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Drug Protocols > Protocols > Flashcards

Protocols Flashcards

1
Q

Indications- Adrenaline

A

 Anaphylaxis OR severe allergic reaction
 Severe life-threatening bronchospasm OR silent chest. (Patients must only be able to speak in single words AND/OR have haemodynamic compromise AND/OR an ALOC.)
 Bradycardia with poor perfusion (unresponsive to atropine AND/OR TCP)
 Cardiac arrest
 Croup (with stridor at rest)
 Shock unresponsive to adequate fluid resuscitation (excluding haemorrhagic cause)

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2
Q

Contraindications-Adrenaline

A

 KSAR

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3
Q

Precautions-Adrenaline

A

 Hypovolaemic shock
 Hypertension
 Patients taking monoamine oxidase inhibitors (MAOIs)

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4
Q

Side effects -Adrenaline

A

 Anxiety
 Hypertension
 Palpitations/tachyarrhythmias
 Pupil dilation

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5
Q

Adrenaline adult dosages-anaphylaxis

A

IMi 500 mcg
Repeated at 5 minutes if no improvement as per ARC guidelines

NEB 5 mg
Single dose only
May be administered for minor facial or tongue swelling thought to be allergic in origin. If stridor present, IM or IV adrenaline must be administered.

IV/IO 20–50mcg (ICP only)
Repeated at 1 minute intervals
No maximum dose

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6
Q

Adrenaline adult dosages- Severe life-threatening bronchospasm OR silent chest
(patients must only be able to speak in single words AND/OR have haemodynamic compromise AND/OR an ALOC.)

A

IM - 500 mcg
Repeated at 5 minutes if no improvement as per ARC guidelines

IV/IO - 20 mcg (ICP)
Repeated at 1 minute intervals.
No maximum dose

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7
Q

Adrenaline adult dosages - Bradycardia with poor perfusion (unresponsive to atropine AND/OR TCP)

A

IV/IO 20 mcg (ICP)

Repeated at 1 minute intervals. No maximum dose

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8
Q

Adrenaline adult dosages - Cardiac arrest

A

IV/IO 1mg

Repeated at 3-5 minute intervals as per ARC guidelines

No maximum dose

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9
Q

Adrenaline adult dosages - Shock unresponsive to adequate fluid resuscitation (excluding haemorrhagic cause)

A

IV/IO 20 mcg (ICP)

Repeated at 1 minute intervals. No maximum dose

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10
Q

Adrenaline paediatric dosages

Anaphylaxis OR severe allergic reaction

A

IM = or > 6 years - 300 mcg
Repeated at 5 minutes if no improvement as per ARC guidelines

< 6 years - 150 mcg
Repeated at 5 minutes if no improvement as per ARC guidelines

NEB 5 mg
Single dose only.
May be administered for minor facial or tongue swelling thought to be allergic in origin. If stridor present, IM or IV adrenaline must be administered.

IV/IO 2 mcg/kg (ICP)
Single dose not to exceed 50 mcg. Repeated at 2 minute intervals.

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11
Q

Adrenaline paediatric dosages -
Severe life-threatening bronchospasm OR silent chest
(patients must only be able to speak in single words AND/OR have haemodynamic compromise AND/OR an ALOC.)

A

IM = or > 6 years - 300 mcg
Repeated at 5 minutes if no improvement as per ARC guidelines

< 6 years - 150 mcg
Repeated at 5 minutes if no improvement as per ARC guidelines

IV/IO 2 mcg/kg (ICP)
Single dose not to exceed 50 mcg. Repeated at 2 minute intervals. No maximum dose

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12
Q

Adrenaline paediatric dosages - Cardiac arrest

A

IV 10 mcg/kg (ICP)
as per ARC guidelines Repeated at 3-5 minute intervals.
No maximum dose

IO 10 mcg/kg
as per ARC guidelines Repeated at 3-5 minute intervals. No maximum dose

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13
Q

Adrenaline paediatric dosages - Croup (with stridor at rest)

A

NEB 5 mg

Single dose only

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14
Q

Adrenaline paediatric dosages - Shock unresponsive to adequate fluid resuscitation
(excluding haemorrhagic cause)

A

IV/IO 2 mcg/kg (ICP)
Single dose not to exceed 50 mcg. Repeated at 2 minute intervals.

No maximum dose

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15
Q

Adrenaline paediatric dosages - Bradycardia with poor perfusion
(unresponsive to atropine AND/OR TCP)

A

IV/IO 2 mcg/kg (ICP)
Single dose not to exceed 50 mcg. Repeated at 2 minute intervals.
No maximum dose

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16
Q

Indications -Amiodarone

A

Cardiac arrest (refractory VF or pulseless VT)

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17
Q

Contra-indications - Amiodarone

A

Nil in Cardiac arrest (refractory VF or pulseless VT)

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18
Q

Precautions - Amiodarone

A 
Cardiac arrest (refractory VF or pulseless VT):
- concomitant use of anti-arrhythmics that prolong the
QT interval
- thyroid disease
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19
Q

Side effects - Amiodarone

A

 Hypotension
 Bradycardia
 Nausea and/or vomiting
 Peripheral paraesthesia

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20
Q

Amiodarone adult dosages - Cardiac arrest (refractory VF or pulseless VT) as per ARC guidelines

A

IV 300 mg
Slow push over 2 minutes.

Repeat once at 150 mg after 5 minutes             Total maximum dose – 450 mg

IO 300 mg
Slow push over 2 minutes.
Repeated once at 150 mg after 5 minutes
Total maximum dose – 450 mg

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21
Q

Amiodarone paediatric dosages - Cardiac arrest (refractory VF or pulseless VT) as per ARC Guidelines

A

IV 5 mg/kg (ICP)
Slow push over 2 minutes.

Single dose only

Syringe preparation: Mix 150 mg (3 mL) of amiodarone with 12 mL of glucose 10% (totalling 15 mL) in a 20 mL syringe to achieve a final concentration of 10 mg/mL.

IO 5 mg/kg
Slow push over 2 minutes.

Single dose only

Syringe preparation: Mix 150 mg (3 mL) of amiodarone with 12 mL of glucose 10% (totalling 15 mL) in a 20 mL syringe to achieve a final concentration of 10 mg/mL.

