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medicines Flashcards

1
Q

All medicines administered must be documented, including:

A

a) The time, dose and route of administration.
b) The infusion rate, infusion concentration and total dose/volume
administered, if an infusion is used.

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2
Q

indications of adenosine

A

Patients aged greater than or equal to 12 years with SVT and a ventricular rate greater than or equal to 150/minute, and
ū Causing moderate cardiovascular compromise, or
ū Known to be responsive to adenosine.

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3
Q

adrenaline mechanism of action

A
  • Adrenaline stimulates alpha and beta receptors, with the predominant effects occurring at alpha 1, beta 1 and beta 2 receptors.
  • Alpha 1 stimulation causes smooth muscle contraction, vasoconstriction of blood vessels and stimulation of glycogenolysis and gluconeogenesis.
  • Beta 1 stimulation causes an increase in inotropy (cardiac contractility), an increase in chronotropy (heart rate) and an increase in dromotropy (speed of electrical conduction within the heart).
  • Beta 2 stimulation causes smooth muscle relaxation, skeletal muscle vasodilation, bronchodilation, and stabilisation of mast cell membranes, reducing histamine release.
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4
Q

indications of adrenaline

A

 Cardiac arrest.
 Anaphylaxis.
 Severe asthma.
 Imminent respiratory arrest from COPD.
 Severe bradycardia.
 Blood pressure support if unresponsive to metaraminol.
 Septic shock, cardiogenic shock and neurogenic shock unresponsive to
0.9% sodium chloride IV and metaraminol IV.
 Moderate to severe stridor.
 IN for clinically significant epistaxis.
 Topical for clinically significant bleeding from a wound.

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5
Q

cautions for adrenaline

A

^ ^
448
Myocardial ischaemia. Adrenaline will increase myocardial oxygen consumption.
Tachydysrhythmias. Adrenaline will usually make tachydysrhythmias wors

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6
Q

topical use of adrenaline

A

Topical: dilute each mg of adrenaline to a total of 10 ml using 0.9% sodium chloride. This solution is 1:10,000 and contains 0.1 mg/ml. Apply topically in addition to direct pressure.

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7
Q

IN administered of adrenaline dose

A

dilute each mg of adrenaline to a total of 10 ml using 0.9% sodium chloride. This solution is 1:10,000 and contains 0.1 mg/ml. Administer the appropriate dose into each bleeding nostril using a mucosal atomising device, in addition to direct pressure.

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8
Q

Neb adrenaline administration

A

administer undiluted.

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9
Q

IM admisnteration of adrenaline

A

undiluted. The preferred IM site is the lateral thigh. If this site is not suitable use the lateral upper arm.

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10
Q

dosage of adrenaline in cardiac arrest

A

a) 1mg IVAdults and children whose weight has been rounded to 50 kg or more: administer undiluted as an IV bolus.
b) Children whose weight has been rounded to 40 kg or less: dilute 1 mg of adrenaline to a total of 10 ml using 0.9% sodium chloride. This solution is 1:10,000 and contains 0.1 mg/ml. Draw up the dose from this solution and administer as an IV bolus.

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11
Q

IV infusion of adrenaline

A

place 1 mg of adrenaline into a 1 litre bag of 0.9% sodium chloride. Shake well and label. This solution is 1:1,000,000 and contains 0.001 mg/ml.
a) For an adult: administer as an IV infusion starting at 2 drops/second. Adjust the rate to the patient’s condition.
b) For a child aged 5-14 years: administer as an IV infusion starting at 1 drop/ second. Adjust the rate to the patient’s condition.

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12
Q

adverse affects of adrenaline

A
  • Tachycardia.
  • Tachydysrhythmia.
  • Myocardial ischaemia.
  • Ventricular ectopy.
  • Hypertension.
  • Nausea and vomiting.
  • Tremor, anxiety and sweating.
  • Hyperglycaemia.
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13
Q

onset of adrenaline

A
  • IV: 5-10 seconds.
  • IM: 2-5 minutes.
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14
Q

usual duration of adrenaline

A

The cardiovascular effects last 5-15 minutes.
* The mast cell membrane effects may last for several hours.

