1
Q
Aspirin Description
A
Aspirin has the following pharmacological actions:
- Analgesic
- Antipyretic
- Anti-inflammatory
- Anti-platelet aggregation agent
Reduces mortality significantly in Acute Myocardial Infarction by minimising platelet aggregation and thrombus formation in order to retard the progression of coronary artery thrombosis.
2
Q
Aspirin Indications
A
- Chest pain or discomfort of presumed cardiac origin.
3
Q
Aspirin Contraindications
A
- Known hypersensitivity to aspirin / salicylates.
- In asthmatic patients with known hypersensitivity to salicylates.
- Children < 12 years of age
4
Q
Aspirin Precautions / Complications
ASHING
A
- Actively bleeding peptic ulcers.
- Suspected AAA.
- Heart burn,
- Increased bleeding time.
- Nausea
- GI bleeding
5
Q
Adrenaline Description
A
- 1mg in 1ml (1:1000);
- A naturally occurring sympathomimetic agent;
- Causes peripheral vasoconstriction;
- Stimulation of cardiac conduction system causes increased contractions;
- Causes bronchodilatation and dilation of blood vessels in muscles;
- IV/IO: Onset 30 seconds, peak 3-5 minutes, duration 5-10 minutes;
- IM: Onset 30-90 seconds, peak 5-10 minutes, duration 5-10 minutes
6
Q
Adrenaline Indications
CASS
A
- Cardiac arrest;
- Anaphylaxis;
- Severe asthma;
- Severe croup with retractive breathing.
7
Q
Adrenaline Precautions / Complications
A
- Ischaemic Heart Disease;
- In the hypothermic patient, withhold until body temperature is above 30C.
- Between 30-35C double the interval between doses
- Dysrhythmias;
- Hypertension;
- Pupil dilation;
- Tremor;
- Anxiety;
- Palpitations
8
Q
Amiodarone Description
A
- 150mg in a 3ml ampoule;
- 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;
- Immediate onset,
9
Q
Amiodarone Indications
A
- Cardiac Arrest with persistent/shock resistant Ventricular
Fibrillation/Ventricular Tachycardia (Post 3 consecutive shocks only);
10
Q
Amiodarone Precautibons / Complications
HAIT
A
- Heart failure;
- Amiodarone is only indicated for shock resistant VF/VT, and should be administered post 3 consecutive shocks;
- Between 30 - 35C double intervals
- In the hypothermic patient, withhold until body temperature is above 30C.
- Thyroid dysfunction
11
Q
Cophenylcaine Description
A
Topical pump spray containing :
- Lignocaine hydrochloride 50mg/ml
- Phenylephrine 5mg/ml
A topical local anaesthetic and haemorrhage control agent for the relief of surface pain, nasal and oral bleeding
12
Q
Copheylcaine Indications
A
- Local pain: abrasions, small cuts and wounds
- Relief of mild and moderate epistaxis
- Post tonsillectomy haemorrhage
- Intra-oral haemorrhage
13
Q
Cophenylcaine Contraindications
A
- Hypersensitivity to lignocaine or other anaesthetics
- Hypersensitivity to phenylephrine
- Paediatrics less than 2 years
- Pregnancy
14
Q
Cophenylcaine Precautions / Complications
FUEL
A
- For oral use, nozzle inserted within the anterior 1/3 of mouth to avoid gag stimulation.
- Used with caution in patients with cardiovascular, hepatic and/or renal disease.
- Each spray delivers a dose of 5mg Lignocaine and the dose of phenylephrine is 0.5mg
- Leaves a transient bitter taste
15
Q
Fentanyl Description
A
short acting synthetic narcotic analgesic:
- Fentanyl: 600mcg in 2ml (300mcg/ml) - Intranasal only.
- Fentanyl Citrate (Sublimaze): 100mcg in 2ml ampoule (50mcg/ml) - IV/IO.
16
Q
Fentanyl Indications
A
- Moderate to severe pain.
- Acute Coronary Syndromes with a pain/discomfort score > 3/10 post 1 spray of GTN.
17
Q
Fentanyl Contraindications
A
- Hypersensitivity to Fentanyl.
- Less than 1 year of age (IV/IO only).
- Occluded nasal passages or epistaxis (IN only).
18
Q
Fentanyl Precautions / Complications
PRINCE
A
- Patients on MAO inhibitors.
- Respiratory Depression
- IV Fentanyl and Ketamine used simultaneously requires medical advisor authorisation.
