Occasional drugs Flashcards

Question

Atropine Type(full definition)

Answer 1

-anticholinergic agent that inhibits the action of acetylcholine on post ganglionic nerves at the neuroeffector site. This blocks vagal stimulation to allow the sympathetic response to increase pulse rate by increasing SA node firing rate, and increasing the conduction velocity through the AV node. - An antidote to reverse the effects of cholinesterase inhibitors such as seen with organophosphate poisoning..

Answer 2

.- Known hypersensitivity. - Patients with cardiac transplant.

Answer 3

- 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).

Answer 4

May not be effective in patients with 3rd degree AV 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. - It is advisable that a 12 Lead ECG is conducted prior to medication administration to rule out Acute Myocardial Infarction (STEMI) and Third-degree atrioventricular (AV) block. o If in doubt transmit 12-lead ECG to CSP SOC to discuss, or seek ASMA advice. - Bradycardia in children is usually a result of hypoxia or vagal stimulation. Ensure all reversible causes addressed and consider commencing resuscitation as per CPG if unresponsive. - Atropine may affect patients with glaucoma. - The maximum dose of Atropine that has shown to produce the desired effect in healthy adults is up to 3mg for bradycardia. In organophosphate poisoning: atropinisation might require significant repeat dosages 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..

Answer 5

1mg in 1ml vial, accompanied by diluent for injection.

Answer 6

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..

Answer 7

- A hyperglycaemic agent that converts stored liver glycogen to glucose to increase blood glucose concentration..

Answer 8

- Onset 4-7 minutes, duration 10-30 minute.

Answer 9

- Hypersensitivity. - Known pheochromocytoma.

Answer 10

- Nausea/vomiting - Gastric pain - Transient rise of blood pressure for patients taking beta blockers..

Answer 11

- Glucagon is effective in treating hypoglycaemia only if sufficient liver glycogen is present (eg: it does not work on alcohol or anorexia induced hypoglycaemia). - Even if fully recovered, patients should be encouraged to be transported to a medical facility to ensure effective follow up and review.

Answer 12

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

Answer 13

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 4mmol/L. - Cardiac arrest, only if hypoglycaemia is suspected as a contributory cause of the arrest, not an early indication..

Answer 14

hypertonic crystalloid solution that provides a readily available source of energy (Glucose). onset within 1 minute contains 100mg glucose anhydrous/ml

Answer 15

- Onset within 1 minute.

Answer 16

- Not to be used if there is no patent IV access.

Answer 17

- Hyperglycaemia - Diuresis - Tissue necrosis - Thrombophlebitis.

Answer 18

- Patients should ideally be cannulated with a large gauge cannula into a large vein, with patency confirmed with a free flowing bolus (>20ml) of 0.9% normal saline, before administering glucose 10% using a 20ml syringe via the injection port, titrated to effect. Administration via an IO should utilise a 20ml 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, patients should be encouraged to be transported to a medical facility to ensure effective follow up and review. - 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 need to be repeated to achieve normoglycaemia.

Answer 19

Ampoule of 5,000 international units (IU) in 5mL.

Answer 20

- Patients with STEMI going directly to Cardiac Catheterisation Laboratory as per receiving hospital 12-lead ECG interpretation..

Answer 21

naturally occurring anticoagulant which inhibits the clotting of blood by enhancing the rate at which antithrombin III neutralises thrombin and activated factor X (Xa)..

Answer 22

- Onset of action is immediate following IV administration..

Answer 23

- Hypersensitivity to Heparin - Presence of known haemorrhagic states.

Answer 24

- Haemorrhage.

Answer 25

- Haemorrhagic risks in case of possible traum.

Answer 26

250mcg in 1ml nebule 20mcg per puff MDI

Answer 27

Severe bronchospasm: Adult: - Severe to life-threatening asthma or COPD Paediatric: - Severe to life-threatening asthma

Answer 28

anticholinergic bronchodilator. It inhibits the vagal reflexes that mediate bronchospasm..

Answer 29

- Combined with a nebulised short acting beta-2 agonist (Salbutamol), Ipratropium bromide produces significantly greater bronchodilation than a beta-2 agonist alone.

Answer 30

- Hypersensitivity.