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15
Q

amieodarone mechanism of action

A
  • Amiodarone is an antidysrhythmic with a broad spectrum of activity.
  • Amiodarone has predominantly class III activity. It prolongs the action potential duration, reduces automaticity and prolongs the refractory period of atrial, nodal and ventricular tissues.
  • The electrophysiological effects result in a reduction in abnormal electrical activity (for example ectopy), a reduction in electrical conduction, a reduction in heart rate and a stabilisation of the SA and AV nodes.
  • Amiodarone also causes a small increase in coronary blood flow (although this is not usually clinically significant) and a reduction in myocardial oxygen consumption by reducing inotropy (the force of cardiac contraction).
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16
Q

indications of amiodarone

A

 Cardiac arrest with VF or VT at any time after the first dose of adrenaline.
 Adults with sustained VT in the absence of cardiac arrest.
 Adults with moderate cardiovascular compromise as a result of fast atrial fibrillation or fast atrial flutter.

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17
Q

contraindicatons to amiodarone

A

Known severe allergy.
Known severe allergy to iodine.
VT secondary to cyclic antidepressant poisoning. In this setting amiodarone administration can be associated with severe worsening of shock, without resolution of the rhythm.

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18
Q

cautions with amiodarone

A

^ None if the patient is in cardiac arrest.
^ Poor perfusion or signs of low cardiac output. Amiodarone reduces inotropy and may cause a significant fall in cardiac output, particularly when administered rapidly.
^ Hypotension. Amiodarone causes vasodilation and may worsen hypotension, particularly when administered rapidly.
^ Atrial fibrillation associated with sepsis. Amiodarone may cause a significant fall in cardiac output.^ Known sick sinus syndrome without an internal pacemaker in place. Amiodarone slows the heart rate and severe bradycardia may occur following reversion of a tachydysrhythmia.
^ Previous 2nd or 3rd degree heart block without an internal pacemaker in place. Amiodarone slows the heart rate and severe bradycardia may occur following reversion of a tachydysrhythmia.
^ Pregnancy.

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19
Q

dosage of ameodarone

A

a) 300 mg for an adult.
b) If VF or VT persists, a second dose of 150 mg may be administered.
c) See the paediatric drug dose tables for a child.

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20
Q

common adverse affect of amiodarone

A
  • Hypotension.
  • Feeling light-headed.
  • Bradydysrhythmia.
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21
Q

usual onset of ameodarone

A

5-10 mins

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22
Q

Amoxicillin/clavulanic acid mechanism of action

A

Amoxicillin/clavulanic acid is a beta-lactam antibiotic with broad activity against gram-negative and gram-positive bacteria. It also has some activity against anaerobic bacteria, particularly those from the mouth.
* Amoxicillin is the active ingredient and is part of the penicillin class of antibiotics. Amoxicillin inhibits production of the bacterial cell wall, causing bacteria to die.
* Many bacteria are resistant to amoxicillin due to their ability to produce beta-lactamase (an enzyme) which destroys the active part of beta-lactam antibiotics. Clavulanic acid inhibits the beta-lactamase enzyme and has no direct antibacterial action.

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23
Q

indications for Amoxicillin/clavulanic acid

A

 Sepsis and:
ū The patient is aged greater than or equal to 12 years, and
ū One or more high risk factors are present, and
ū Time to hospital is greater than 30 minutes.
 Cellulitis. In this setting a single IV dose may be administered if the patient is being referred to primary care and there may be a delay in the patient seeing a doctor.

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24
Q

dose of Amoxicillin/clavulanic acid

A

1.2g, Dissolve 1.2 g using approximately 4 ml of 0.9% sodium chloride and dilute to a total of 10 ml.
* Administer IV over 1-2 minutes, preferably into a running IV line.
* Do not administer IM if IV access cannot be obtained.