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22
Q

Indications -Aspirin

A

 Suspected ACS

 Acute cardiogenic pulmonary oedema

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23
Q

Contraindications - Aspirin

A 
 KSAR to aspirin or other NSAIDs
 Chest pain associated with psych stimulant overdose
 Bleeding disorders
 Current GI bleeding or peptic ulcers
 Patients < 12 years
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24
Q

Precautions - Aspirin

A

 Possible aortic aneurysm or any other condition that may require surgery
 Pregnancy
 History of GI bleeding or peptic ulcers
 Concomitant anticoagulant therapy (excluding clopidogrel)

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25
Q

Side effects - Aspirin

A 
 Epigastric pain/discomfort
 Nausea and/or vomiting
 Gastritis
 GI bleeding
 NSAID induced bronchospasm
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26
Q

Aspirin adult dosages -
 Suspected ACS
 Acute cardiogenic pulmonary oedema

A

PO >12 years - 300 mg

Chewed and followed by a small sip of water (where possible)

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27
Q

Indications- Atropine

A

 Bradycardia (with poor perfusion – Pre Adrenaline)
 Envenomation (with increased parasympathetic activity)
 Hypersalivation (with ketamine administration)
 Organophosphate toxicity (with cardiac AND/OR respiratory compromise).

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28
Q

Contraindications - Atropine

A

 KSAR

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29
Q

Precautions -Atropine

A

 Atrial flutter
 Atrial fibrillation
 AMI
 Glaucoma

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30
Q

Side effects - Atropine

A 
 Agitation
 Hallucinations
 Dilated pupils
 Dry mouth/dry skin/reduced bronchial and gastric secretions
 Tachycardia
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31
Q

Atropine adult dosage -

Bradycardia (with poor perfusion)

A

IV/IO 600 mcg (ICP)

Repeated once after 2 minutes

Total maximum dose 1.2 mg

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32
Q

Atropine adult dosages - Envenomation (with increased parasympathetic activity)

A

IM 1.2 mg (ICP)

Repeated at 5 minute intervals.

No maximum dose

IV/IO 1.2 mg (ICP)

Repeated at 5 minute intervals.

No maximum dose

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33
Q

Atropine adult dosages - Hypersalivation (with ketamine administration)

A

IV/IO 600 mcg (ICP)

Single dose only

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34
Q

Atropine adult dosage - Organophosphate toxicity (with cardiac AND/OR respiratory compromise)

A

IM 1.2 mg (ICP)
Repeated at 5 minute intervals.
No maximum dose

IV/IO 1.2 mg (ICP)
Repeated at 5 minute intervals.
No maximum dose

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35
Q

Atropine paediatric dosage - Bradycardia (with poor perfusion)

A

IV/IO 20 mcg/kg (ICP)
Single dose not to exceed 600 mcg.
Repeated once after 2 minutes.
Total maximum dose 40 mcg/kg

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36
Q

Atropine paediatric dosage -
 Envenomation (with increased parasympathetic activity)
 Organophosphate toxicity (with cardiac AND/OR respiratory compromise)

A

IM 20 mcg/kg (ICP)
Single dose not to exceed 600 mcg.
Repeated at 5 minute intervals.
No maximum dose

IV/IO 20 mcg/kg (ICP)
Single dose not to exceed 600 mcg.
Repeated at 5 minute intervals.
No maximum dose

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37
Q

Atropine paediatric dosage -

Hyper-salivation (with ketamine administration)

A

IV/IO 20 mcg/kg (ICP)

Single dose only, not to exceed 600 mcg

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38
Q

Indications - Calcium Gluconate 10%

A

 Suspected hyperkalaemic cardiac arrest.
 Severe hyperkalaemia (with haemodynamic compromise AND/OR significant cardiac rhythm disturbance)
 Calcium channel blocker toxicity
 Hypotension associated with a magnesium infusion (that fails to respond to intravenous fluid therapy

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39
Q

Contraindications - Calcium Gluconate 10%

A

 KSAR

 Digoxin (digitalis) overdose

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40
Q

Precautions - Calcium Gluconate 10%

A

 Respiratory acidosis

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41
Q

Side effects - Calcium Gluconate

A

Suspected hyperkalaemic cardiac arrest:
 nil

For all other SJANT indications IV administration may cause:
 syncope
 hypotension
 bradycardia
 cardiac dysrrhythmias
 cardiac arrest
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42
Q

Calcium Gluconate 10% adult dosage-

 Suspected hyperkalaemic cardiac arrest
 Severe hyperkalaemia
(with haemodynamic compromise ANT/OR significant cardiac rhythm disturbance)
 Calcium channel blocker toxicity
 Hypotension associated with a magnesium infusion (that fails to respond to intravenous fluid therapy)

A

IV/IO 10 mL (ICP)
Slow push over 2 minutes
Repeated once at 10 minutes

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43
Q

Calcium Gluconate 10% paediatric dosages-

 Suspected hyperkalaemic cardiac arrest
 Severe hyperkalaemia (with haemodynamic compromise ANT/OR significant cardiac rhythm disturbance)
 Calcium channel blocker toxicity
 Hypotension associated with a magnesium infusion (that fails to respond to intravenous fluid therapy)

A

IV/IO 0.2 mL/kg (ICP)
Slow push over 2 minutes
Repeated once at 10 minutes

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44
Q

Indications - Ceftriaxone

A

 Suspected meningococcal septicaemia (with a non- blanching petechial AND/OR purpuric rash).

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45
Q

Contraindications - Ceftriaxone

A

 < 1 month old
 KSAR to cephalosporin drugs
 Known anaphylaxis or severe allergic reaction to penicillin based drugs – (isolated minor drug rash attributed to penicillin does not contraindicate the use of ceftriaxone.

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46
Q

Precautions - Ceftriaxone

A

Nil

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47
Q

Side effects - Ceftriaxone

A

 Nausea and/or vomiting

 Pain at the IM administration site

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48
Q

Ceftriaxone Adult dosages

Suspected meningococcal septicaemia
with a non-blanching petechial AND/OR purpuric rash

A

IM 4g
The solution should be administered by deep intramuscular injection
Syringe preparation:
Reconstitute two 2 gram vials with approximately 2.4mL of water for injection to achieve a final concentration of
4 g/4 mL (1 g/mL).

