcaine Contraindications
Hypersensitivity to phenylephrine, lignocaine or other anaesthetics
Children <2yrs
Pregnancy
Cophenylcaine Precautions
Caution with cardiovascular, hepatic and/or renal disease.
For oral use, nozzle inserted within the anterior 1/3 of mouth to avoid gag stimulation.
Each spray delivers 100 microlitres of fluid. The dose of lignocaine in each squirt is 5 mg and the dose of phenylephrine in each squirt is 0.5mg
Cophenylcaine Special Considerations
Oral administration may cause a transient bitter taste.
Pause between subsequent doses.
Droperidol Presentation
10mg in 2ml
Droperidol Introduction
A neuroleptic, antipsychotic agent that acts on Alpha and Dopamine receptors, resulting in sedation
Use of a sedative agent should never be considered routine. Have a high threshold to offer or administer
Droperidol Onset
3-5 min IV and IM
Droperidol Indications
- Disturbed and Abnormal Behaviour (RASS 1 ~ 3) if considered appropriate where risk to safety is evident and de-escalation has not been effective.
- Dementia and frail patients where Olanzapine cannot be administered or is ineffective.
Droperidol Contraindications
- Known allergy
- Known Parkinson’s Disease
- Where Ketamine has been administered to sedate this episode
- Age < 6 years old
- Post-ictal Disturbed & Abnormal Behaviour
Droperidol Precautions
- Address organic causes for behavioural presentations at all times- eg. CVA, TBI, Hypoxia, Hypoglycaemia, etc
- Post-ROSC agitation - consult ASMA / SOC CSP
- Dementia patients – apply caution. Use lower doses
‘Agitated or Excited Delirium’, ‘Acute Behavioural Disturbance’ and ‘Drug Induced Psychosis’ are some alternative terms
Droperidol Special Considerations
- Extrapyramidal effects / Dyskinesia
- Increased falls risk
- Hypotension
- Apply monitoring as soon as practicable
Sedation Warnings
- Sedation is HIGH RISK – only after careful deliberation between officers and must not be based primarily at the request or influence of other agencies on scene (e.g. Police etc.)
- Positive RASS score does not automatically = need to sedate
- Age <16 years old – prior ASMA consult wherever practicable
- ETOH / Intoxication – apply caution
- Repeat & Maintenance doses – have low threshold to consult ASMA for repeat or maintenance doses
- SpO2 and EtCO2 monitoring whenever level of consciousness drops (~RASS -2 or below)
- DO NOT transport in supine position (increases risk of laryngospasm from secretions) – transport in lateral position
- Monitor airway and breathing effort closely for signs of impairment
- Restraint – Prone and/or handcuffed to rear carries excessive risk and MUST NOT occur. Physical restraint in any position that amplifies the risk of positional asphyxia, must be closely observed for signs of air hunger and hypoxia
- RASS scores must be agreed and documented
- Estimated weight must be agreed before administration and documented
Fentanyl Presentation
IN: 450mcg in 1.5ml
IV/IO: 100mcg in 2ml
Fentanyl Introduction
A short acting synthetic narcotic analgesic
Fentanyl Indications
Moderate to severe pain.
Acute Coronary Syndromes where GTN has been ineffective
Fentanyl Contraindications
Hypersensitivity
Child <1 year of age (IV / IO only)
Occluded nasal passages or epistaxis (IN only)
Fentanyl Precautions
- Elderly patients
- Respiratory depression: especially those at risk e.g. patients with severe COPD
- Patients currently on MAO inhibitors or MAO inhibitor use within previous 14 days
- Caution in larger doses of women in active labour
- Use of IV Ketamine as analgesic prior to minimum dose of IV Fentanyl requires ASMA authorisation:
Paediatric: 100 microg
Adult < 70 years old: 200 microg
Adult > 70 (or frail): 100 microg - Administer slowly
- Cease administration prior to calculated dose if desired effect is obtained.
