Traffic Lights Flashcards
Indications, Contras and Precautions + Doses as per CPGs
Adrenaline - Presentation
1 mg in 1 mL glass ampoule (1:1000)
1 mg in 10 mL glass ampoule (1:10,000)
Adrenaline - Primary emergency indications
- Cardiac arrest - VF/VT, Asystole or PEA
- Inadequate perfusion (cardiogenic or non-cariogenic/non-hypovolaemic)
- Bradycardia with poor perfusion
- Anaphylaxis
- Severe asthma - imminent life threat not responding to nebuliser therapy, or unconscious with no BP
- Croup
Adrenaline - Contraindications
- Hypovolaemic shock without adequate fluid replacement
Adrenaline - Precautions
Consider reduced dose for:
- Elderly/frail Pt
- Pt with cardiovascular disease
- Pt on monoamine oxidase inhibitors
- Higher doses may be considered for Pts on beta blockers
Aspirin- Presentation
300 mg chewable tablet
300 mg soluble/water dispensable tablet
Aspirin - Primary emergency indications
- ACS
Aspirin - Contraindications
- Hypersensitivity to aspirin/salicylates
- Actively bleeding peptic ulcers
- Bleeding disorders
- Suspected dissecting aortic aneurysm
- Chest pain associated with psychostimulant OD if systolic BP >160mmHg
Aspirin - Precautions
- Peptic ulcers
- Asthma
- Pt on anticoagulants
Dexamethasone - Presentation
8 mg in 2 mL glass vial
Dexamethasone - Primary emergency indications
- Bronchospasm associated with acute respiratory distress not responsive to nebulised Salbutamol
- Moderate - severe croup
- Acute exacerbation of COPD
Dexamethasone - Contraindications
- Known hypersensitivity
Dexamethasone - Precautions
- Solutions which are not clear or are contaminated should be discarded
Dextrose 10 - Presentation
25g in 250mL infusion soft pack
Dextrose 10 - Primary emergency indications
- Diabetic hypoglycaemia (BGL analysis < 4 mol/L) in Pt with altered conscious state who is unable to self-administer oral glucose
Dextrose 10 - Contraindications
- Nil of significance in the above indication
Dextrose 10 - Precautions
- Nil of significance in the above indication
Fentanyl - Presentation
100 mcg in 2 mL glass ampoule
250 mcg in 1 mL glass ampoule or cartridge (IN use only)
Fentanyl - Primary emergency indications
- Sedation to facilitate intubation
- Sedation to maintain intubation
- Sedation to facilitate transthoracic pacing
- Sedation to facilitate synchronised cardioversion
- CPR interfering Pt - ALS
- Analgesia - IV/IN
- Hx of hypersensitivity or allergy to morphine
- Known renal impairment/failure
- Short duration of action desirable
- Hypotension
- Nausea and/or vomiting
- Severe headache
Fentanyl - Contraindications
- Hx of hypersensitivity
- Late second stage of labour
Fentanyl - Precautions
- Elderly/frail Pt
- Impaired hepatic function
- Respiratory depression e.g. COPD
- Current asthma
- Pt on monoamine oxidase inhibitors
- Known addiction to opioids
- Rhinitis, rhinorrhea or facial trauma (IN route)
Glucagon - Presentation
1mg (IU) in 1mL hypokit
Glucagon - Primary emergency indications
- Diabetic hypoglycaemia (BGL <4mmol/L) in Pt with an altered conscious state who are unable to self-administer oral glucose
Glucagon - Contraindications
- Nil of significance in the above indication
Glucagon - Precautions
- Nil of significance in the above indication
GTN - Presentation
- 3mg tablet
- 6mg tablets
Transdermal GTN Patch (50mg 0.4mg/hr release)
GTN - Primary emergency indications
- Chest pain with ACS
- Acute LVF
- Hypertension associated with ACS
- Autonomic dysreflexia
- Preterm labour (consult)
GTN - Contraindications
- Known hypersensitivity
- Systolic blood pressure <110 mmHg tablet
- Systolic blood pressure <90 mmHg patch
- Sildenafil Citrate (Viagra) or Vardenafil (Levitra) administration in the last 24hr or Tadalafil (Cialis) administration in the previous 4 days (PDE5 inhibitors)
- Heart rate > 150bpm
- Bradycardia HR <50bpm (excluding autonomic dysreflexia)
- VT
- Inferior STEMI with systolic BP <160 mmHg
- Right ventricular MI
GTN - Precautions
- No previous administration
- Elderly Pt
- Recent MI
- Concurrent use with other tocolytics
Ipratropium Bromide - Presentation
250 mcg in 1 mL nebule or polyamp
Ipratropium Bromide - Primary emergency indications
- Severe respiratory distress associated with bronchospasm
- Exacerbation of COPD irrespective of severity
Ipratropium Bromide - Contraindications
- Known hypersensitivity to Atropine or its derivatives
Ipratropium Bromide - Precautions
- Glaucoma
- Avoid contact with eyes
Methoxyflurane - Presentation
3 mL glass bottle
Methoxyflurane - Primary emergency indications
- Pain relief
Methoxyflurane - Contraindications