IV 4g
Slow push over 3 - 5 minutes
Syringe preparation:
Reconstitute two 2 gram vials with approximately 8.4 mL of water for injection to achieve a final concentration of
4g/10 mL (400 mg/mL)
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49
Q

Ceftriaxone Paediatric dosages -

Suspected meningococcal septicaemia
with a non-blanching petechial AND/OR purpuric rash

A

IM 100 mg/kg (> 1 month)
The solution should be administered by deep
intramuscular injection
Syringe preparation:
Reconstitute 2 g of ceftriaxone with 3.6 mL of water for injection to achieve a final concentration of
2 g/4 mL (500 mg/mL)

IV 100 mg/kg (> 1 month) -ICP
Slow push over 3 - 5 minutes
Syringe preparation:
Reconstitute 2 g of ceftriaxone with 9.6 mL of water for injection to achieve a final concentration of
2 g/10 mL (200 mg/mL)
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50
Q

Indications - Fentanyl

A

 Significant pain

 Sedation for the maintenance of an established ETT

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51
Q

Contraindications - Fentanyl

A

KSAR or hypersensitivity to fentanyl

NAS administration:

  • GCS < 14
  • suspected nasal or mid fractures
  • blood or mucous obstructing the nasal passage
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52
Q

Precautions - Fentanyl

A 
 Elderly patients
 Hypotension
 Respiratory tract burns
 Respiratory depression and/or failure
 Known addiction to narcotics
 Patients taking monoamine oxidase inhibitors (MAOIs)
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53
Q

Side effects - Fentanyl

A 
 Bradycardia
 Drowsiness
 Hypotension
 Nausea and/or vomiting
 Pin point pupils
 Respiratory depression
 Muscular rigidity (particularly muscles of respiration)
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54
Q

Fentanyl Adult dosages - Significant Pain

A

IM 25–100mcg (ICP)
Repeated at up to 50 mcg every 10 minutes No maximum dose

IV/IO 25–50mcg (ICP)
Repeated at up to 50 mcg every 5 minutes
No maximum dose

NAS 1.5 mcg/kg
Repeated once at 1 mcg/kg after 10 minutes

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55
Q

Fentanyl adult dosage - Sedation for the maintenance of an established ETT

A

IV/IO 25 mcg (ICP)
Consider administration with midazolam. Repeated PRN
No maximum dose

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56
Q

Fentanyl Paediatric dosages

Significant pain

A

NAS > 1 year – 1.5 mcg/kg
Repeated once at 1 mcg/kg at 10 minutes.

Total maximum dose 100 mcg

< 1 year – SJANT on-call medical officer consult and approval required in all situations

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57
Q

Indications - frusemide

A

 Congestive cardiac failure
 Fluid overload
 Oliguria (after correction of hypotension and hypovolamia)

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58
Q

Contraindications - frusemide

A

 KSAR

 Patients < 12 years of age

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59
Q

Precautions - frusemide.

A

 Hypotension

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60
Q

Side effects - frusemide

A

 Marked diuresis can lead to hypotension

 Potassium loss associated with diuresis may aggravate or potentiate dysrrhythmias

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61
Q

Adult dosages - frusemide

 Congestive cardiac failure
 Fluid overload
 Oliguria
after correction of hypotension and hypovolaemia

A

IV 40 mg (ICP)
Consider repeating after 5 minutes.
Maximum total dose 80 mg

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62
Q

Indications - Gastrolyte

A

 Oral correction of fluid and electrolyte loss

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63
Q

Contraindications - Gastrolyte

A

 Not be administered to infants <2 year

 Intestinal obstruction

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64
Q

Precautions - Gastrolyte

A

 Only mixed with water

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65
Q

Side effects - Gastrolyte

A

Nil

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66
Q

Adult dosages Gastrolyte

Symptomatic dehydration (with the ability to self administer)

A

PO 1 sachet
Re-constituted with 200 ml water
May repeat PRN

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67
Q

Gastrolyte paediatric dosage

A

PO 1 sachet
Re-constituted with 200 ml water
May repeat PRN

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68
Q

Indications - Glucagon

A

 Symptomatic hypoglycaemia (with the inability to self- administer oral glucose)

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69
Q

Contraindications - Glucagon

A

KSAR

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70
Q

Precautions - Glucagon

A

Nil

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71
Q

Side effects - Glucagon

A

Nil

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72
Q

Adult dosages - Glucagon

Symptomatic hypoglycaemia
with the inability to self administer oral glucose

A

IM 1mg

Single dose only

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73
Q

Glucagon Paediatric dosages

Symptomatic hypoglycaemia
with the inability to self administer oral glucose

A

IM
>25Kg -1mg Single dose only

< 25 Kg – 500 mcg Single dose only

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74
Q

Indications - Glucose 5%

A

 As a vehicle for drug delivery during IV drug infusion administration.

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75
Q

Contraindications - Glucose 5%

A

Nil

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76
Q

Precautions - Glucose 5%

A

 Hyperglycaemia

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77
Q

Side effects - Glucose 5%

A

Nil

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78
Q

Glucose 5% Adult dosages

As a vehicle for drug delivery during IV drug infusion administration

A

IV INF
As documented on DTP

Maximum Dosage 1000ml

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79
Q

Glucose 5% Paediatric dosages

As a vehicle for drug delivery during IV drug infusion administration

A 
IV INF (ICP)
As documented on DTP

Maximum Dosage 500ml

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80
Q

Indications - Glucose 10%

A

 Symptomatic hypoglycaemia (with the inability to self- administer oral glucose)

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81
Q

Contraindications - Glucose 10%

A

Nil

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82
Q

Precautions - Glucose 10%

A

 Tissue and/or vascular necrosis secondary to extravasation.

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83
Q

Side effects - Glucose 10%

A

Nil

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84
Q

Glucose 10% Adult dosages

Symptomatic hypoglycaemia
with the inability to self administer oral glucose

A

IV 150 ml

Repeated at 100 mL boluses every 5 minutes until BGL > 4.0 mmol/L

IO 150 mL ( ICP)
Repeated at 100 mL boluses every 5 minutes until BGL > 4.0 mmol/L

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85
Q

Glucose 10% Paediatric dosages

Symptomatic hypoglycaemia
with the inability to self administer oral glucose

A

IV 2.5 mL/kg (ICP)
Repeated at 1 mL/kg boluses every 5 minutes
until BGL > 4.0 mmol/L

IO 2.5 mL/kg (ICP)
Repeated at 1 mL/kg boluses every 5 minutes until BGL > 4.0 mmol/L

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86
Q

Indications - Glucose gel

A

 Symptomatic hypoglycaemia (with the ability to ingest oral glucose)

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87
Q

Contra indications - Glucose gel

A

 KSAR
 Unconsciousness
 Patients with difficulty swallowing
 Patients < 2 years

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88
Q

Precautions - Glucose gel

A

Nil

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89
Q

Side effects - Glucose gel

A

 Nausea and/or vomiting

 Diarrhoea

90
Q

Glucose gel Adult dosages

Symptomatic hypoglycaemia (with the ability to ingest oral glucose)

A

PO 15g
Repeated once at 15 minutes
if BGL < 4.0 mmol/L.

