Miscellaneous

Question 1

Indications for Chlorphenamine?q

Answer 1

Allergic reactions falling short of anaphylaxis, but causing distress.
Alleviating cutaneous symptoms in anaphylaxis after emergency treatment, and oral administration of antihistamine not possible.

Question 2

Actions of Chlorphenamine?

Answer 2

Antihistamine, blocks the effects of histamine released during allergic reaction.

Question 3

Contra-indications of Chlorphenamine?

Answer 3

Monoamine oxidase inhibitor (MAOI) treatment within last 14 days.
MAOIs intensify the anticholinergic properties of chlorphenamine.

Question 4

Cautions of Chlorphenamine?

Answer 4

Pregnancy/breastfeeding.
Hypotension.
Epilepsy.
Glaucoma.
Severe liver disease.

Question 5

Side effects of Chlorphenamine?

Answer 5

Sedation
Dry mouth
Headache
Blurred vision
Urinary retention
Psychomotor impairment
GI disturbance
Convulsions (rare)
With IV: transient hypotension, CNS stimulation and irritant effects

Question 6

Dose of Chlorphenamine?

Answer 6

IM or IV.
10 mg in 1 ml. Only one dose.

Question 7

Indication for Co-amoxiclav?

Answer 7

Reduce risk of infection in patients with open fractures.
- Obvious open fracture.
- Signs consistent with a fracture and wound visible over the site of fracture.
- Major trauma to a limb where significant wounds and a high suspicion of a fracture is present.

Question 8

Contra-indications of Co-amoxiclav?

Answer 8

<12 months.
Contains penicillin - beware hypersensitivity.
Renal impairment.
Current antibiotic treatment.

Question 9

Dose of Co-amoxiclav?

Answer 9

IV or IO.
NOT IM.
1.2 g (1000 mg/200 mg vials) dissolved in 20 ml water for injection.
Only one dose.

Question 10

Indications for Misoprostol?

Answer 10

Primary or secondary PPH with excessive bleeding from birth canal, uncontrolled by Syntometrine or Syntometrine is contra-indicated/unavailable.
Confirmed miscarriage with excessive bleeding from the birth canal, uncontrolled by Syntometrine or Syntometrine is contra-indicated/unavailable.

Question 11

Actions of Misoprostol?

Answer 11

Uterotonic medicine which stimulates contraction of the uterus for control of bleeding.

Question 12

Contra-indications of Misoprostol?

Answer 12

Any reason to suspect another fetus is in the uterus, do not administer.
Known anaphylaxis to misoprostol or component of.

Question 13

Dose of Misoprostol?

Answer 13

800 mcg, 4 x 200 mcg tablet.
Oral or rectal.

Question 14

Indications of Syntometrine?

Answer 14

Primary or secondary PPH, with excessive bleeding from the birth canal.
Confirmed miscarriage or terminated pregnancy with excessive bleeding.

Question 15

Action of Syntometrine?

Answer 15

Oxytocin in Syntometrine stimulates contraction of the uterus. Ergometrine produces a sustained uterine contraction for control of bleeding after birth.

Question 16

Contra-indications of Syntometrine?

Answer 16

Current severe hypertension (140/90 or more, or systolic 150 or more)
Known anaphylaxis to active substances
Known/suspected fetus in utero
Severe cardiac, liver or kidney disease

Question 17

Dose of Syntometrine?

Answer 17

500 mcg in 1 ml. Only one dose.

Question 18

Indications of Oxygen?

Answer 18

Critical illnesses requiring high levels of oxygen.
Serious illnesses requiring moderate levels of supplemental oxygen.
COPD and other conditions requiring controlled or low-dose oxygen therapy.
Conditions where oxygen not required unless hypoxaemic.

Question 19

Cautions of Oxygen?

Answer 19

Increases fire hazard.
Ensure defib pads applied firmly to reduce spark risk.
For COPD, high levels of oxygen can produce increased CO2 levels which may cause respiratory depression > arrest.

Question 20

Dose of Oxygen?

Answer 20

Sats <85 = 10-15 litres per minute
Sats 85-93 = 5-10 litres per minute

Question 21

What conditions need high levels of oxygen?

Answer 21

Cardiac arrest/resuscitation.
Major trauma.
Anaphylaxis.
Major pulmonary haemorrhage.
Sepsis.
Shock.
Active convulsion.
Hypothermia.

Question 22

Indications for Sodium Chloride?

Answer 22

Medical conditions with/without haemorrhage.
Trauma-related haemorrhage.
Burns.
Crush injury.
Flush to confirm patency and following drug administration.

Question 23

Dose of Sodium Chloride?

Answer 23

Medical conditions without haemorrhage - 250 ml, up to 2 L.

Sepsis (BP <90) - 500 ml, repeat if hypotensive, up to 2 L.

DKA - 500 ml, up to 1 L.

Medical conditions with haemorrhage (BP <90, signs of poor perfusion) - 250 ml, up to 2 L.

Blunt trauma, head trauma, penetrating limb trauma (maintain palpable radial, or BP of 90) - 250 ml up to 2 L.

Penetrating torso trauma (maintain palpable carotid, or BP of 60) - 250 ml up to 2 L.

Burns (between 15%-25% TBSA and time to hospital > 30 mins, or >25% TBSA) - 1 L initial and max.

Crush injury - 2 L initial and max.