- Pre-existing renal disease / renal impairment
- Concurrent use of tetracycline antibiotics
- Exceeding total dose of 6 mL in 24hr period
- Personal or family history of malignant hypothermia
- Muscular dystrophy
Methoxyflurane - Precautions
- The Penthrox inhaler must be hand-held by the Pt so that if unconsciousness occurs it will fall from the patient’s face. Occasionally the operator may need to assist but must continuously assess the level of consciousness
- Pre-eclampsia
- Concurrent use with oxytocin may cause hypotension
Morphine - Presentation
10 mg in 1 mL glass ampoule
Morphine - Primary emergency indications
- Pain relief
- Sedation to maintain intubation
- Sedation to enable intubation
- RSI
Morphine - Contraindications
- History of hypersensitivity
- Renal impairment / failure
- Late second stage of labour
Morphine - Precautions
- Elderly / frail Pt
- Hypotension
- Respiratory depression
- Current asthma
- Respiratory tract burns
- Known addiction to opioids
- Acute alcoholism
- Pt on monoamine oxidase inhibitors
Naloxone - Presentation
0.4 mg in 1 mL glass ampoule
Naloxone - Primary emergency indications
- Altered conscious state and respiratory depression secondary to administration of opioids or related drugs
Naloxone - Contraindications
- Nil of significance in the above indication
Naloxone - Precautions
- If Pt is known to be physically dependent on opioids, be prepared for a combative Pt after administration
- Neonates
Normal Saline - Presentation
10 mL polyamp
500 mL and 1000 mL infusion soft pack
Normal Saline - Primary emergency indication
- As a fluid replacement in volume depleted patients
- Cardiac arrest secondary to hypovolaemia or where the Pt might be fluid responsive
- To expand intravascular volume in the non-cardiac, non-hypovolaemic hypotensive Pt e.g. anaphylaxis, burns. sepsis
- As a fluid challenge in unresponsive, non-hypovolaemic, hypotensive patients (other than LVF). e.g. asthma
- Fluid for diluting and administering IV drugs
- Fluid TKVO for IV administration of emergency drugs
Normal Saline - Contraindications
- Nil of Significance in the above indication
Normal Saline - Precautions
- Consider modifying factors when administering for hypovolaemia
Ondansetron - Presentation
4 mg orally disolved tablet
8 mg in 4 mL glass bottle
Ondansetron - Primary emergency indications
- Undifferentiated nausea and vomiting
- Prophylaxis for spinally immobilised or eye injured Pt
- Vestibular nausea in Pt <21 years of age
Ondansetron - Contraindications
- Known hypersensitivity
- Concurrent Anpomorphine use
- Known long Q-T syndrome
- Hypokalaemia or hypomagnesaemia
Ondansetron - Precautions
- Pt with liver disease should not receive more than 8 mg of Ondansetron per day
- Care should be taken with patients on diuretics who may have an underlying electrolyte imbalance
- Ondansetron contains aspartame and should not be given to patients with phenylketonuria
- Concurrent use of Tramadol
- Pregnancy
Paracetamol - Presentation
500 mg tablets
120 mg in 5 mL oral liquid (24 mg/mL)
Paracetamol - Primary emergency indications
- Mild pain
- Headache
Paracetamol - Contraindications
- Hypersensitivity to paracetamol
- Children < 1 month of age
- Paracetamol already administered within past 4hrs
- Total paracetamol intake within past 24hrs exceeding 4 g (adults) or 60 mg/kg (children)
- Chest pain in suspected acute coronary syndrome
Paracetamol - Precautions
- Impaired hepatic function or liver disease
- Elderly/frail
- Malnourished
Prochlorperazine (Stemetil) - Presentation
12.5 mg in 1 mL glass ampoule
Prochlorperazine (Stemetil) - Primary emergency indications
- Treatment or prophylaxis of nausea / vomiting for
- Motion sickness
- Planned aeromedical evacuation
- Known allergy or C/I to Ondansetron administration
- Headache irrespective of nausea / vomiting
- Vertigo
Prochlorperazine (Stemetil) - Contraindications
- Circulatory collapse (cool, pale, clammy skin, tachycardia, hypotension)
- CNS depression
- Previous hypersensitivity
- Pt < 21 years of age
- Pregnancy
Prochlorperazine (Stemetil) - Precautions
- Hypotension
- Epilepsy
- Pt affected by alcohol or on anti-depressants
Salbutamol - Presentation
5 mg in 2.5 mL polyp
pMDI (100 mcg per actuation)
Salbutamol - Primary emergency indications
- Respiratory distress with suspected bronchospasm:
- asthma
- severe allergic reactions
- COPD
- smoke inhalation
- oleoresin capsicum spray exposure
Salbutamol - Contraindications
- None of significance in the above indications
Salbutamol - Precautions
- Large doses of Salbutamol have been reported to intracellular metabolic acidosis