Answer 31

- Headache. - Nausea, dizziness - Dry Mouth, throat irritation - Taste disturbance - Skin rash

Answer 32

- Glaucoma - Avoid contact with eyes..

Answer 33

Oral administration: 25mg sublingual wafer Intravenous/intraosseous administration: 200mg in 2mL.

Answer 34

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 Paramedic only - (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

Answer 35

- Rapid acting dissociative anaesthetic. Use of a sedative agent should never be considered routine.Have a high threshold to offer or administer

Answer 36

- IM onset: 5-10 minutes - IV onset: 1 minute.

Answer 37

* 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 CLEARLY not RASS 4 or where other sedative agents have already been administered (ASMA authority required) * Rapid tranquilisation only: age <16 * Age <1 Year of age

Answer 38

- 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.

Answer 39

Psychiatric, thyroid, min dose, opiod-dependent, sedation warnings Used with caution in patients with stable psychiatric disorders such as Schizophrenia Use with caution in patients with 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 in opioid-dependent patients - consider SOC CSP consult Sedation warnings

Answer 40

20mg/2ml OR 50mg/5mL; (both 1%) in a plastic ampoule.

Answer 41

Local anaesthesia for: - IV cannulation - IO infusion - Suturing - Finger thoracostomy in the conscious patient.

Answer 42

Reversible interrupt impulse conduction in peripheral nerves and stabilise excitable cell membranes by blocking sodium channels

Answer 43

- Onset 1-2 minutes.

Answer 44

- Hypersensitivity

Answer 45

- Tinnitus, dizziness, anxiety, confusion, perioral numbness - Cardiovascular effects: Bradycardia, hypotension, dysrhythmias - CNS effects - Respiratory depression.

Answer 46

- Adverse drug reactions are rare when lignocaine is used as a local anaesthetic and is administered correctl.

Answer 47

15mg in 3mls (5mg/ml).

Answer 48

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

Answer 49

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.

Answer 50

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

Answer 51

Hypersensitivity Use of Midazolam for sedation after Ketamine requires ASMA authority

Answer 52

- Respiratory depression - Hypotension - Anterograde and retrograde amnesia - Myasthenia Gravis.

Answer 53

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 below. 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 Sedation warning

Answer 54

0.4mg (400mcg) in 1ml vial.

Answer 55

- Reversal of respiratory depression in a suspected narcotic overdose.

Answer 56

- Naloxone is a pure opioid antagonist .

Answer 57

.exerts its effect by competitive inhibition at the opioid receptor sites. It prevents or reverses the effects of opioids, including respiratory depression, sedation and hypotension. In the absence of opioids it exhibits essentially no pharmacological activity.

Answer 58

Hypersensitivity to Naloxone

Answer 59

Withdrawal symptoms such as: - Aggression - Agitation - Nausea/vomiting - Dilated pupils and lacrimation.

Answer 60

Polypharmacy overdose. Naloxone half-life may be less than that of a longer acting opioids (e.g. methadone, diphenoxylate, codeine). Response to Naloxone is rapid, reconsider diagnosis if there is a failure to respond to 2mg Naloxone. Patients may be aggressive post Naloxone and administration due to hypoxia. Scene safety and personal safety are paramount.

Answer 61

30mL of 25mg in 5mL suspension of Redipred.

Answer 62

- Mild / Moderate croup - Severe croup after nebulised Adrenaline administration.

Answer 63

Redipred 30mL elixir for oral administation

Answer 64

- Prednisolone is a steroid. It prevents the release of inflammatory mediators. Peak effect within 1hr

Answer 65

- Known hypersensitivity to corticosteroids - Live virus immunisation within last 48 hours (e.g. MMR, Chicken Pox, Yellow Fever).

Answer 66

- Side effects occur following prolonged use and are of little consequence in an emergency setting - Vomiting.

Answer 67

- 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.

Answer 68

- Salbutamol nebules5mg in 2.5mL - Metered Dose Inhaler (MDI)100mcg per puff.

Answer 69

Bronchospasm and respiratory distress associated with wheeze: - Acute Bronchial Asthma - Severe allergic / anaphylactic reactions - Acute Pulmonary Oedema of non-cardiac origin - Bronchitis - COPD - Smoke inhalation - Salt Water Aspiration Syndrome (SCUBA divers).