Total maximum dose 30 g

91
Q

Glucose gel paediatric dosages

Symptomatic hypoglycaemia (with the ability ingest oral glucose

A

PO > 2 years – 15 g
Repeated once at 15 minutes if BGL < 4.0 mmol/L

Total maximum dose 30 g

92
Q

Indications - Glyceryl Trinitrate

A

 Suspected ACS
 Acute cardiogenic pulmonary oedema
 Autonomic dysreflexia (with a systolic BP > 160 mmHg)
 Irukandji syndrome (with a systolic BP > 160 mmHg)

93
Q

Contra indications - Glyceryl Trinitrate

A

 KSAR
 Heart rate < 50 OR > 150 beats per minute
 Systolic BP < 100 mmHg
 Acute CVA
 Head trauma
 Erectile dysfunction medication (e.g. Viagra® or Levitra®) in the previous 24 hours.

94
Q

Precautions - Glyceryl Trinitrate

A

 Suspected inferior AMI
 Cerebral vascular disease
 Risk of hypotension and/or syncope
 Intoxication (GTN effects are enhanced)
 Erectile dysfunction medication (e.g. Viagra® or Levitra®) in the previous 4 days

95
Q

Side effects - Glyceryl Trinitrate

A 
 Dizziness
 Hypotension
 Syncope
 Reflex tachycardia
 Vascular headaches
96
Q

Glyceryl trinitrate Adult dosages:

*Suspected ACS
(with a systolic BP >100 mmHg)

  • Acute cardiogenic pulmonary oedema (with a systolic BP >100 mmHg)
  • Autonomic dysreflexia (with a systolic BP > 160 mmHg)

*Irukandji syndrome
(with a systolic BP > 160 mmHg)

A

SL 300 mcg – 600 mcg (Tablet)

Repeated at 5 minute intervals

No maximum dose

97
Q

Glyceryl trinitrate Paediatric dosages:

 Autonomic dysreflexia (with a systolic BP > 160 mmHg
 Irukandji syndrome
with a systolic BP > 160 mmHg)

A

SL (ICP)

SJANT on-call medical officer consultation and approval required in all situations.

98
Q

Indications - Hydrocortisone

A

 Moderate OR severe asthma.
 Acute exacerbation of COPD
(with evidence of respiratory distress).
 Severe allergic reaction OR anaphylaxis
(requiring adrenaline administration).
 Symptomatic adrenal insufficiency
(with a known history of Addison’s disease, congenital adrenal hyperplasia, pan-hypopituitarism or long-term steroid administration).

99
Q

Contra indications - Hydrocortisone

A

 KSAR

100
Q

Precautions - hydrocortisone

A

 Hypertension

101
Q

Side effects - hydrocortisone.

A

Nil

102
Q

Adult dosages hydrocortisone

 Moderate OR severe asthma
 Acute exacerbation of COPD (with evidence of respiratory distress)
 Severe allergic reaction OR anaphylaxis (requiring adrenaline administration)

A

IM 200 mg (ICP)
Single dose only

IV 200 mg (ICP)
Single dose only
Slow push over 1 minute

103
Q

Hydrocortisone adult dosages:

Symptomatic adrenal insufficiency
(with a known history of Addison’s disease, congenital adrenal hyperplasia, pan- hypopituitarism or long-term steroid administration

A 
IM 100mg (ICP)
Single dose only

IV 100 mg (ICP)
Single dose only
Slow push over 1 minute

104
Q

Hydrocortisone Paediatric dosages:

 Moderate OR severe asthma
 Severe allergic reaction OR anaphylaxis (requiring adrenaline
administration)
 Symptomatic adrenal insufficiency
(with a known history of Addison’s disease, congenital adrenal hyperplasia, pan-hypopituitarism or long-term steroid administration)

A

IM 5 mg/kg (ICP)

Single dose only, not to exceed 100 mg

IV 5 mg/kg (ICP)

Single dose only, not to exceed 100 mg
Slow push over 1 minute

Note: In all other instances SJANT officers are not authorised to administer hydrocortisone to paediatric patients.

105
Q

Indications - Ipratropium Bromide

A

 Severe bronchospasm OR silent chest

Patients must only be able to speak in single words AND/OR have haemodynamic compromise AND/OR an ALOC

106
Q

Contra indications - Ipratropium bromide

A

 KSAR to anticholinergics

 Patients < 2 years.

107
Q

Precautions - Ipratropium bromide

A

 Glaucoma

 Prostatic hypertrophy

108
Q

Side effects - Ipratropium bromide

A

 Dilated pupils
 Dry mouth
 Palpitations

109
Q

Ipratropium bromide Adult dosages:

Severe life-threatening bronchospasm OR silent chest (patients must only be able to speak in single words AND/OR have
haemodynamic compromise AND/OR an ALOC)

A

NEB 500 mcg

Single dose only

110
Q

Ipratropium bromide Paediatric dosages:

Severe life-threatening bronchospasm OR silent chest
(patients must only be able to speak in single words AND/OR have haemodynamic compromise AND/OR an ALOC)

A

NEB 250 mcg
Single dose only

Note: SJANT officers are not authorised to administer ipratropium bromide to patients < 2 years of age.

111
Q

Indications - Ketamine

A

Severe traumatic pain
(following 0.1 – 0.2 mg/kg morphine) associated with:
* fracture reduction and splinting;
* multiple or significant fractures requiring facilitated extrication.

Severe traumatic pain
(following 0.2 – 0.3 mg/kg morphine) associated with burns.

112
Q

Contra indications - Ketamine

A

 KSAR
 Age < 5 years
 GCS< 12
 Uncontrolled hypertension (SBP > 180 mmHg AND/OR DBP > 11o mmHg)
 Suspected acute ACS or acute heart failure
 Known hydrocephalus or raised intra-ocular pressure

113
Q

Precautions - Ketamine

A

 Age > 65 years
 Patients who have been administered midazolam or other CNS depressant medication
 Patients with significant hypovolaemia – exaggerated effects and a delayed onset of action
 Globe injuries
 Complex facial injuries and fractures
 Patients who have impaired respiratory function
 Patients exhibiting psychotic symptoms

114
Q

Side effects - Ketamine

A 
 Dissociation and trance-like state
 Transient hypertonicity and nystagmus
 Disinhibition
 Emergence (up to 10% more common in Adults)
 Hypertension
 Tachycardia
 Depression of consciousness
 Hypersalivation
 Nausea and/or vomiting
 Laryngospasm
 Respiratory depression (rare)
115
Q

Ketamine Adult dosages

Severe traumatic pain
(following 0.1 – 0.2 mg/kg morphine) associated with:

 fracture reduction and splinting;

 multiple or significant fractures requiring facilitated extrication

A

IV /IO 10–20mg (ICP)
Repeated every 2 – 3 minutes Total maximum dose 1 mg/kg
Syringe preparation:

Mix 200 mg (2 mL) of ketamine with 18 mL sodium chloride 0.9% OR water for injection in a 20 mL syringe to achieve a final concentration of
10 mg/mL.