- Patients under extended care (e.g. ‘ramped’ patients) who have already been administered pain relief should have careful consideration with regards to the dosages of fentanyl administered, titrating only to effect.
Fentanyl Special Considerations
- Adopt a low threshold to engage with the ED team if pain remains difficult to control
- Drowsiness
- Nausea/vomiting
- Respiratory depression; (monitor pulse oximetry)
- Cardiovascular effects:
Bradycardia
Hypotension (rare)
Glucagon Presentation
1mg in 1ml
Glucagon Introduction
A hyperglycaemic agent that converts stored liver glycogen to glucose to increase blood glucose concentration.
Glucagon Onset
4-7 minutes, duration 10-30 minutes.
Glucagon Indications
For demonstrated hypoglycaemia where oral glucose cannot be administered and IV access cannot be obtained in a safe and timely manner.
- Altered conscious state in a known diabetic or of otherwise unknown cause where blood glucose level is below 4mmol/L.
Glucagon Contraindications
Hypersensitivity
Known pheochromocytoma, insulinoma & glucagonma
Glucagon Precautions
- Only effective if sufficient liver glycogen is present (eg: it does not work on alcohol or anorexia induced hypoglycaemia).
- Even if fully recovered, encourage transport for follow up and review.
- Give complex carbohydrates orally when patient has responded to prevent recurrence
Glucagon Special Considerations
Nausea/vomiting
Gastric pain
Transient rise of blood pressure for patients taking beta blockers
Glucose (IV) Presentation
500ml bag 10% glucose
10g per 100ml
Glucose (IV) Introduction
- A hypertonic crystalloid solution that provides a readily available source of energy (glucose)
- Contains 100 mg glucose anhydrous/ml
Glucose (IV) Onset
1 minute
Glucose (IV) Indications
Demonstrated hypoglycaemia where oral glucose administration is inappropriate in:
- Altered conscious state in known diabetic or of otherwise unknown cause where blood glucose level is below 4 mmol/L. - Cardiac arrest, only if hypoglycaemia is suspected as a contributory cause of the arrest, not an early indication.
Glucose (IV) Contraindications
No IV access
Glucose (IV) Precautions
- Large gauge cannula into a large vein, with patency with free flowing bolus (>20 mL) of 0.9% normal saline, before administering glucose 10% using a 20 mL syringe via the injection port, titrated to effect.
- Administration via an IO should utilise a 20 mL syringe and a three way tap.
- High concentration of IV glucose may aggravate dehydration due to its hypertonicity whereby it draws water from the cells.
- IV glucose is corrosive and IV patency must be ensured before administration.
- Careful titration of glucose in head injured patients is vital as glucose leaking into CNS tissue will aggravate the injury, resulting in cerebral oedema.
- Monitor blood glucose level carefully; beware of drop in level again after the patient has recovered.
- Even if fully recovered, encourage transport
- IO administration is only as a last resort after all other avenues have been exhausted and the patient needs lifesaving glucose.
- Do not wait on scene for glucose to take effect.
- Note that repeat doses of Glucose 10% (Intravenous) may be needed achieve normoglycaemia
Glucose (IV) Special Considerations
Hyperglycaemia
Diuresis
Tissue necrosis
Thrombophlebitis
Glucose Oral Gel Presentation
15g tube
Glucose Oral Gel Introduction
Rapidly absorbed from oral/buccal mucosa to increase blood glucose concentration
Contains 15g glucose
Glucose Oral Gel Onset
2-5 minutes; duration 12-25 minutes
Glucose Oral Gel Indications
Demonstrated hypoglycaemia in:
- Altered conscious state in a known diabetic.
- Altered conscious state of unknown medical cause, where blood glucose level is below 4 mmol/L.
Glucose Oral Gel Contraindications
Nil
Glucose Oral Gel Precautions
- Airway patent and in lateral position if unconscious.
- Always consider airway when administering gel.
- Even if fully recovered, encourage to be transported to a medical facility to ensure effective follow up and review.