- Nausea/vomiting.
- Cardiovascular effects: - Bradycardia & Hypotension (rare)
- Elderly patients.
19
Q
Glucagon Description
A
- 1mg in 1ml vial, accompanied by diluent for injection.
- A hyperglycaemic agent that converts stored liver glycogen to glucose to increase blood glucose concentration.
- Onset 4–7 minutes, duration 10–30 minutes
20
Q
Glucagon Indications
A
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.
- Altered conscious state of unknown medical cause, where blood glucose level is below 4mmol/L.
21
Q
Glucagon Contraindications
A
- Hypersensitivity.
- Known pheochromocytoma
22
Q
Glucagon Precautions / Complications
GENT
A
- Glucagon is effective in treating hypoglycaemia only if sufficient liver glycogen is present
- Encourage Pts to be transported to a medical facility to ensure follow up and review.
- Nausea, vomiting & gastric pain
- Transient rise of blood pressure for patients taking beta blockers
23
Q
Glucose Oral Gel Description
A
15g glucose gel in tube.
- Rapidly absorbed from oral/buccal mucosa to increase blood glucose concentration.
- Onset 2-5 minutes, duration 12-25 minutes
24
Q
Glucose Oral Gel indications
A
Demonstrated hypoglycaemia in:
- Altered conscious state in a known Diabetic.
- Altered conscious state of unknown medical cause, where blood glucose Level is below 4mmol/L.
25
Glucose Oral Gel Precautions / Complications
LEACH
* Liquefies over 30C, however it is still useable
* Encourage Pts to be transported to a medical facility to ensure effective follow up and review
* Airway obstruction risk
* Consider patient’s airway when administering gel.
* Have patients airway patent and in lateral position if unconscious.
26
Heparin Sodium Description
A naturally occurring anticoagulant which inhibits the clotting of blood by enhancing the rate at which antithrombin III neutralises thrombin and activated factor X (Xa).
* Ampoules 5,000 IU/5ml.
* Onset of action is immediate following IV administration.
27
Heparin Sodium Indications
Patients with STEMI going directly to Cardiac Catheterisation Laboratory as per receiving hospital 12-lead ECG interpretation.
28
Heparin Sodium Contraindications
* Hypersensitivity to Heparin
* Presence of known haemorrhagic states
29
Heparin Sodium Precautions / Complications
* Haemorrhagic risks in case of possible trauma
* Haemorrhage
30
Atrovent Description
* Presents as 250mcg in 1ml nebule.
* An anticholinergic bronchodilator. It inhibits the vagal reflexes that mediate bronchospasm.
* Combined with a nebulised beta-2 agonist (Salbutamol), Ipratropium bromide produces a significantly greater bronchodilation than a beta-2 agonist alone.
31
Atrovent Indications
Severe bronchospasm:
* Paediatric- severe to life-threatening asthma (CPG 3.2).
* Adult- severe to life-threatening asthma (CPG 3.2) and COPD (CPG 3.3).
32
Atrovent Contraindications
* Hypersensitivity
33
Atrovent Complications / Precautions
SHANDING
* Skin rash
* Headache
* Avoid eye contact
* Nausea
* Dry mouth
* It may not benefit less severe exacerbations
* Nebulised form is preferred in children due to its unpleasant taste.
* Glaucoma.
34
IV crystalloid Solutions Description
* Normal saline (NaCl 0.9%) in 1000ml soft plastic bag.
* 10 ml plastic vial
* A sterile isotonic crystalloid solution
35
IV Crystalloid Solutions Indications
* Fluid replacement (volume expansion) for the treatment of shock, fluid loss, and cardiac arrest.
36
IV Crystalloid Solutions Contraindications
* Circulatory overload
37
IV Crystalloid Solutions Complications / Precautions
* IV access/ fluid administration should be avoided in patients on the side of mastectomy or lymph node removal unless life-saving.
* Circulatory Overload
38
Intravenous Glucose Description
500ml bag 10% glucose (10g per 100ml).
* A hypertonic crystalloid solution that provides a readily available source of energy (Glucose).
* Onset within 1 minute.
39
Intravenous Glucose Indications
Demonstrated hypoglycaemia where oral glucose administration is inappropriate in:
* Altered conscious state in known diabetic.
* Altered conscious state of unknown medical cause with blood glucose Level below 4mmol/L
* Cardiac arrest.
40
Intravenous Glucose Contraindications
DIGACPU
* Diabetic coma where blood glucose levels are excessively high.