116
Q

Ketamine adult dosage:

Severe traumatic pain
(following 0.2 – 0.3 mg/kg morphine) associated with:
 burns

A

IV /IO 10–20mg (ICP)

Repeated every 2 – 3 minutes Total maximum dose 1 mg/kg

Syringe preparation:
Mix 200 mg (2 mL) of ketamine with 18 mL sodium chloride 0.9% OR water for injection in a 20 mL syringe to achieve a final concentration of 10 mg/mL.

117
Q

Ketamine Paediatric dosages:

Severe traumatic pain
(following 0.1 – 0.2 mg/kg morphine) associated with:
 fracture reduction and splinting;

 multiple or significant fractures requiring facilitated extrication

A

ICP only
IV /IO > 1 year - 100 mcg/kg (0.1 mg/kg) Repeated every 2 – 3 minutes
Total maximum dose 1 mg/kg

Syringe preparation:
Mix 200 mg (2 mL) of ketamine with 18 mL sodium chloride 0.9% OR water for injection in a 20 mL syringe to achieve a final concentration of
10 mg/mL. Decant 18 mL of the prepared solution and dilute with a further 18mL of sodium chloride 0.9% in a 20 mL syringe to achieve a final concentration of 1 mg/mL.

118
Q

Ketamine paediatric dosage:

Severe traumatic pain
(following 0.2 – 0.3 mg/kg morphine ) associated with:
 burns

A

IV /IO > 1 year - 100 mcg/kg (0.1 mg/kg) ICP
Repeated every 2 – 3 minutes

Total maximum dose 1 mg/kg

Note: SJANT officers are not authorised to administer ketamine to patients < 1 years of age.

119
Q

Indications - Lignocaine 2%

A

 Conscious VT (without haemodynamic compromise)
 To reduce the pain associated with IO drug and fluid administration following EZ-IO® needle insertion (when the patient is not in cardiac arrest)
 Local anaesthesia

120
Q

Contra indications - Lignocaine 2%

A

 Conscious VT without haemodynamic compromise:
- KSAR
- bradycardia
- current heart failure
- heart block or conduction defects
- Torsades de Pointes
 To reduce the pain associated with IO drug and fluid administration following EZ-IO® needle inserted (when patient is not in cardiac arrest):
- KSAR
 Local anaesthesia for the purpose of radial artery line placement:
- KSAR

121
Q

Precautions - Lignocaine 2%

A

 Conscious VT without haemodynamic compromise:
- hypotension and poor perfusion

 Local anaesthesia for the purpose of radial artery line placement:
- potential for intravascular injection

122
Q

Side effects - lignocaine 2%

A

 Convulsions
 Hypotension
 Nausea
 Tinnitus

123
Q

Lignocaine Adult dosages:

Conscious VT
without haemodynamic compromise

A

IV 1 – 1.5 mg/kg (ICP)
slow IV push over 2 minutes

Repeated once at half the initial dose at 10 minutes.

Total maximum dose 300 mg

124
Q

Lignocaine adult dosages:

To reduce pain associated with IO drug and fluid administration following EZ-IO® needle insertion
(when the patient is not in cardiac arrest)

A

IO 60 mg (ICP)

(40 mg followed by a rapid sodium chloride 0.9% 10 mL flush, followed by an additional 20 mg).

Total maximum dose 60 mg.

125
Q

Lignocaine 2% Paediatric dosages:

To reduce pain associated with IO drug and fluid administration following EZ-IO® needle insertion
(when the patient is not in cardiac arrest)

A

IO 1 mg/kg (ICP)
single dose only

Maximum dose 20 mg

Note: In all other instances, SJANT officers are not authorised to administer lignocaine 2% to paediatric patients.

126
Q

Indications - Magnesium sulphate

A

 Box jellyfish (Chironex fleckeri) envenomation (unresponsive to vinegar, ice, narcotic)
 Eclampsia
 Irukandji syndrome (with intractable pain unrelieved by
narcotic analgesia AND/OR systolic BP > 160 mmHg)
 Torsades de Pointes
 Severe life-threatening asthma (only in patients who require IM/IV adrenaline)

127
Q

Contra Indications - Magnesium sulphate

A

 KSAR
 Heart block
 Renal failure

128
Q

Precautions - Magnesium sulphate

A

 Renal impairment

129
Q

Side effects - Magnesium sulphate

A

 Pain at the cannulation site
 Magnesium toxicity
- hypotension/respiratory depression
- loss of deep tendon reflexes

130
Q

Magnesium sulphate Adult dosages

Severe life-threatening asthma
only in patients who have required IM/IV adrenaline

A

IV 10 mmol (ICP)
Slow push over 10 minutes.
Single dose only

IO 10 mmol (ICP)
Slow push over 10 minutes.
Single dose only

131
Q

Magnesium sulphate dosages:

Torsades de Pointes

A

IV / IO 10 mmol (ICP)
Slow push over 10 minutes.
Repeated once at 10 minutes

Total maximum dose 20 mmol

132
Q

Magnesium sulphate dosages:

```
Irukandji syndrome
with intractable pain unrelieved by narcotic analgesia AND/OR systolic BP > 160 mmHg
~~~

A

IV/IO Loading dose – 20 mmol (ICP)
Slow push over 10 minutes.

Repeated once at 10 minutes (only if indicated for ongoing treatment).

133
Q

Magnesium sulphate Adult dosages:

Eclampsia

A

IV Loading dose – 20 mmol (ICP)
Slow push over 10 minutes.
Repeated once at 10 minutes (only if indicated for ongoing treatment).

134
Q

Magnesium sulphate adult dosages:

Box jellyfish (Chironex fleckeri) envenomation (unresponsive to vinegar, ice, narcotic)

A

IV /IO 20 mmol (ICP)

Slow push over 10 minutes.
Single dose only

135
Q

Magnesium sulphate Paediatric dosages:

Severe life-threatening asthma
only in patients who have required IM/IV adrenaline

A

IV / IO 0.1 mmol/kg (ICP)
(rounded up to the nearest 0.5 mmol)
Slow push over 10 minutes.
Single dose only, not to exceed 5 mmol

136
Q

Magnesium sulphate paediatric dosages:

Torsades de Pointes

A

IV /IO 0.1 mmol/kg (ICP)
(rounded up to the nearest 0.5 mmol)
Slow push over 10 minutes.
Single dose not to exceed 5 mmol

Repeated once at 10 minutes

Total maximum dose 10 mmol

137
Q

Magnesium sulphate Paediatric dosages:

 Irukandji syndrome
(with intractable pain unrelieved by narcotic analgesia AND/OR systolic BP > 160 mmHg)
 Box jellyfish (Chironex fleckeri) envenomation
(unresponsive to vinegar, ice, narcotic)

A

IV / IO 0.1 mmol/kg (ICP)
(rounded up to the nearest 0.5 mmol)
Slow push over 10 minutes.
Single dose not to exceed 5 mmol

Repeated once at 10 minutes.