- Will liquefy over 30°C, however it is still useable.
Glucose Oral Gel Special Considerations
Airway Obstruction
GTN Presentation
400mcg per spray
GTN Introduction
Nitrates cause the relaxation of vascular smooth muscle resulting in:
- Vasodilation
- Peripheral pooling and reduced venous return
- Reduced left ventricular end diastolic pressure (preload)
- Reduced systemic vascular resistance (afterload)
- Reduced myocardial energy and oxygen requirements
- Relaxes spasm of coronary arteries
GTN Indications
- Chest pain/discomfort of presumed cardiac origin not relieved by rest and reassurance with systolic BP > 90 mmHg.
- Acute Cardiac Pulmonary Oedema with systolic BP >90 mmHg.
- Autonomic Dysreflexia with systolic BP > 160 mmHg.
GTN Contraindications
- Hypersensitivity
- Hypotension < 90 mmHg
- Recent use of medications used for erectile dysfunction:
Sildenafil (Viagra®) or Vardenafil (Levitra®) or Avanafil (Spedra®) use in the previous 24 hours
Tadalafil (Cialis®) use in the previous 3 days
GTN Precautions
- Nitrates = early intervention, do not delay
- Administer in seated or semi-recumbent position
- Do not shake GTN bottle prior to administration
- Assess BP before every dose
- Severe hypotension is an uncommon side effect
- Intoxication (effect are enhanced)
- Phosphodiesterase 5 inhibitor medication administration in previous 4 days
GTN Special Considerations
Hypotension (rare)
Tachycardia
Flushing
Headache
Dizziness
- when GTN infusion used for ACPO, hypotension side effects amplified
Heparin Sodium Presentation
5000IU in 5mL
Heparin Introduction
A naturally occurring anticoagulant which inhibits the clotting of blood by increasing the rate at which antithrombin III neutralises thrombin and activated factor X (Xa)
Heparin Onset
IV: Immediate
Heparin Indications
Patients with STEMI going directly to Cardiac Catheterisation Laboratory as per receiving hospital 12-lead ECG interpretation
Heparin Contraindications
- Hypersensitivity to Heparin
- Active bleeding (excluding menses) or disease states with an increased risk of bleeding (e.g. haemophilia)
Heparin Precautions
Haemorrhagic risks in case of possible trauma
Heparin Special Considerations
Haemorrhage
Hyperkalaemia
Thrombocytopenia
Intravenous Crystalloid Solutions (Normal Saline) Presentation
0.9% in 250ml or 1000ml
10ml flush
Normal Saline Introduction
A sterile isotonic crystalloid solution
Normal Saline Indications
Fluid replacement (volume expansion) for the treatment of shock, fluid loss, and cardiac arrest.
Normal Saline Contraindications
Severe pulmonary oedema
Normal Saline Precautions
Adult patients with penetrating trauma, ectopic pregnancy or aortic aneurysm with hypotension and signs of impaired organ perfusion may benefit from permissive hypotension (systolic blood pressure of 70mmHg)
Normal Saline Special Considerations
Hypervolemia
Ipratropium Bromide Presentation
250mcg in 1ml
20mcg per puff MDI
Ipratropium Bromide Introduction
- An anticholinergic bronchodilator. It inhibits the vagal reflexes that mediate bronchospasm
- Combined with a nebulised short-acting beta-2 agonist (e.g. salbutamol), ipratropium bromide produces significantly greater bronchodilation than a short-acting beta-2 agonist alone
Ipratropium Bromide Indications
Severe bronchospasm:
- Adult: Severe to life-threatening asthma or COPD
- Paediatric: Severe to life-threatening asthma
Ipratropium Bromide Contraindications
Hypersensitivity
Ipratropium Bromide Precautions
- Glaucoma
- Avoid contact with eyes
Ipratropium Bromide Special Considerations
Headache
Nausea, dizziness
Dry mouth, throat irritation
Taste disturbance
Skin rash
Ketamine Presentation
200mg in 2ml
Ketamine Introduction
Rapid acting dissociative anaesthetic
Use of a sedative agent should never be considered routine. Have a high threshold to offer or administer
Ketamine Onset
IM: 5-10 minutes
IV: 1 minute
Ketamine Indications