* Intraspinal or intracranial haemorrhage.
* Glucose / galactose malabsorption syndrome.
* Anuria.
* Corn (maize) allergy.
* Patients at risk of ischaemic stroke.
* Use after an ischaemic stroke.
41
Intravenous Glucose Precautions / Complications
HIDE BITTCH
* High concentration may aggravate dehydration due to its hypertonicity.
* IV glucose is corrosive, ensureIV patency.
* Diuresis
* Encourage pts to be transported to ensure efffective follow up and review
* Beware drop in BGL after Pt has recovered
* IO administration only as a last resort
* Tissue necrosis
* Thrombophlebitis
* Careful titration in head injured patients as glucose leaking into CNS tissue will result in cerebral oedema. .
* Hyperglycaemia.
42
Glyceryl Trinitrate Description
Glyceryl Trinitrate (GTN): Spray bottle containing 200 x 0.4mg atomised sprays. Nitrates cause the relaxation of vascular smooth muscle resulting in:
* Vasodilation.
* Peripheral pooling and reduced venous return.
* Reduced left ventricular and diastolic pressure (preload).
* Reduced systemic vascular resistance (afterload).
* Reduced myocardial energy and oxygen requirements.
* Relaxes spasm of coronary arteries
43
Glyceryl Trinitrate Indications
* Chest pain/discomfort of presumed cardiac origin not relieved by rest and reassurance with systolic BP \> 90mmHg
* Acute Cardiac Pulmonary Oedema with systolic BP \> 90mmHg
44
Glyceryl Trinitrate Contraindications
* Hypersensitivity.
* Hypotension \< 90mmHg.
* Medications used for erectile dysfunction within 24 hours (e.g. Sildenafil®, Vardenafil®).
45
Glyceryl Trinitrate Precautions / Complications
NADAST
* Nitrates are an early intervention and should not be delayed
* Administer to the patient in seated or semi-recumbent position.
* Do not shake GTN bottle prior to administration.
* Assess BP before every dose.
* Severe hypotension is an uncommon side effect.
* Tachycardia, Flushing, Headache
46
Ketamine Description
200mg in 2ml.
* Rapid acting dissociative anaesthetic.
* IM onset: 5-10 minutes.
* IV onset: 1 minute
47
Ketamine Indications
* A second line agent for severe pain of traumatic origin.
* Actively disturbed patients requiring sedation where midazolam has already been utilised.
* Combative Traumatic Brain Injury.
48
Ketamine Contraindications
* Hypersensitivity.
* Age
* Non traumatic pain
* Active cardiovascular disease including cardiac chest pain, heart failure, severe or poorly controlled hypertension.
* Active psychiatric condition (unless pretreatment with midazolam).
49
Ketamine Precautions / Complications
HERBS HITT
* Hypersalivation.
* Emergence reactions (10%).
* Radnom movements, twitching and rash are common
* BP and HR frequently elevated
* Stable psych conditions - use with caution
* Hyperthroidism or thyroid replacement - use with caution
* IV fentanyl and ketamine potentiation risk - 5 minute intervals
* Transient laryngospasm.
* Transient apnoea or respiratory depression
50
Lignocaine Description
20mg/2ml - (1%) in a plastic ampoule
* Sodium Channel blocker
* Onset 1-2 minutes
51
Lignocaine Indications
Local anaesthesia for:
* IV cannulation
* IO infusion
* Suturing
52
Lignocaine Contraindications
* Hypersensitivity
53
Lignocaine Precautions / Complications
DATA PCR
* Dizziness,
* Anxiety,
* Tinnitus
* Altered GCC confusion
* Perioral numbness
* Cardiovascular: Bradycardia, hypotension, dysrhythmias
* Respiratory depression
54
Methoxyflurane Description
3ml Ampoule.
* A halogenated ether that produces powerful modification of the awareness of pain with an associated light headed sensation.
* 6-8 breaths/ 1-2 min onset with maximum level after 2-4 minutes.
55
Methoxyflurane Indications
* Pain
56
Methoxyflurane Contraindications
* Patients who are unable to understand or co-operate.
* Patients with severe renal impairment. Patients with head injury and altered consciousness that prevents co-operation with its use.
* Hypersensitivity e.g. malignant hyperthermia
57
Methoxyflurane Precautions / Complications
PLUM WIFI
* Place in sealed bag post use
* Light headed, dizziness and nausea are side effects
* Use PenthroxTM inhaler only with charcoal filter attached.