Total maximum dose 10 mmol

138
Q

Indications - Methoxyfluorane

A

Pain

139
Q

Contra indications - Methoxyfluorane

A

 KSAR
 Patients < 5 year
 Concurrent use of tetracycline antibiotics
 History of significant liver or renal disease
 Pre eclampsia
 History of malignant hyperthermia

140
Q

Precautions - Methoxyfluorane

A

 ALOC

 Intoxicated or drug affected patients

141
Q

Side effects - Methoxyfluorane

A

 ALOC
 Cough
 Renal/hepatic failure (following repeated high dose exposure)

142
Q

Methoxyfluorane Adult dosages:

Pain

A

INH 3 mL self-administered

Repeated once after 20 minutes.

Total maximum dose 6 mL.

143
Q

Methoxyfluorane Paediatric dosages:

Pain

A

INH 3 mL > 5 year, self-administered

Single dose only.

144
Q

Indications - Metoclopramide

A

 Nausea AND/OR vomiting
 Prophylactic use if the patient has previously experienced nausea AND/OR vomiting with narcotics AND/OR motion sickness
 Suspected Spinal Injuries
 Aero Medical Evacuation

145
Q

Contra indications - Metoclopramide

A

 KSAR
 Patients < 12 years
 History of dystonic reactions
 Not to be given within 6 hours of phenothiazine administration (e.g. Stemetil® (prochlorperazine)/ promethazine)
 GI haemorrhage
 Patients with bowel obstruction or perforation

146
Q

Precautions - Metoclopramide

A

 Patients with undiagnosed abdominal pain

147
Q

Side effects - Metoclopramide

A

 Drowsiness, lethargy
 Dry mouth
 Oculogyric crisis
 Dystonic reaction

148
Q

Metoclopramide Adult dosages:

 Nausea AND/OR vomiting
 Prophylactic use if the patient has previously experienced nausea AND/OR vomiting with narcotics AND/OR motion
sickness
 As per indications

A

IM > 12 years – 10 mg

IV >12 years – 10 mg

Slow push over 1 – 2 minutes.

149
Q

Indications - Midazolam

A

 Seizures/convulsions
 Sedation for:
*maintenance of established ETT
*severely agitated patients (not due to pain) agitated head injuries *to facilitate assessment and treatment
*procedures (e.g. TCP or cardioversion)
*ketamine disinhibition or agitated emergence

150
Q

Contra indications - Midazolam

A

 KSAR to benzodiazepines

 Patients being restrained in a prone position

151
Q

Precautions - Midazolam

A

 Reduced dosages may be required in elderly patients, patients with chronic renal failure, congestive cardiac failure, or shock.
 Can cause severe respiratory depression in patients with COPD.
 Myasthenia gravis
 Multiple sclerosis

152
Q

Side effects - Midazolam

A

 Hypotension

 Respiratory depression particularly when associated with alcohol or narcotics.

153
Q

Midazalom Adult dosages:

Seizures/convulsions

A

IN 5 mg
Repeated PRN after 2 minutes
Maximum dose 10 mg

IM 5 mg
Repeated PRN every 10 minutes
Maximum dose 20 mg

IV Up to 2.5mg
Repeated PRN every 5 minutes
No maximum dose

IO Up to 2.5mg (ICP)
Repeated PRN every 5 minutes
No maximum dose

154
Q

Midazolam adult dosages:

Sedation for maintenance of an established ETT

A

IV / IO 1 - 2.5 mg (ICP)
Consider administration with morphine/fentanyl.
RepeatedPRN. Maximumdose20mg

155
Q

Midazolam adult dosages:

Sedation for agitated head injuries (to facilitate assessment and treatment)

A

IV/IO 1 - 2.5 mg (ICP)

Repeated PRN every 5 minutes until patient is coopreative or allows administration of oxygen and maintenance of spinal immobilisation. Should be avoided in significant hypovolaemia.

Maximum dose 20 mg

SJANT medical officer consultation and approval required to exceed maximum dose.

156
Q

Midazolam Adult dosages:

Sedation for procedures (e.g. TCP or cardioversion)

A

IV / IO 1mg (ICP)

Repeated every 2 minutes until moderate level of
sedation achieved.

Maximum dose 20 mg

157
Q

Midazolam adult dosages:

Sedation for severely agitated patients (not due to pain)

A

IM 2.5-5mg
Repeated PRN every 10 minutes to achieve moderate sedation.

Total maximum dose 20 mg.

IV 1 – 2.5 mg

Repeated PRN every 5 minutes to achieve moderte
sedation.

Total maximum dose 20 mg.

SJANT medical officer consultation and approval required to exceed maximum dose.

158
Q

Midazolam adult dosages:

Sedation for ketamine disinhibition or agitated emergence

A

IV 1 – 2.5 mg (ICP)
Repeated PRN.

Total maximum dose 5 mg

159
Q

Midazolam Paediatric dosages:

Seizures/convulsions

A

IM 200 mcg/kg
Single dose not to exceed 5 mg
Repeated at half the initial dose (max 2.5 mg) at 10 minute intervals.
No maximum dose

IN 5 mg
Repeated PRN after 2 minutes
Maximum dose 10 mg

IV / IO 100 mcg/kg (ICP)
Single dose not to exceed 2.5 mg.
Repeated at 5 minute intervals.

160
Q

Midazolam paediatric dosages:

Sedation for patients suffering ketamine disinhibition or agitated emergence

A

IV / IO 50 mcg/kg (ICP)
Single dose not to exceed 2.5 mg.
Repeated after 5 minutes
Total maximum dose of 5 mg

161
Q

Midazolam paediatric dosages:

Sedation for maintenance of an established ETT

A

IV / IO Up to 100 mcg/kg (ICP)
Single dose not to exceed 2.5 mg.
Consider administration with morphine. Repeated after 5 minutes
No maximum dose

162
Q

Midazolam Paediatric dosages:

Sedation for all other indications

A

IM

SJANT on-call medical officer consultation and approval required in all situations.

100 mcg/kg

Single dose not to exceed 2.5 mg. Repeated PRN after 5 minutes

Total maximum dose 5 mg

IV / IO

SJANT on-call medical officer consultation and approval required in all situations.