- IV: Second line agent for severe pain of traumatic origin post IV Fentanyl administration. ASMA consult needed if IV Fentanyl minimum dose (age dependent as per CPG) has not been given prior to IV Ketamine administration
- IM: First line agent for severe pain of traumatic origin should other means of administering pain medication not be available
- Combative Traumatic Brain Injury
- (RASS 4) First line agent for severely disturbed or abnormal behaviour where there is an immediate risk to safety and rapid tranquilisation is required and no other sedative medications have already been administered to this patient
Ketamine Contraindications
- Hypersensitivity
- Active cardiovascular disease including cardiac chest pain, heart failure, severe or poorly controlled hypertension
- Patients with delayed transfer of care (i.e. ‘ramped’)
- Disturbed and abnormal behaviour that are clearly not RASS 4 or where other sedative agents have already been administered (ASMA authority required)
- Rapid Tranquilsation ONLY: Age < 16 years old
- Age < 1 years old
Ketamine Precautions
- Stable psychiatric disorders such as Schizophrenia
- Hyperthyroidism or receiving thyroid replacement due to increased risk of hypertension and tachycardia
- Analgesia – IV Fentanyl minimum dose (age dependant as per CPG) should be given prior to IV Ketamine administration
- Analgesia for Non traumatic pain (IM / IV / IO) in opioid-dependent patients – consider SOC CSP consult
- Sedation warnings
Ketamine Special Considerations
Blood pressure and pulse frequently elevated
Random purposeless movements, muscle twitching and rash are common
Hypersalivation
Emergence reactions (10%)
Transient laryngospasm
Transient apnoea or respiratory depression
Lignocaine Presentation
20mg in 2ml OR 50mg in 5ml
Lignocaine Onset
1-2 minutes
Lignocaine Introduction
Reversibly interrupt impulse conduction in peripheral nerves and stabilise excitable cell membranes by blocking Sodium Channels
Lignocaine Indications
Local anaesthesia for:
- IV cannulation
- IO infusion
- Suturing
- Finger thoracostomy in the conscious patient
Lignocaine Contraindications
Hypersensitivity
Lignocaine Precautions
Adverse drug reactions are rare when lignocaine is used as a local anaesthetic and is administered correctly.
Lignocaine Special Considerations
- Tinnitus, dizziness, anxiety, confusion, perioral numbness
- Cardiovascular effects: Bradycardia, hypotension, dysrhythmias
- CNS effects
- Respiratory depression
Methoxyflurane Presentation
3mL ampoule
Methoxyflurane Introduction
A halogenated ether that produces powerful modification of the awareness of pain with an associated light headed sensation.
Methoxyflurane Onset
6-8 breaths, 1-2 minutes, peak 2-4 minutes
Methoxyflurane Indications
Pain
Methoxyflurane Contraindications
Patients who are unable to understand or co-operate.
Patients with severe renal impairment.
Patients with head injury and altered consciousness that prevents co-operation with its use.
Hypersensitivity e.g. malignant hyperthermia
Methoxyflurane Precautions
- Use charcoal filter
- Use extractor fan during transit
- Instruct the patient to breathe in through their mouth and out through their mouth via the inhaler. For maximum effect cover the air dilutor hole.
- Initial breath is strong and may cause the patient to cough, so advise to take gently
- Watch for drowsiness
- If oxygen is required deliver separately
- Place in a sealed plastic bag when not in use
Methoxyflurane Special Considerations
Lightheaded
Dizziness
Drowsy
Nausea
Malignant hyperthermia
Midazolam Presentation
15mg in 3ml
Midazolam Introduction
A water-soluble benzodiazepine that has anxiolytic, sedative and anticonvulsive characteristics. This is due to its bonding with receptors in the CNS; its action to increase the inhibitory effect of the g-aminobutyric acid (GABA) neurotransmitter on the GABA receptors and subsequent membrane threshold.