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25
aspirin mechanism of action
* Aspirin (acetylsalicylic acid) has antiplatelet, antipyretic, anti-inflammatory and analgesic effects. In the out-of-hospital setting aspirin is only administered for its antiplatelet activity. * Aspirin inhibits the enzyme cyclooxygenase which results in a reduction in the formation of prostaglandins and thromboxane.
26
contraindications of aspirin
 Known severe allergy.  Third trimester of pregnancy.
27
cautions for aspirin
^ Known bleeding disorder. Aspirin will increase the risk of bleeding, however the balance of risk is usually in favour of administering aspirin. ^ Clinically significant bleeding. Aspirin will increase the risk of bleeding and the nature and risk of the bleeding must be taken into account. ^ Known worsening of bronchospasm with NSAIDs. Some patients with asthma or COPD have known worsening of bronchospasm with NSAIDs (including aspirin) and a decision must be made based on the balance of risk. If there is a clear history of significant bronchospasm with NSAIDs, aspirin should be withheld.
28
dose of aspirin
300 mg
29
Ceftriaxone indication
Suspected meningococcal septicaemia
30
Ceftriaxone dosage
* 2 g IV for an adult. * 2 g IM for an adult if IV access cannot be immediately obtained. * See the paediatric drug dose tables for a child.
31
admin of ceftriaxone
a) Add 4 ml of 0.9% sodium chloride to a 2 g ampoule and shake until dissolved. b) Draw up the ampoule using two syringes with approximately half in each. The total volume will be 5 ml. c) Discard unrequired volume before administration for a child. d) Administer one syringe into each lateral thigh. If this site is not suitable, use each lateral upper arm.
32
Clopidogrel mechanism of action
* Clopidogrel has antiplatelet activity. * Clopidogrel antagonises (blocks) the binding of adenosine diphosphate (ADP) to platelets and impairs platelet function. Clopidogrel provides significantly more antiplatelet activity than aspirin.
33
indications of clopidogrel
STEMI in conjunction with fibrinolytic therapy.
34
dose of clopidogrel
300 mg if the patient is aged less than 75 years. * 75 mg if the patient is aged greater than or equal to 75 years.
35
droperidol mechanism
* Droperidol blocks dopamine and alpha receptors centrally, resulting in sedation, reduced agitation and a state of mental detachment.
36
droperidol indications
Patients aged greater than or equal to 12 years with agitated delirium causing a mild to moderate risk to safety, when olanzapine has not been administered or is ineffective.
37
cautions for droperidol
^ Parkinson’s disease. There is a risk of worsening the movement disorder associated with Parkinson’s disease. ^ Concurrent administration of other sedatives. This will increase and prolong the effects. ^ Intoxication. This will increase and prolong the effects. ^ Elderly and/or frail. These will increase and prolong the effects
38
dosage of droperidol
* 10 mg IM or IV. * Reduce the dose to 5 mg if the patient is frail. * The dose may be repeated once after 20 minutes.
39
admin of droperidol
* Administer IM undiluted. The preferred site is the lateral thigh as this has the best absorption. If this site is not suitable use the lateral upper arm. The IM route is as effective as the IV route. * Dilute 10 mg to a total of 10 ml and administer IV over 1-2 minutes. * IV administration may occur if IV access is already in place, but IM administration should not be delayed while IV access is obtained.
40
mechanism of Enoxaparin
* Enoxaparin is a low molecular weight heparin (LMWH) anticoagulant. * Enoxaparin potentiates the activity of antithrombin lll (a naturally occurring anticoagulant) causing inhibition of multiple coagulation factors, particularly factor Xa.
41
indication of enoxaparin
STEMI in conjunction with fibrinolytic therapy.
42
mechanism of fentanyl
Fentanyl is an opiate analgesic. It is an opiate agonist (or stimulator) that binds to opiate receptors in the brain and spinal cord causing analgesia.
43
dosage for fentanyl
* IV for analgesia: a) 10-50 mcg every five minutes for an adult. Use a dose at the lower end of the range if the patient is small, frail or cardiovascularly unstable. b) See the paediatric drug dose tables for a child. * IN for analgesia: a) 100 mcg IN for an adult weighing 80 kg or less. Further doses of 50 mcg may be administered every ten minutes without a maximum dose. Halve these doses if the patient is frail or cardiovascularly unstable. b) 200 mcg IN for an adult weighing greater than 80 kg. Further doses of 100 mcg may be administered every ten minutes without a maximum dose. Halve these doses if the patient is frail or cardiovascularly unstable. c) See the paediatric drug dose tables for a child. * IM for analgesia if IV access cannot be obtained and IN administration is inappropriate: a) 50-100 mcg IM for an adult. Use a dose at the lower end of the range if the patient is small, frail or cardiovascularly unstable. This may be repeated once after 20 minutes. b) See the paediatric drug dose tables for a child. This may be repeated once after 20 minutes. * IV for RSI: see the ‘RSI’ section. * IV for sedation post intubation: see the ‘post intubation’ section.