* Malignant hyperthermia
* Watch for drowsiness
* Instruct the patient to breathe in and out through their mouth via the inhaler.
* For maximum effect cover the air dilutor hole.
* Initial breath is strong and may cause the patient to cough, so advise to take gently.
58
Midazolam Description
* 15mg in 3mls (5mg/ml).
* A water-soluble benzodiazepine that has anxiolytic, sedative and anticonvulsive characteristics. These are based on its
bond with receptors in the central nervous system; 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 central nervous system quickly.
59
Midazolam Indications
* Seizures (CPG 2.3).
* Disturbed/ abnormal behaviour (CPG 2.5).
* Back pain due to muscular spasm in adults.
60
Midazolam Contraindications
* Hypersensitivity
61
Midazolam Precautions / Complications
IF HARM
* If small, frail or over 65 years old, try half adult dose first.
* Further doses above max require ASMO consult
* Hypotension
* Anterograde and Retrograde Amnesia
* Respiratory Depression
* Myasthenia gravis.
62
Naloxone Description
0. 4mg (400mcg) in 1ml vial
* Naloxone is a pure narcotic antagonist that 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.
63
Naloxone Indications
* Reverse of respiratory depression in a suspected narcotic overdose.
64
Naloxone Contraindications
* Responsive patients with adequate respirations and who are protecting their own airway
65
Naloxone Precautions / Complications
* Polypharmacy overdose.
* Naloxone half life may be less than that of the Narcotic
* Withdrawal symptoms eg: aggression, agitation, nausea, vomiting, dilated pupils, lacrimation
66
Ondansetron Description
4mg in 2mls ampoule.
* 4mg Oral wafers.
* Anti-nauseant and anti-emetic.
* Selective 5-HT3 receptor antagonist blocking serotonin centrally in the chemoreceptor trigger zone and peripherally on Vagus nerve terminals.
* Onset of action up to 30 minutes.
67
Ondansetron Indications
* Moderate to severe nausea.
* Active vomiting.
* Prophylaxis for eye and spinal injuries
68
Ondansetron Contrainidications
* IM - Paediatrics less than 2 years old.
* Hypersensitivity.
69
Ondansetron Precautions / Complications
* Administer IV Ondansetron slowly over 2 minutes (neat or diluted) to prevent blurred vision and dizziness.
* Preferred method for paediatric patients is oral wafer.
* Headache. Malaise / fatigue. Drowsiness. Dizziness. Rash/ allergic reaction.
70
Paracetamol Description
* Simple oral analgesia for mild to moderate pain and fever
71
Paracetamol Indications
500mg tablets.
* Headache.
* Minor pain / ache.
* Fever.
72
Paracetamol Contraindications
* Known allergy to paracetamol.
* Paracetamol during the preceding four hours.
73
Paracetamol Precautions / Complications
* Advise not to take more Paracetamol during the next 4 hours.
* Overdose may cause serious, potentially fatal liver damage.
74
Salbutamol Sulphate Description
5mg in 2.5ml plastic nebule 100mcg dose per puff from MDI.
* Sympathomimetic — a short acting synthetic beta 2 adrenoreceptor stimulant that causes relaxation of bronchial smooth muscle (bronchodilation).
* Initial effect 2-5 minutes maximum by 10 minutes.
75
Salbutamol Sulphate Indications
SCAABSS
Bronchospasm and respiratory distress associated with wheeze:
* Salt Water Aspiration Syndrome
* COPD
* Acute Bronchial Asthma (CPG 3.2)
* APO - non cardiac
* Bronchitis.
* Smoke inhalation.
* Severe allergic / anaphylactic reactions.
76
Salbutamol Sulphate Contraindications
* Hypersensitivity
* Cardiogenic Pulmonary Oedema
77
Salbutamol Sulphate Precautions / Complications
* Tachycardia
* A spacer / MDI is the preferred when Pt presents with influenza like illness.
* Muscle tremors
78
ROSC management
* Revaluate ABCDE;
* 12-lead ECG;
* Treat precipitating causes;
* Treat hypotension (SBP \< 90 mmHg) Fluids and Adrenaline
* Avoid hyperventilation. Start at age appropriate rates and titrate to a target EtCO2 of 35-40 mmHg.
* Titrate oxygen delivery as required to achieve SpO2 \> 95%.
* Targeted Temperature Control – RINSE trial.
CPG 25 EXAM
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