Answer 70

.- Short acting Beta 2 agonist that causes relaxation of bronchial smooth muscle (bronchodilation

Answer 71

Onset: 2-5 minutes maximum by 10 minutes.

Answer 72

- Known hypersensitivity to Salbutamol - Cardiogenic Pulmonary Oedema - Age <12 months

Answer 73

- Muscle tremor - Tachycardia, palpitations - Headache

Answer 74

.spacer / MDI is the preferred route for Salbutamol administration where the patient presents with influenza like illness. - The use of a Multi Dose Inhaler (MDI) and spacer is equally as effective as nebulisation, in all asthma situations, where the 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.

Answer 75

150mg in a 3ml ampoule.

Answer 76

Cardiac Arrest with persistent/shock resistant Ventricular Fibrillation/pulseless Ventricular Tachycardia, post 3rd shock(ANZCOR 2016).

Answer 77

Amiodarone has effects within the first four classes of the Vaughan-Williams classification. However it is primarily classified as a Class III antidysrhythmic agent that prolongs the action potential duration and hence the refractory period of atrial, nodal and ventricular tissue. It has characteristics of all Vaughan-Williams classes of antidysrhythmics.

Answer 78

Cardiac Arrest Adult:300mg in 6ml IV/IO as soon as practicable after 3rd shock Repeat dose of 150mg in 3ml may be administered after 5th shock

Answer 79

Cardiac Arrest Paediatric / Infant:5mg/kg IV/IO (to maximum 300mg) as soon as practicable after 3rd shock Repeat 5mg/kg IV/IO (to maximum 150mg) after 5th shock

Answer 80

Immediate onset, peak <10min, duration 30-60mins.

Answer 81

No contraindications in cardiac arrest Not compatible with Saline (if infusion dose is advocated by a specifically authorised person)

Answer 82

Bradycardia Hypotension Polymorphic tachycardias Nausea Tremor Dizziness Paraesthesia Headaches.

Answer 83

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).

Answer 84

Vial: 100mg in 2mL (powder for reconstitution)

Answer 85

Patients with known adrenal insufficiency who are symptomatic of adrenal crisis

Answer 86

n adrenocortical steroid that produces an anti-inflammatory process.

Answer 87

Known hypersensitivity

Answer 88

Tachycardia

Answer 89

This inhibits the accumulation of inflammatory cells at inflammation sites, phagocytosis, lysosomal enzyme release and synthesis and/or release of mediators of inflammation. Additionally, it prevents and suppresses cell mediated immune reactions.

Answer 90

Hypertension The specific method of preparing hydrocortisone for injection can be found here. Rarely, patients in adrenal crisis may present with severe psychosis

Answer 91

.10mg/2ml (equivalent to 5mg/ml)

Answer 92

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.

Answer 93

neuroleptic, antipsychotic agent that acts on Alpha and Dopamine receptors, resulting in sedation

Answer 94

Onset of effect usually 3-5 mins both IM and IV Use of a sedative agent should never be considered routine. Have a high threshold to offer or administer.

Answer 95

Known allergy Known Parkinson’s Disease Where Ketamine has been administered to sedate this episode Age < 6 years old Post-ictal Disturbed & Abnormal Behaviour

Answer 96

Extrapyramidal effects / Dyskinesia Increased falls risk Hypotension Apply monitoring as soon as practicable

Answer 97

Organic, post-ROSC, dementia, delirium, sedation warnings 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 that may be used by other agencies Sedation warnings

Answer 98

Significant trauma (< 3 hours) with signs of hypovolaemia or Significant active haemorrhage that requires the use of o Tourniquet/s o 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

Answer 99

1g Tranexamic Acid in 10ml vial (100mg/ml).

Answer 100

Antifibrinolytic Tranexamic Acid (TXA) is 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

Answer 101

Onset: Within minutes Duration: 17 hours Half-life: 3 hours

Answer 102

Known hypersensitivity to Tranexamic Acid. Injury time more than 3 hours (associated with increase in mortality).