44
admin of IV fentanyl
a) Dilute 100 mcg to a total of 10 ml for an adult or a child whose weight has been rounded up to 30 kg or more. This final solution contains 10 mcg/ml. b) Dilute 100 mcg to a total of 100 ml for a child whose weight has b
45
IN admin of fentanyl for kids
1 ml syringes. When drawing up the first syringe, draw up an additional 0.1 ml of fentanyl over and the above the planned volume and expel this slowly through the mucosal atomiser in order to fill the dead space. This does not need to be done with subsequent doses.b) Administer fentanyl IN by rapidly injecting one syringe (half of the total dose) into each nostril. Rapid injection is required in order to achieve a fine mist, which maximises absorption.
46
IN fentanyl for adults
a) Draw up fentanyl undiluted using 1 ml syringes. Administer a maximum of 1 ml at a time per nostril. The dead space of the mucosal atomiser is very small in relation to the overall volume administered and does not need to be taken into account. b) Administer fentanyl IN by rapidly injecting one syringe (half of the total dose) into each nostril. Rapid injection is required in order to achieve a fine mist, which maximises absorption. c) If the dose is 200 mcg, administer 1 ml into each nostril, wait five minutes and then administer a further 1 ml into each nostril. This maximises absorption
47
onset of fetnyl
2-5 mins
48
indication of gentamicin
Sepsis (in addition to amoxicillin/clavulanic acid), where the site of infection is the urinary tract, the abdomen, or is unknown and: ū The patient is aged greater than or equal to 12 years, and ū One or more high risk factors are present, and ū Time to hospital is greater than 30 minutes.
49
dosage of gentamicin
* 400 mg if weighs greater than 80 kg. * 320 mg if weighs 60-80 kg. * 240 mg if weighs less than 60 kg.
50
glucagon indication
Hypoglycaemia when the patient cannot safely swallow glucose/food and IV access cannot be obtained.
51
mechanism of glucagon
Glucagon increases the blood glucose level by stimulating glycogenolysis (the breakdown of glycogen into glucose), predominantly within the liver.
52
dosage of glucagon
* 1 mg IM once for an adult or child aged greater than or equal to five years. * 0.5 mg IM once for a child aged less than five years.
53
indication of glucose gel
 Hypoglycaemia in adults and children provided the patient is conscious enough to be able to swallow safely.  Hypoglycaemia in neonates.
54
dose of glucose gel
10-20 g for all ages. * Administer one sachet and repeat every ten minutes if hypoglycaemia persists or recurs.
55
GTN mechanism of action
* GTN is a vasodilator. It acts on vascular smooth muscle to cause venous and arterial vasodilation, with the predominant effect being on veins. * The mechanism of action is not clear, but it appears that GTN results in the formation of nitric oxide which is a vasodilator. GTN causes: ū A reduction in venous return (preload) to the heart. This reduces ventricular filling and cardiac output which reduces myocardial oxygen demand. ū Arterial dilation which reduces peripheral resistance (afterload). This reduces the force the left ventricle must overcome to eject blood into the arteries which reduces myocardial oxygen demand. ū Dilation of the coronary arteries which may increase coronary blood supply, though this is not usually clinically significant.
56
indications fo GTN
 Myocardial ischaemia.  Cardiogenic pulmonary oedema.  Control of hypertension associated with autonomic dysreflexia.  Control of hypertension (usually in conjunction with labetalol or metoprolol) prior to fibrinolytic treatment for STEMI.  Control of hypertension (usually in conjunction with labetalol or metoprolol) during inter-hospital transfer for STEMI.
57
contraindications of GTN
 Known severe allergy.  Systolic BP less than 100 mmHg.  Heart rate less than 40/minute.  Heart rate greater than 150/minute.  Ventricular tachycardia.
58
cautions with GTN