100 mcg/kg

Single dose not to exceed 2.5 mg. Repeated PRN after 5 minutes

Total maximum dose 5 mg

163
Q

Indications - Morphine

A

 Significant pain
 Autonomic dysreflexia
(with a systolic BP > 160 mmHg)
 Sedation for the maintenance of an established ETT

164
Q

Contra indications - Morphine

A

KSAR

165
Q

Precautions - Morphine

A 
 Elderly patients
 Hypotension
 Respiratory tract burns
 Respiratory depression and/or failure
 Known addiction to narcotics
 Patients on monoamine oxidase inhibitors (MAOIs)
166
Q

Side effects - Morphine

A 
 Bradycardia
 Drowsiness
 Hypotension
 Nausea and/or vomiting
 Pin point pupils
 Respiratory depression
167
Q

Morphine Adult dosages:

 Significant pain
 Autonomic dysreflexia (with a significant BP > 160 mmHg)

A

IM 2.5–10mg
Repeated at up to 5 mg every 10 minutes Maximum dose 20 mg

IV 2.5-5mg
Repeated at up to 5 mg every 5 minutes
Titrate to pain control
No maximum dose

IO 2.5-5mg (ICP)
Repeated at up to 5 mg every 5 minutes
Titrate to pain control
No maximum dose

168
Q

Morphine adult dosages:

Sedation for the maintenance of an established ETT

A

IV 2.5 mg (ICP)
Consider administration with midazolam. Repeated PRN.
No maximum dose

IO 2.5 mg (ICP)
Consider administration with midazolam. Repeated PRN.
No maximum dose

169
Q

Morphine Paediatric dosages:

 Significant pain
 Autonomic dysreflexia (with a significant BP > 160 mmHg)

A

IM > 1 year – 100 – 200 mcg/kg
Single maximum dose 5 mg
Total maximum dose 200 mcg/kg

< 1 year – SJANT on-call medical officer consultation and approval required in all situations.

IV/IO > 1 year –100 mcg/kg
Single maximum dose 2.5 mg
Repeated at 50 mcg/kg (maximum 2.5 mg) at 10 minute intervals
No maximum dose

< 1 year – SJANT on-call medical officer consultation and approval required in all
situations.

170
Q

Morphine Paediatric dosages:

Sedation for the maintenance of an established ETT

A

IV/IO > 1 year – 100 mcg/kg (ICP)
Single dose not to exceed 2.5 mg.

Consider administration with midazolam
No maximum dose

< 1 year – SJANT on-call medical officer consultation and approval required in all situations.

Note: SJANT officers are not authorised to administer morphine to paediatric patients presenting with cardiogenic chest pain.

171
Q

Indications - Naloxone

A

Respiratory depression (secondary to the administration of narcotic drugs).

172
Q

Contra indications - Naloxone

A

KSAR

173
Q

Precautions - Naloxone

A

Use with caution on patients with pre-existing cardiac disease.

174
Q

Side effects - Naloxone

A

 Narcotic reversal can cause combativeness, vomiting, sweating, tachycardia and hypertension.
 May produce acute withdrawal convulsions in the chronic narcotic user.
 Pulmonary oedema

175
Q

Naloxone Adult dosages:

Respiratory depression (secondary to the administration of narcotic drugs)

A

IM 800 mcg

Maximum Dose : 4.0 mg

IV 50 mcg

Repeated PRN to facilitate airway management, titrating to patients response.

No maximum dose.

176
Q

Naloxone Paediatric dosages:

Respiratory depression (secondary to the administration of narcotic drugs)

A

IM 20 mcg/kg

Single dose only, not to exceed 800 mcg.

IV/IO 20 mcg/kg (ICP)

Titrating to patients response No maximum dose.

177
Q

Indications - Ondansetron

A 
 Nausea AND/OR vomiting.
 Prophylactic use if the patient has previously experienced
nausea AND/OR vomiting with narcotics.
 Suspected Spinal Injuries
 Aero Medical Evacuation
178
Q

Contra indications - Ondansetron

A

 KSAR to Ondansetron or other 5-HT3 receptor antagonists.

 Patients under the age of 3 years

179
Q

Complications - Ondansetron

A

 Hepatic impairment

 Intestinal obstruction

180
Q

Side effects - Ondansetron

A 
 Headache
 Constipation
 Sensation of warmth or flushing
 Extrapyramidal effects
 Dysrrhythmias
181
Q

Ondansetron Adult dosages:

 Nausea AND/OR vomiting
 Prophylactic use if the patient has previously experienced nausea AND/OR vomiting with narcotics

A

ODT 4mg

Single dose only

182
Q

Ondansetron Paediatric dosages:

 Nausea AND/OR vomiting
 Prophylactic use if the patient has previously experienced nausea AND/OR vomiting with narcotics

A

ODT > 3 years – 2 mg
Single dose only

Note: SJANT officers are not authorised to administer Ondansetron to paediatric patients under the age of 3 years.

183
Q

Contra indications - Oxygen

A

 Known paraquat poisoning with SpO2 > 88

 History of bleomycin therapy with SpO2 >88.

184
Q

Precautions - Oxygen

A

 Patients with paraquat poisoning or bleomycin lung injury may be harmed by supplemental oxygen. Avoid oxygen unless the patient is hypoxaemic – target Sp02 88 – 92%
 Prolonged administration to premature neonates.
 High concentration given to COPD patients with hypoxic drive.

185
Q

Side effects - oxygen

A

 Hypoventilation in some COPD patients with hypoxic drive.

 Drying of airway mucous membranes.

186
Q

Indications - Paracetomol

A

 Minor pain and fever

187
Q

Contra indications - Paracetomol

A

 KSAR

 Patients < 25 Kg

188
Q

Complications - Paracetomol

A

 Hepatic or renal dysfunction

 Patients taking anticoagulant medications

189
Q

Side effects - Paracetomol

A

 Nausea

190
Q

Paracetomol Adult dosages:

Minor pain and fever

A

PO 0.5 g – 1 g
Repeated every 4 hours
Total max dose 4 g in 24 hours

191
Q

Paracetomol Paediatric dosages:

Minor pain and fever

A

PO > 25Kg -20mg/kg Single dose only

Must not be administered within 4 hours of previous paracetamol administration.

Note: SJANT officers are not authorised to administer paracetamol to paediatric patients less than ≤ 25 Kg.

192
Q

Indications - Salbutomol

A

 Bronchospasm

 Suspected hyperkalaemia (with QRS widening AND/OR AV dissociation)

193
Q

Contra indications - Salbutomol

A

 KSAR

 Patients < 2 years

194
Q

Precautions - Salbutomol

A

 Acute pulmonary oedema

 Ischaemic heart disease

195
Q

Side effects - Salbutomol

A

 Anxiety
 Tachyarrhythmias
 Tremors
 Hypokalaemia and metabolic acidosis

196
Q

Salbutomol Adult dosages:

Bronchospasm

A

NEB 5 mg
Repeated PRN
No maximum dose

197
Q

Salbutomol adult dosages:

Suspected hyperkalaemia (with QRS widening AND/OR AV dissociation)

A

NEB 20 mg

Single dose only

198
Q

Salbutomol Paediatric dosages:

Bronchospasm

A

NEB = or > 2 years - 5 mg
Repeated PRN
No maximum dose

Note:
SJANT officers are not authorised to administer salbutamol to paediatric patients presenting with bronchospasm under the age of 2 years.