Answer 103

Hypotension (fast infusion rate) Headache Dizziness Convulsions (lowers seizure threshold) Nausea and/or vomiting Diarrhoea

Answer 104

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

Answer 105

Adult: Intranasal: Max 10 squirts (5 squirts per nostril) Topically: Max 5 squirts Oral use: 1 spray then pause, repeat if required to max. 5 sprays. Paediatric: Intranasal: 2-4 years: 1 squirt per nostril 4-8 years: 2 squirts per nostril 8-12 years: 3 squirts per nostril Topically: Max 5 squirts Oral use: 1 spray then pause, repeat if required to max. 5 sprays. Maximum dosages should not be administered more than once in 24 hours.

Answer 106

Adult: Squeeze contents of tube (or as much as practical) into lower cheek pouch over gums/cheek and externally massage cheek. Repeat after 10 minutes if still altered consciousness or deteriorating. Child: Administer small amounts of oral glucose gel into lower cheek pouch over gums/cheek and externally massage cheek. Repeat after 10 minutes if still altered consciousness or deteriorating. Do not delay transport. Neonate/Infant: Process for buccal administration of oral glucose gel: Wearing a clean glove, gently dry the infant's buccal mucosa with gauze/pad. Place a small amount of oral glucose gel onto gloved finger and gently massage into the infants buccal mucosa. DO NOT administer the gel directly from the tube into the infants mouth. Use only a portion of the tube, titrate to effect. Repeat as necessary after 10 minutes if still altered consciousness or deteriorating. Do not delay transport.

Answer 107

Adult: 15 g (150 mL) IV If BGL < 4 mmol/L after 5-10 minutes, give 10 g (100 mL) IV titrating to effect Paediatric: 2 mL/kg (0.20g/kg or 200mg/kg) up to 15 g (150 mL) IV/IO If BGL < 4 mmol/L after 5-10 minutes, give 0.2 g/kg IV/IO titrating to effect Newborn: 2 mL/kg (0.20 g/kg or 200 mg/kg) Repeat once only, if clinically indicated (BGL <2 mmol/L)

Answer 108

Intramuscular injection into deltoid muscle or mid-lateral thigh Adult: 1mg in 1ml IM. Repeat IM Glucagon after 10 minutes if unable to obtain IV access and patient still has inadequate GCS and blood glucose level. Paediatric: <5 years: 0.5mg in 0.5ml 6-12 years: 1.0mg in 1.0ml Single dose only

Answer 109

Adult: 1 mg IV/IO, repeat every 3-5 minutes as clinically indicated Paediatric / Newborn: Dilute 1 mL of 1:1000 adrenaline solution with 9 mL sodium chloride 0.9% to produce 1000 microg in 10 mL (1:10,000) 10 microg/kg = 0.1 mL/kg of 1:10,000 adrenaline solution IV/IO, repeat every 3-5 minutes as clinically indicated. Maximum bolus dose 1mg (10mL of 1:10,000 adrenaline solution).

Answer 110

Dilute 1 mL of 1:1000 adrenaline solution with 9 mL sodium chloride 0.9% to produce 1000 microg in 10 mL (1:10,000) Adult: 50 microg (0.5 mL) every 3-5 min as required to maintain systolic blood pressure >100 mmHg Paediatric: 1 microg/kg every 3-5 min (maximum bolus 50 microg (0.5 mL)) to maintain systolic blood pressure > 80 mmHg Titrate Adrenaline as required, to achieve and / or maintain the SBP requirements as listed above.

Answer 111

Adult: 0.5 mg IM into lateral mid-thigh (0.5 mL of 1:1000), repeat every 5 minutes as clinically required Paediatric > 1 month: 10 microg/kg IM into lateral mid-thigh (0.01 mL of 1:1000) (maximum single dose = 0.5 mg or 0.5 mL), repeat every 5 minutes as clinically required

Answer 112

Infants (>1 month) / Paediatric: Nebulise 5 mg (5 mL of 1:1000) undiluted, as a single dose

Answer 113

Adult: 300mg in 6ml IV/IO as soon as practicable after 3rd shock Repeat dose of 150mg in 3ml may be administered after 5th shock Paediatric / Infant: 5mg/kg IV/IO (to maximum 300mg) as soon as practicable after 3rd shock Repeat 5mg/kg IV/IO (to maximum 150mg) after 5th shock