^ STEMI, particularly STEMI involving the right ventricle. GTN may cause a significant fall in cardiac output and if there are signs of low cardiac output GTN should be withheld. ^ The patient is small, frail or physiologically unstable. ^ Poor perfusion. This is a sign of reduced cardiac output which may fall further with GTN administration^ Dysrhythmia. This may cause a reduced cardiac output which may fall further with GTN administration. ^ A drug for erectile dysfunction has been taken within the last 24 hours. See common interactions. ^ Known aortic or mitral stenosis. With aortic or mitral stenosis, cardiac output may be reduced as a result of the narrowed valve and a fall in preload may cause a further fall in cardiac output.
59
dosage og GTN
* Myocardial ischaemia: 0.4 mg every 3-5 minutes. Increase the dosing interval to ten minutes if caution is required. * Cardiogenic pulmonary oedema: 0.8 mg every 3-5 minutes. Increase the dosing interval to ten minutes if caution is required. Increase the dose and frequency if the patient is not improving, provided the systolic BP is greater than 100 mmHg. * Control of hypertension: 0.4-0.8 mg every 3-5 minutes.
60
adverse affects of GTN
* Hypotension. * Flushing. * Headache. * Tachycardia. * Feeling light-headed.
61
heparin mechanism of action
Heparin is an anticoagulant. It potentiates the activity of antithrombin lll (a naturally occurring anticoagulant) causing inhibition of multiple coagulation factors.
62
indication of heparin
STEMI in conjunction with fibrinolytic therapy.
63
contradictions of heparin
 Known severe allergy.  Age 75 years or older. When heparin is administered in combination with fibrinolytic therapy in patients aged 75 years or older, there is an increased risk of fatal intracerebral haemorrhage.
64
ipratropium mechanism
* Ipratropium is a bronchodilator. * Ipratropium is an anticholinergic agent with predominantly antimuscarinic activity. It antagonises (blocks) acetylcholine receptors, causing vagal inhibition resulting in bronchodilation.
65
Ipratropium indication
 Bronchospasm secondary to asthma or COPD.  Prominent bronchospasm secondary to airway burns, smoke inhalation or chest infection
66
mechanism of ketamine
* Ketamine is an analgesic. It has complex actions, but is predominantly an N-methyl-d-aspartate (NMDA) receptor antagonist (blocker), resulting in inhibition of excitatory neurotransmitters in the brain. * Low doses cause analgesia, larger doses cause amnesia and dissociation, and high doses cause anaesthesia.
67
dose of ketamine for analgesia
a) 30 mg IV over approximately 15 minutes if the patient weighs greater than 80 kg. Repeat as required. b) 20 mg IV over approximately 15 minutes if the patient weighs 50-80 kg. Repeat as required. c) See the paediatric drug dose tables for a child and administer IV over approximately 15 minutes. d) 0.5 mg/kg IM or PO (up to a maximum of 50 mg) if IV access cannot be obtained. This may be repeated once after 20 minutes.
68
how to administered ketamine
* The preferred route of administration is IV. * Administer analgesia doses IV over approximately 15 minutes as this appears to reduce adverse side effects. * Dilute 100 mg (1 ml) of ketamine in a 100 ml bag of 5% glucose. Shake well and label: a) For adults: draw up the dose and administer 2 mg (2 ml) every 1-2 minutes. b) For children: draw up the dose, dilute the volume further to a total of 20 ml and administer 2 ml every 1-2 minutes.
69
lignocaine mechanism
* Lignocaine is a local anaesthetic. * Lignocaine blocks the initiation and transmission of nerve impulses by blocking the movement of sodium ions across the nerve cell membrane
70
indications of lignocaine
 Subcutaneous injection for prophylaxis of pain associated with IV cannulation.  Subcutaneous injection for digital ring blocks for analgesia.  Intraosseous injection for bone pain associated with fluid infusion via an intraosseous needle.
71
lignocaine subcutaneous dosage
a) The maximum subcutaneous dose for an adult is 200 mg (20 ml of 1% lignocaine). b) See the paediatric drug dose tables for the maximum dose for a child. c) The subcutaneous dose may be repeated once after 30 minutes.
72
indication of loratadine
 Minor allergic reactions confined to skin involvement.  Prominent itch associated with anaphylaxis, provided all systemic signs of anaphylaxis have resolved.
73
methoxy mechanism
* Methoxyflurane is an inhalational analgesic. * The mechanism of action is not clear.
74
contraindications of methoxy
 Known severe allergy.  Personal or family history of malignant hyperthermia.  Unable to obey commands.  Known renal impairment.  Has received methoxyflurane within the last week. Frequent administration increases the risk of renal impairment.
75
mechanism of midazolam
* Midazolam is a benzodiazepine. * Midazolam enhances the activity of gamma-aminobutyric acid (GABA) at GABA receptors within the central nervous system, resulting in anticonvulsant activity, sedation, amnesia, anxiolysis and muscle relaxation.
