Meds

Question 1

Adrenaline

Answer 1

I)
- Anaphylaxis
- life-threatening asthma
- cardiac arrest
- post-ROSC
- severe croup

C/I)
- there are no absolutebcontraindications in adrenaline

1 mg/1 mL (1:1,000) ampoule

Question 2

Amiodarone

Answer 2

I)
- cardiac arrest w/ persistent/shock resistant VT/VF post 3rd shock

C/I)
- none in cardiac arrest
Not compatible w/ saline (infusion)

150mg in 3mL ampoule

Question 3

Amiodarone

Answer 3

I)
- cardiac arrest w/ persistent/shock resistant VT/VF post 3rd shock

C/I)
- none in cardiac arrest
Not compatible w/ saline (infusion)

150mg in 3mL ampoule

Question 4

Aspirin

Answer 4

I)
- pts w/ suspected ACS

C/I)
- known hypersensitivity to aspirin/salicylates/NSAIDs
- children <16

300mg chewable/dispersible aspirin

Question 5

Atropine

Answer 5

I)
- symptomatic bradycardia (hypotension, ALOC, diaphopresis, SOB/cyanosis, syncope)
- organophosphate poisoning w/ cholinergic affects

C/I)
- hypersensitivity
- cardiac transplant

1.2mg /1mL Ampoule

Question 6

Coohenylcaine

Answer 6

I)
- local pain: abrasions, small cuts and wounds
- relief of mild and moderate epistaxis
- post tonsillectomy haemorrhage
- intra-oral haemorrhage

C/I)
- hypersensitivity to phenylephrine, lidocaine or other anaesthetic
- children <2
- pregnancy

Pump spray w/ nozzle

Question 7

Droperidol

Answer 7

I)
- disturbed and abnormal behaviour (RASS 1-3) if considered appropriate and risk to safety is evident and de-escalation has not been effective
- dementia and frail where olanzapine cannot be administered or is ineffective

C/I)
- known allergy
- Parkinson’s disease
- where ketamine has been administered to sedate this episode
- age <6
- post-octal ABD

10mg/2ml (5mg/ml)

Question 8

Fentanyl

Answer 8

I)
- moderate to severe pain
- ACS w/ GTN ineffective

C/I)
- hypersensitivity
- child <1 (IV/IO only)
- occluded nasal passage or epistaxis (IN)

IN 450mcg/1.5ml
IV/IO 100mcg/2ml or 500mcg/10ml

Question 9

Glucagon

Answer 9

I)
- hypoglycaemia when cannot oral glucose and IV unable
- ALOC in diabetics or not <4mmol/L

C/I)
- Hypersensitivity
- known pheochromocytoma, insulinoma, glucagonoma

1mg in 1ml

Question 10

Glucose Gel

Answer 10

I)
- hypoglycaemia ALOC in diabetics, <4mmol/L in unk medical cause

C/I)
- nil

15g glucose gel

Question 11

Glucose IV

Answer 11

I)
- hypoglycaemia by ALOC in known or not known diabetics <4mmol/L
- cardiac arrest if hypoglycaemia expected cause

C/I)
- not be used when no patent IV

500ml bag 10% glucose (10g per 100mL)

Question 12

GTN

Answer 12

I)
- chest pain from presumed cardiac cause where sys BP >90 mmhg and HR 50-150 bpm
- ACPO w/ sys BP >90mmHg
- autonomic dysreflexia w/ SYS BP >160 mmhg

C/I)
- hypersensitivity
- hypotension SYS <90mmHg
- VT
- Recent erectile dysfunction meds
: sildanefil, vardenafil, avanafil <24hrs
: tadalafil <3 days

Spray bottle 200x sprays, 400mcg per spray

Question 13

Heparin

Answer 13

I)
- pts w/ STEMI going to Cath lab as per receiving hospital 12-lead ECG interpretation

C/I)
- hypersensitivity
- active bleeding (excluding menses) or disease states w/ incr risk of bleeding (e.g. haemophilia)

5,000 IU in 5ml

Question 14

IV crystalloid solutions (normal saline)

Answer 14

I)
- fluid replacement (volume expansion) for the treatment of shock, fluid loss, and cardiac arrest