Answer 114

Dosage to be given should be in line with patients own management plan. In the absence of patients own management plan the following dosages should be followed: Adult: IM: 100mg single dose Paediatric: IM: Age Weight Dosage < 6 Months <7kg 25mg 6 months to 2 years 8 - 12 kg 50mg 3 - 10 years 13 - 30kg 75mg >10 years >30kg 100mg

Answer 115

Adult: Nebulised (combined with salbutamol): 500 microg in 2 mL (250 microg/mL) Dilute solution for nebulisation to 2-3ml with sodium chloride 0.9% Repeat nebulised dose every 20mins; maximum of 3 doses. MDI: 8 puffs (160 microg), 1 breath per puff - if possible, give via spacer Repeat MDI dose every 20 minutes; maximum of 3 doses. Paediatric: < 6 years > 6 years Subsequent dose if required Notes Nebulised 250 microg in 1 mL 500 microg in 2 mL Repeat nebulised dose every 20 minutes; maximum of 3 doses. Dilute solution for nebulisation to 2-3mL with sodium chloride 0.9% MDI 4 puffs (80 microg) 8 puffs (160 microg) Repeat MDI dose every 20 minutes; maximum of 3 doses Give via spacer

Answer 116

MDI / Space chamber as per Clinical Skill Adult/Child > 6 years: 4-12 puffs (400-1200 microg), repeat every 20 minutes (or sooner if needed) for the first hour Paediatric < 6 years: 2-6 puffs (200-600 microg), repeat every 20 minutes (or sooner if needed) for the first hour Using an MDI with spacer: Press once firmly on the MDI to discharge 1 puff into the spacer Instruct the patient to breathe in and out normally for 4 breaths Repeat 1 puff at a time until the appropriate number of puffs have been taken Repeat as clinically required as per dosing schedule above Nebulised as per Clinical Skill Use 1-2 nebules (5-10 mg in 2.5-5 mL) with 6-8 L/min oxygen in a nebuliser mask Give salbutamol via continuous nebulisation in life threatening asthma Repeat as clinically required

Answer 117

Adult: IM (pre-hospital only): Initial dose: 1 mg/kg Subsequent doses at 5 minute intervals – 0.5 mg/kg Concentration: 200 mg/2 ml = 100 mg/ml IV/IO (pre-hospital only): Initial dose: 5 - 20 mg titrated to effect over at least 1 minute Subsequent doses at 5 minute intervals: 5 - 10 mg titrated to effect Paediatric: IM (pre-hospital only): Initial dose: 1 mg/kg; Subsequent doses at 5 minute intervals: 0.5 mg/kg; Concentration: 200 mg/2 ml = 100 mg/ml IV/IO (pre-hospital only): 0.1 mg/kg administered over at least 1 minute and titrated to effect Repeat at 5 minute intervals as required

Answer 118

IM: Adult 16 or over Initial dose (agreed ideal body weight): up to 2 mg/kg repeat if necessary to a maximum cumulative dose of 200 mg in moderate to severe alcohol intoxication OR up to 4 mg/kg repeat if necessary to a maximum cumulative dose of 400 mg in nil to mild alcohol intoxication Adequate sedation may be achieved with lower doses on a case-by-case basis IV access obtained as soon as practicable: ASMA consult required where IV access is not achieved and further sedation required. IV for maintenance of ketamine-induced sedation only: 0.5 mg/kg repeated every 5 - 10 minutes ONLY IF REQUIRED

Answer 119

IM: Initial dose: 2 mg/kg to a maximum of 200 mg (agreed ideal body weight) IV access obtained as soon as practicable IV/IO: 0.5 mg/kg repeated every 5-10 minutes IF REQUIRED

Answer 120

Intradermal: 0.1mL Intraosseous: Small child: 10mg in 1mL Small adult/large child: 20mg in 2mL Adult: 40mg in 4mL (2 ampoules) May be repeated at a second site if needed. Finger Thoracostomy: 50mg in 5mL