- Midazolam is lipid-soluble in physiological pH and it reaches the CNS quickly.
- Use of a sedative agent should never be considered routine. Have a high threshold to offer or administer.
Midazolam Indications
- Prolonged seizure activity - generalised seizure lasting ≥ 5 minutes OR recurrent / status seizure activity as per CPG
- Focal seizure activity which is prolonged (≥ 5 minutes) and is associated with a GCS ≤ 12 as per CPG
- Second-line IV agent for maintenance of sedation after Droperidol administration for Disturbed and/or Abnormal Behaviour
Midazolam Contraindications
Hypersensitivity
Use of Midazolam for sedation after Ketamine requires ASMA authority
Midazolam Precautions
- Early monitoring as soon as practicable is required when administering midazolam; including SpO2, respiratory rate, pulse and blood pressure
- SpO2 and EtCO2 monitoring must be applied whenever level of consciousness drops consistent with the Sedative Warnings section.
- Psychostimulants, in toxic levels can produce severe agitation and psychotic behaviour
- Paediatric patients:
Intramuscular administrations should always be prepared in a 1mL IM syringe
Have a low threshold to consult with ASMA when repeat or maintenance doses are required for sedation
Midazolam Special Considerations
Respiratory depression
Hypotension
Anterograde and retrograde amnesia
Myasthenia Gravis
Naloxone Presentation
0.4mg in 1ml
Naloxone Introduction
A pure opioid antagonist; exerts effect by competitive inhibition at the opioid receptor sites.
Prevents or reverses the effects of opioids, including: respiratory depression sedation and hypotension.
In the absence of opioids, it exhibits essentially no pharmacological activity.
Naloxone Indications
Reversal of respiratory depression in a suspected narcotic overdose
Naloxone Contraindications
Hypersensitivity
Naloxone Precautions
- Polypharmacy overdose.
- Half-life of naloxone is < 1 hour; repeat doses may be required to maintain effect with longer acting opioids and those with active metabolites (e.g. methadone, diphenoxylate, codeine). Observe patients who respond to naloxone for 2-3 hours after administration for signs of re-narcotisation.
- Response to Naloxone is rapid; reconsider diagnosis if there is a failure to respond to 2 mg Naloxone.
- Patients may be aggressive post Naloxone and administration due to hypoxia. Scene safety and personal safety are paramount.
Naloxone Special Considerations
Withdrawal symptoms such as:
Aggression
Agitation
Nausea/vomiting
Dilated pupils and lacrimation
THN - max dose is 3.6mg, attempt to convince to transport to hospital, if not leave them with THN, document if given, only give to SJA patients
Olanzapine Presentation
5mg tablet
Olanzapine Introduction
A second generation antipsychotic agent that acts on multiple receptors (incl. serotonin and dopamine receptors), resulting in sedation
Use of a sedative agent should never be considered routine. Have a high threshold to offer or administer.
Olanzapine Onset
~10 minutes
Olanzapine Indications
- Disturbed and Abnormal Behaviour (RASS 1 ~ 3) if considered appropriate where risk to safety is evident and de-escalation has not been effective
- Patient is able to tolerate or self-administer an oral wafer
- Preferred first line sedation agent in frail patients and those with Dementia
Olanzapine Contraindications
Known Allergy
Known Parkinsons Disease
Age < 6 years old
Olanzapine Precautions
- Address organic causes for behavioural presentations at all times- eg. CVA, TBI, Hypoxia, Hypoglycaemia, etc
- Dementia patients – apply caution. Use lower doses
- Oral dispersible tablet may be dissolved in water (may slightly delay onset of action but still preferable in non-emergent cases)
- ‘Agitated or Excited Delirium’, ‘Acute Behavioural Disturbance’ and ‘Drug Induced Psychosis’ are some alternative terms that may be used by other agencies
Olanzapine Special Considerations
Extrapyramidal effects / Dyskinesia
Increased falls risk
Hypotension – Apply monitoring as soon as practicable
Ondansetron Presentation
4mg in 2ml
4mg wafer
Ondanestron Introduction
- Anti-nauseant and anti-emetic
- Selective 5-HT3 receptor antagonist blocking serotonin centrally in the chemoreceptor trigger zone and peripherally on Vagus nerve terminals.