SJANT officers are not authorised to administer salbutamol to paediatric patients presenting with suspected hyperkalaemia with QRS widening AND/OR AV dissociation.

199
Q

Indications - Sodium bicarbonate 8.4%

A

 Cardiac arrest:
* > 15 minutes duration;
* secondary to suspected hyperkalaemia (e.g. chronic renal failure);
* secondary to tricyclic antidepressant (TCA) overdose
 Significant injury with potential for crush syndrome
 TCA overdose with cardiac rhythm disturbance (prolonged QRS.QT interval) OR attributed seizure activity.
 Suspected hyperkalaemia (with QRS widening AND/OR AV dissociation)

200
Q

Contra indications - Sodium bicarbonate 8.4%

A

Nil.

201
Q

Complications - Sodium bicarbonate 8.4%

A

Administration of sodium bicarbonate 8.4% in the paediatric resuscitation may worsen respiratory acidosis.

202
Q

Side effects - Sodium bicarbonate 8.4%

A

 Cerebral oedema

 Congestive heart failure

203
Q

Sodium bicarbonate 8.4% Adult dosages:

 Cardiac arrest
- > 15 minutes duration
- secondary to suspected hyperkalaemia (e.g. chronic renal failure)
- secondary to TCA overdose
 Significant injury with potential for crush syndrome
 TCA overdose with cardiac rhythm disturbance
(prolonged QRS/QT interval) OR attributed seizure activity
 Suspected hyperkalaemia
(with QRS widening AND/OR AV dissociation)

A 
IV 100mL ( ICP only except potential for crush syndrome)
Single dose only
IO 100mL (ICP)
Single dose only
204
Q

Sodium bicarbonate 8.4% Paediatric dosages:

 Cardiac arrest
- > 15 minutes duration
- secondary to suspected hyperkalaemia (e.g. chronic renal failure)
- secondary to TCA overdose
 Significant injury with potential for crush syndrome
 TCA overdose with cardiac rhythm disturbance
(prolonged QRS/QT interval) OR attributed seizure activity
 Suspected hyperkalaemia
(with QRS widening AND/OR AV dissociation)

A

IV 1mL/kg (ICP only)
Single dose only

IO 1 mL/kg (ICP only)
Single dose only

205
Q

Indications - Sodium chloride 0.9%

A

 Hypovolaemic shock (Inadequate tissue perfusion)
 Burns deep dermal/full thickness > 15%
 Cardiogenic shock (Inadequate tissue perfusion)
 To dissolve and dilute drugs for the purpose of IM, IV or IO administration
 As a flush following IV or IO drug administration.

206
Q

Contraindications - Sodium chloride 0.9%

A

Nil

207
Q

Precautions - Sodium chloride 0.9%

A

 Patients with acute and/or history of heart failure
 Pre-existing renal failure
 Uncontrolled haemorrhage (unless associated with severe head injury.

208
Q

Side effects - Sodium chloride 0.9%

A

 Excessive administration will result in fluid overload.

209
Q

Sodium chloride 0.9% Adult dosages:

 Hypovolaemic shock
*Inadequate tissue perfusion/shock
 Burns deep dermal/full thickness > 15%

A

IV INF 250 - 500mL aliqots

Repeat as required – titrate according to the
patient’s physiological response to treatment.

Total maximum dose 40 mL/kg.

IO INF 250 - 500mL aliqots (ICP only)

Repeat as required – titrate according to the
patient’s physiological response to treatment.

Total maximum dose 40 mL/kg.

Further fluid may be administered by ICP officers following SJANT on-call medical officer consultation and approval.

210
Q

Sodium chloride 0.9% adult dosages:

To dissolve and dilute drugs for the purpose of IM, IV or IO administration

A

IM
As documented on DTP

IV
As documented on DTP

IO
As documented on DTP

211
Q

Sodium chloride 0.9% adult dosages:

As a flush following IV or IO drug administration

A

IV
PRN

IO
PRN

212
Q

Sodium chloride 0.9% Paediatric dosages:

 Hypovolaemic shock
*Inadequate tissue perfusion/shock
 Burns deep dermal/full thickness > 15%

A

IV INF 20 mL/kg (ICP only)

May be repeated once following assessment of patient’s needs and physiological response to treatment.

Total maximum dose 40 mL/kg.

Further fluid may be administered by ICP officers following SJANT on-call medical officer consultation and approval.

IO INF 20 mL/kg (ICP only)

May be repeated once following assessment of patient’s needs and physiological response to treatment.

Total maximum dose 40 mL/kg.

Further fluid may be administered by ICP officers following SJANT on-call medical officer consultation and approval.

213
Q

Sodium chloride 0.9% paediatric dosages:

To dissolve and dilute drugs for the purpose of IM, IV or IO administration

A

IM
As documented on DTP

IV (ICP only)
As documented on DTP

IO
As documented on DTP

214
Q

Sodium chloride 0.9% Paediatric dosages:

As a flush following IV or IO drug administration

A

IV (ICP only)
PRN

IO
PRN

215
Q

Indications - water for injection

A

To dissolve and dilute drugs for the purpose of IM, IV, NEB or IO administration.

216
Q

Contraindications - water for injection

A

Nil

217
Q

Precautions - water for injection

A

Nil

218
Q

Side effects - water for injection

A

Nil

219
Q

Water for injection Adult dosages:

To dissolve and dilute drugs for the purpose of IM, IV or IO administration

A

IM
As documented on DTP

IV
As documented on DTP

IO
As documented on DTP

220
Q

Water for injection Paediatric dosages:

To dissolve and dilute drugs for the purpose of IM, IV or IO administration

A

IM
As documented on DTP

IV (ICP only)
As documented on DTP

IO
As documented on DTP

221
Q

Sodium chloride adult dosages:

 Cardiogenic shock
Inadequate tissue perfusion/shock

A

IV/IO INF 250mL aliqots (ICP only)

Repeat as required – titrate according to the
patient’s physiological response to treatment.

 Excessive fluid infusion may lead to cardiogenic pulmonary oedema in the cardiac patient.

Total maximum dose 1000 ml

222
Q

Sodium chloride paediatric dosages:

 Cardiogenic shock
*Inadequate tissue perfusion/shock

A

IV/IO INF

SJANT on-call medical officer consultation and approval required in all situations.

Drug Protocols (1 decks)

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