C/I)
- severe pulmonary oedema

1L bags, 250ml bags, 10ml vials, 5ml pre-filled

Question 15

Ipratropium Bromide (Atrovent)

Answer 15

I)
- severe bronchospasm
ADULT - severe to life-threatening asthma or COPD

PAEDS - severe to life-threatening asthma

C/I)
- hypersensitivity

250mcg/ml nebule OR MDI 20mcg per puff

Question 16

Ketamine

Answer 16

I)
- IV: 2nd line treatment of pain from traumatic origin. ASMA consult if minimum Fentanyl amount hasn’t been given yet
- IM: first line treatment of pain if other means unable or unavailable
- combative TBI
- RASS 4 first line for rapid tranq and no other methods have been administered

C/I)
- hypersensitivity
- active cardiovascular disease (CP, HF, severe or poorly controlled hypertension)
- delayed transfer of care (Ramped)
- anything below RASS 4 or other sedatives have been given (ASMA consult)
- Rapid tranq ONLY <16
- age <1

200mg/2ml

Question 17

Lignocaine 1%

Answer 17

I)
- local anaesthesia (IV, IO, suturing, finger thoracostamy on conscious pt)
- Cardia Arrest (persistent Vf/Vt and max dose Ami given)

C/I)
- hypersensitivity

20mg/2ml OR 50mg/5ml

Question 18

Methoxyflurane

Answer 18

I)
- pain

C/I)
- unable to understand or cooperate
- w/ severe renal impairment
- injury or ALOC preventing cooperation
- hypersensitivity e.g. malignant hyperthermia

3mL ampoule via penthrox inhaler

Question 19

Midazolam

Answer 19

I)
- prolonged seizure activity - generalised seizure >=5mins OR recurrent / status seizure activity as per CPG
- focal seizure activity which is prolonged (>=5mins) and associated w/ GCS >=12 as per CPG
- second line IV agent for maintenance of sedation after Droperidol for ABD

C/I)
- hypersensitivity
- use of Midaz for sedation after ketamine requires ASMA consult

15mg/3ml ampoule

Question 20

Naloxone

Answer 20

I) reversal of respiratory depression in a suspected narcotic overdose

C/I)
- Hypersensitivity

400mcg in 1mL vial

Question 21

Olanzapine

Answer 21

I)
- disturbed and abnormal behaviour (RASS 1-3) if considered appropriate where risk to safety is evident and de-escalation not effective
- pt is able to tolerate and self-administer wafer
- preferred first line sedation agent in frail pts and dementia

C/I)
- known allergy
- Parkinson’s disease
- age <6

5mg oral dispersible tablet

Question 22

Ondansteron

Answer 22

I)
- moderate to severe nausea
- active vomiting
- prophylaxis of eye and spinal injury

C/I)
- paeds <2
- hypersensitivity

4mg/2mL OR 4mg wafer

Question 23

Oxygen

Answer 23

I)
ADULTS - titrated to achieve 94-98% (88-92% for COPD), achieved through different masks and flow rates

PAEDS - all pts w/ significant illness or injury should receive O2. Newborn resus ideally commenced w/ RA first few breaths

C/I)
- normoxia
- explosive or flammable environments

490L or 1640L bottles

Question 24

Paracetamol

Answer 24

I)
- mild to moderate pain
- as a component of multi model analgesic regime

C/I)
- hypersensitivity
- cannot exceed max single dose or max daily dose (24hrs)
- taken in last 4hrs

500mg Tablets
100mg/mL (2000/20mL) suspension

Question 25

Prednisalone

Answer 25

I)
- mild to moderate croup
- severe croup after nebuliser adrenaline

C/I)
- hypersensitivity
- live virus vaccine in last 48 hrs (MMR, chicken pox)

25mg in 5mL

Question 26

Tranexamic Acid

Answer 26

I) all <3hrs
- significant trauma w/ signs of hypovolaemia
- significant active haemorrhage that requires tourniquet/s and/or haemostatic/pressure dressing/s
- suspected head injury w/ GCS motor score of 4 or below
- severe primary or secondary PPH (>1L) or PPH w/ signs of hypovolaemia
- significant post-tonsillectomy haemorrhage

C/I)
- hypersensitivity
- injury more than 3hrs

1g in 10mL