Ondansetron Onset
Up to 30 minutes
Ondansetron Indications
Moderate to severe nausea
Active vomiting
Prophylaxis for eye and spinal injuries
Ondansetron Contraindications
Paediatrics <2 years old
Hypersensitivity
Ondansetron Precautions
- Oral wafer is the preferred method of administration for ALL patients unless actively vomiting.
- Administer IV Ondansetron slowly over 2 minutes (neat or diluted) to prevent blurred vision and dizziness.
Ondansetron Special Considerations
Headache
Malaise/fatigue
Drowsiness
Dizziness
Rash/allergic reaction
Oxygen Introduction
Oxygen is a treatment for hypoxaemia and has not been shown to have any effect on breathlessness in non-hypoxaemic patients.
Oxygen Indications
Adult:
- Oxygen should be titrated to achieve oxygen saturations of between 94 – 98%, (or 88 – 92% for COPD patients). These are achieved through the use of different flow rates and oxygen masks.
Paediatric:
- All paediatric patients with significant illness or injury should receive oxygen. Newborn resuscitation should ideally be commenced with room air for the first couple of breaths.
Oxygen Contraindications
Explosive or flammable environments
Normoxia
Oxygen Precautions
- If the target saturations cannot be maintained with the nasal cannula or medium concentration mask then change to a non-rebreather oxygen mask.
- Oxygen increases the toxicity in paraquat poisoning, target saturations of 88–92%.
- Remember that some conditions can affect SpO2 readings e.g. carbon monoxide poisoning and cold digits
Oxygen Special Considerations
- Patients with acute episodes of COPD are at risk of developing carbon dioxide retention if they are given excessive supplemental oxygen. This can cause acidosis and subsequent organ dysfunction.
- High oxygen concentrations can lead to increased production of reactive free radicals resulting in cellular damage. This may be responsible for the detrimental effects observed with the use of high flow oxygen in myocardial infarction and stroke.
Paracetamol Presentation
500mg tablet
Paracetamol Introduction
A p-aminophenol derivative that exhibits analgesic and antipyretic activity.
Paracetamol Onset
≥ 30 minutes
Paracetamol Indications
Mild to moderate pain
- For example, headache, sprain/strain, toothache, etc.
- As a component of a multimodal analgesic regime.
Paracetamol Contraindications
- Known hypersensitivity to Paracetamol.
- Do not give if patient has had Paracetamol in the preceding 4 hours.
- Cannot exceed the maximum allowed single dose or exceed the maximum allowed paracetamol daily dose (24hrs).
Paracetamol Precautions
- There is no evidence that fever itself worsens the course of an illness. The primary goal should be to improve overall comfort
- SJA do not support the use of paracetamol in infants < 6 months.
- 100mg/mL suspension bottle (20 mL) Paracetamol suspension bottle is single patient use only.
Only used enteral syringe/dropper with suspension
Paracetamol Special Considerations
Nil known at therapeutic doses
Prednisolone Presentation
25mg in 5ml
Prednisolone Introduction
Redipred Oral 30ml elixir for oral administration
A steroid that prevents the release of inflammatory mediators
Prednisolone Onset
Peak effect 1 hour
Prednisolone Indications
- Mild / Moderate croup
- Severe croup after nebulised Adrenaline administration
Prednisolone Contraindications
Known hypersensitivity to corticosteroids
Live virus immunisation within last 48 hours (e.g. MMR, Chicken Pox, Yellow Fever)
Prednisolone Precautions
- 30ml Bottle is single patient use only
- Children who are on immunosuppressant drugs are more susceptible to infections than healthy children, e.g.: Chicken pox and measles
- Impaired immune responsiveness
Prednisolone Special Considerations
- Side effects occur following prolonged use and are of little consequence in an emergency setting
- Vomiting
Salbutamol Presentation
5mg in 2.5ml
100mcg per puff
Salbutamol Introduction
Short acting Beta 2 agonist that causes relaxation of bronchial smooth muscle (bronchodilation).