Answer 121

Adult < 70 years: IM 5 mg, repeat once after 10 min if needed and no IV access. IV/IO 2.5 - 5 mg, repeat dose 2.5 mg every 5 min as needed to 15 mg max. Adult ≥ 70 years or frail: IM 2.5 mg, repeat once after 10 min if required and no IV access. IV/IO 2.5 mg, repeat dose 1 mg every 5 min as needed to 15 mg max. Paediatric: IM 0.2 mg/kg max single bolus 5 mg, repeat once after 10 min if needed and no IV access. IV/IO 0.1 mg/kg to a max single bolus dose of 2.5 mg, repeat as needed every 5 min to a 10 mg max. The use of Midazolam in both adults and paediatric patients for other seizure types outside of CPG requires ASMA authority.

Answer 122

DILUTION IV / IO Dilute 15 mg / 3 ml with 12 ml NaCl in 20 ml syringe (equivalent to 1 mg/ml) Part dilution into a 10 ml syringe is no longer advocated Adult < 70 years of age: IV 1 - 2 mg, titrated to effect every 5 - 10 mins as required to a total max dose 5 mg Adult ≥ 70 years or frail: IV 0.5 - 1 mg, titrated to effect every 5 - 10 mins as required to a total max dose 5 mg Paediatric (6-15 years of age): IV 0.5 mg - 1 mg, titrated to effect every 5 - 10 mins as required to a total max dose 5 mg

Answer 123

Adult IV / IO: 1 g slowly over 10 minutes (Rapid administration may cause hypotension) OR 1 g in 250 mL of normal saline, slow IV / IO infusion over 10 minutes. SINGLE DOSE ONLY Paediatric (<12 years) IV / IO: 15 mg/kg slowly over 10 minutes (max injection rate 50 mg/minute) OR 15 mg/kg in 100 mL of normal saline, slow IV / IO infusion over 10 minutes. Maximum total dose of 1 g SINGLE DOSE ONLY

Answer 124

Adult: IM/IV/IO: 0.4-0.8 mg (400-800 microg) repeat dose every 2 minutes as required, titrated to clinical response to a maximum of 10 mg. IN: One spray (1.8 mg) of Nyxoid® into nostril. Repeat at 2 minutes in opposite nostril if the patient does not respond. Paediatric: IM/IV/IO: 0.01 mg/kg (10 microg/kg, maximum dose 0.4 mg (400 microg), repeat every 2-3 minutes minutes as required, titrated to clinical response. If high suspicion of overdose, a 0.1 mg/kg (100 microg/kg) dose (maximum 2 mg) may be given following a lack of response to initial dose.

Answer 125

Each 1ml of solution contains 5mg of prednisolone Administer 1mg/kg to maximum single dose of 25mg Single dose only

Answer 126

IV / IO Dilute 10 mg/2 ml with 8 ml NaCl (equivalent to 1 mg/ml) Adults < 70 years old: IM (preferred route): 10 mg IV: 2.5 - 5 mg titrate to effect Repeat as necessary each 15 mins to a maximum cumulative dose 20 mg/24 hrs (via all routes). Consider switch to IV Midazolam only if necessary after maximum dose reached. Adults > 70 years of age or frail or with dementia: IM (preferred route): 5 mg IV: 2.5 mg Repeat as necessary each 15 mins to a maximum cumulative dose 10 mg/24 hrs (via all routes). Consider switch to IV Midazolam only if necessary after maximum dose reached. Paediatrics 6-15 years old: IM (preferred route): 0.2 mg/kg to a maximum of 5 mg Repeat as necessary each 15 mins to a maximum cumulative dose 10 mg/24 hrs (via all routes). IV: 0.2 mg/kg to a maximum of 5 mg Repeat as necessary each 30 mins to a maximum cumulative dose 10 mg/24 hrs (via all routes).

Answer 127

Cardiac Arrest Paediatric / Newborn:Dilute 1mg adrenaline in 9ml normal saline (1000 mcg in 10mls, 1:10,000)10mcg/kg = 0.1ml/kg (1:10000) every 3-5 minutes. Post-ROSC Paediatric:1mcg/kg every 3-5 min (max bolus 50mcg) to maintain systolic blood pressure > 80 mmHg