76
indications of midaz
 Prolonged seizures.  Agitated delirium causing a mild to moderate risk to safety and droperidol is unavailable or ineffective.  Pain associated with severe muscle spasm.  Sedation, for example for joint relocation.  Sedation post intubation.  Severe anxiety associated with COPD.
77
admin of midaz
IV administration: a) Dilute 2 ml from a 15 mg/3 ml ampoule to a total of 10 ml using 0.9% sodium chloride. This solution contains 1 mg/ml. b) Administer IV as a bolus. * IM administration: a) Draw up the dose from a 15 mg/3 ml ampoule. Do not dilute. b) The preferred site is the lateral thigh as this has the best absorption. If this site is not suitable use the lateral upper arm. * For sedation post intubation: combine 10 mg of midazolam with 100 mcg of fentanyl and dilute to a total of 10 ml using 0.9% sodium chloride.
78
naloxone indications
 Opiate poisoning is suspected and the patient has a significantly impaired level of consciousness or significantly impaired breathing.  Excess adverse effects from administration of opiates.
79
mechanism of action of naloxone
Naloxone is an opiate receptor antagonist (blocker). By blocking opiate receptors naloxone reverses the effects of opiates, particularly respiratory depression and sedation.
80
olanzapine indications
Patients aged greater than or equal to 12 years with agitated delirium causing a mild to moderate risk to safety, when the patient will take an oral medicine
81
dosage of olanzapine
* 10 mg PO. * Reduce the patient to 5 mg PO if the patient is frail. * The dose may be repeated once after 20 minutes.
82
ondansetron mechanism
* Ondansetron is an antiemetic. * Ondansetron antagonises (blocks) serotonin receptors centrally in the brain and peripherally in the gastrointestinal tract, resulting in a reduction in nausea and vomiting
83
dosage of ondansetron
* 8 mg IV once for an adult. See the paediatric drug dose tables for a child. * 4 mg IM for an adult, if IV access cannot be obtained. See the paediatric drug dose tables for a child. * The IM dose may be repeated once after 20 minutes if required. * One IV dose may be administered in addition to one IM dose, if clinically significant nausea and/or vomiting persists and IV access is subsequently obtained. For example, in this setting a maximum total dose of 12 mg may be administered to an adult.
84
oxytocin indication
 Following normal birth.  Postpartum haemorrhage.
85
Prednisone and prednisolone indications
 Bronchospasm associated with asthma or COPD.  Croup.  Prominent rash associated with anaphylaxis, provided all systemic signs of anaphylaxis have resolved.  Minor allergy associated with rash.
86
dose of Prednisone
* 40 mg for an adult. * See the paediatric drug dose tables for a child.
87
mechanism of salbutamol
Salbutamol is a bronchodilator. It is an agonist (stimulator) of beta-2 receptors.
88
indications of salbutamol
 Bronchospasm secondary to asthma or COPD.  Prominent bronchospasm secondary to airway burns, smoke inhalation or chest infection.  Release syndrome following crush injury.
89
tenecteplase indication
STEMI when primary percutaneous coronary intervention (PCI) is not the chosen reperfusion strategy.
90
tramadol mechanism
* Tramadol is an analgesic. It has multiple actions within the central nervous system, including opiate receptor stimulation and inhibition of the re-uptake of noradrenaline and serotonin.
91
indication of tramadol
Aged greater than or equal to 12 years with moderate to severe pain (usually in combination with paracetamol and/or ibuprofen), particularly if personnel are not available to administer fentanyl and/or ketamine.
92
Valproate indication
Status epilepticus that has not responded to two doses of midazolam.
93
doseage of valproate
* 1200 mg for an adult. * See the paediatric drug dose tables for a child.
94
valproate mechanism
* Valproate is an anticonvulsant. It predominantly blocks sodium channels but also enhances the activity of gamma-aminobutyric acid (GABA) at GABA receptors within the central nervous system. * The active ingredient in sodium valproate is valproate.
95
indications for oxygen admin
a) An SpO2 less than 94% on air (exceptions – see high risk patients below and the ‘neonatal resuscitation’ section). b) Airway obstruction. c) Severe respiratory distress (exception – see high risk patients). d) Severe shock. e) Severe traumatic brain injury. f) Suspected carbon monoxide (CO) poisoning. g) Smoke inhalation. h) Decompression illness. i) A condition requiring sedation to be administered. j) Cluster headache.

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