Salbutamol Onset
2-5 minutes, maximum by 10 minutes.
Salbutamol Indications
Bronchospasm and respiratory distress associated with wheeze:
- Acute Bronchial Asthma
- Bronchitis
- Smoke inhalation
- Severe allergic / anaphylactic reactions
- Acute Pulmonary Oedema of non-cardiac origin
- Salt Water Aspiration Syndrome (SCUBA divers)
- Chronic Obstructive Pulmonary Disease (COPD)
Salbutamol Contraindications
Known hypersensitivity to salbutamol
Cardiogenic pulmonary oedema
Age <12 months
Salbutamol Precautions
- A spacer / MDI is the preferred route for influenza like illness.
- MDI and spacer is equally as effective as nebulisation, in all asthma situations, where patient is still able to adequately inhale.
- Use of a nebuliser is recommended where the patient loses this ability.
- If hypoxic, nebulise salbutamol in preference to MDI, to address both hypoxia and bronchospasm. The nebulised route also makes it possible to administer Ipratropium Bromide simultaneously.
Salbutamol Special Considerations
Muscle tremor
Tachycardia, palpitations
Headache
Tranexamic Acid Presentation
1mg in 10ml
Tranexamic Acid Introduction
- Antifibrinolytic
- A synthetic derivative of the amino acid lysine that inhibits fibrinolysis (clot breakdown) by blocking the lysine binding site on plasminogen, competitively inhibiting the activation of plasminogen to plasmin.
- Hepatic metabolism with renal excretion.
Tranexamic Acid Onset
Within minutes
Duration 17 hours, half-life 3 hours
Tranexamic Acid Indications
- Significant trauma (< 3 hours) with signs of hypovolaemia or
- Significant active haemorrhage that requires the use of :
- Tourniquet/s
- Haemostatic/pressure dressing/s
- Suspected head injury (< 3hours) with GCS motor score of 4 (withdrawing from pain) or below
- Severe Primary or Secondary Post-Partum Haemorrhage (> 1000 mL) or PPH with signs of hypovolaemia (birth/bleed occurred < 3hrs)
- Significant post-tonsillectomy haemorrhage
Tranexamic Acid Contraindications
- Known hypersensitivity to Tranexamic Acid.
- Injury time more than 3 hours (associated with increase in mortality).
Tranexamic Acid Precautions
- TXA administration in the traumatic patient in the metropolitan area should ordinarily prompt transport to a major trauma centre
- Rapid administration may lead to hypotension and dizziness.
- No medications or blood products (except 0.9% Sodium Chloride Solution) should be added or co-administered through the same giving set.
- Give as early as possible post event. Survival benefit is reduced by 10% for every fifteen minute delay with no benefit seen after 3 hours
- Address critical interventions (airway management, control of major haemorrhage etc.) before administration of tranexamic acid.
- Tranexamic acid administration should not delay transfer, noting it may be administered en route.
- Slow IV push is the first line management option. TXA can be given via an infusion, however, familiarity in using infusions and availability of an appropriate label to identify the infusion should dictate if this option is utilised.
- Safety during pregnancy has not been demonstrated, but the balance of risk is such that it should be administered if the indications are met in life threatening circumstances
Tranexamic Acid Special Considerations
Hypotension (fast infusion rate)
Headache
Dizziness
Convulsions (lowers seizure threshold)
Nausea and/or vomiting
Diarrhoea
