2012 Sjaa Cpg Drug List

Front 1

Description:
Adrenaline

Back 1

1 mg in 1ml ampoule (1:1000)
Naturally occurring sympathomimetic
Causes peripheral vasodilation
Stimulates cardiac conduction cycle causing increased contractions
Causes bronchodilation & vasodilation in musculature
IV/IO: onset 30s, peak 3-5min, duration 5-10min
IM: onset 30-90s, peak 5-10min, duration 5-10min

Front 2

Indications:
Adrenaline

Back 2

Cardiac arrest
Anaphylaxis
Severe asthma
Severe croup with retractive breathing

Front 3

Management/Dose:
Adrenaline

Back 3

Cardiac Arrest:
Adult: 1mg IV/IO every 3-5 minutes.
Paediatric: 10mcg/kg IV/IO to a max 1mg IV/IO every 3-5 minutes.
Anaphylaxis/Severe Asthma:
Adult: 0.5mg IM into lateral mid-thigh ((0.5ml of 1:1000).
Paediatric: IM into lateral mid-thigh.
Age: < 1 / 5-10kg / 0.05-0.1mL
Age: 1-2 / 10kg / 0.1mL
Age: 2-3 / 15kg / 0.15mL
Age: 4-6 / 20kg / 0.2mL
Age: 7-10 / 30kg / 0.3mL
Age: 10-12 / 40kg / 0.4mL
Age: >12 / >50kg / 0.5mL

Front 4

Contraindications:
Adrenaline

Back 4

There are no absolute contraindications
for adrenaline, as long as indications are present

Front 5

Description of:
Aspirin

Back 5

White 300mg tablet of soluble aspirin, dispirin or dispirin direct
Analgesic, antipyretic, anti inflammatory, anti platelet aggregation agent
Reduces mortality significantly in AMI by minimising platelet aggregation and thrombus formation in order to retard the progression of coronary artery thrombosis

Front 6

Indications for:
Aspirin

Back 6

Chest pain of presumed cardiac origin

Front 7

Management/dose for:
Aspirin

Back 7

Oral administration, preferably chewed
300mg

Front 8

Contraindications for:
Aspirin

Back 8

Hypersensitivity
Under 12 years
Active bleeding peptic ulcers
Suspected AAA
Bleeding disorders

Front 9

Indications for:
Methoxyflurane

Back 9

Pain (eases discomfort rather than pain relief)

Front 10

Contraindications for:
Methoxyflurane

Back 10

Unable to understand/cooperate
Sever renal impairment
Known sensitivity (malignant hyperthermia)
Head injury w/ ACS

Front 11

Management/dose for:
Methoxyflurane

Back 11

Initial dose 1x3ml ampoule
Max dose 6ml per day; 15ml per week
Repeat after 15mins if necessary
Do not double-dose inhaler
Risk of inhaling droplets/fluid; serious overdose

Front 12

Description of:
Methoxyflurane

Back 12

Halogenated ether; modification of pain reception w/ associated light headedness.
3ml clear liquid in sealed screw-top vial
Strong fruity smell (inc. low concentration)
Dissolves many plastics
Onset: 6-8 breaths / 1-2min, max effectiveness at 2-4min post administration
By Penthrox inhaler only

Front 13

Description of:
Glucose Oral Gel

Back 13

15g glucose gel in tube
Rapidly absorbed from oral/buccal mucosa to increase BSL
Onset 2-5min, duration 12-25min

Front 14

Indication for:
Glucose Oral Gel

Back 14

Demonstrated hypoglycaemia in:
ACS in known diabetic
ACS in unknown cause where BSL <4mmol/L.

Front 15

Management/Dose for:
Glucose Oral Gel

Back 15

Adult: squeeze contents of tube (or as much as practical) into lower cheek pouch over gums/cheek and externally massage cheek.
Paeds: use proportion of the tube
Repeat after 10mins if still ACS or deteriorating.

Front 16

Contraindications for:
Glucose Oral Gel

Back 16

None - as long as indications are present

Front 17

Management/Dose for:
Cophenylcaine

Back 17

Adult:
Intranasal: 10sq max (5/ nostril)
Topically: 5sq max
Paediatric:
2-4yrs: 1/nostril
4-8yrs: 2/nostril
8-12yrs: 3/nostril
>12yrs: as per adult
Orally: One spray then wait 1-2mins & repeat if needed

Front 18

Indications:
Cophenylcaine

Back 18

Local pain: abrasions, small cuts/wounds
Relief of mild to moderate epistaxis
Post tonsilectomy haemorrhage
Intraoral haemorrhage

Front 19

Description of:
Cophenylcaine

Back 19

A topical pump spray containing:
Lignocaine 50mg/ml
Phenylepherine 5mg/ml
A topical local anaesthetic and haemorrhage control agent for the relief of surface pain, nasal and oral bleeding

Front 20

Contraindications:
Cophenylcaine

Back 20

Hypersensitivity to lignocaine, phenylepherine or other anaesthetics
<2yrs old
Pregnancy

Front 21

Description of:
Salbutamol

Back 21

5mg in 2.5ml plastic nebule [OR]
100mcg dose per puff from MDI

Sypathomimetic - short acting synthetic B2 adrenoreceptor stimulant that causes relaxation of bronchial smooth muscle (bronchodilation)
Initial effects 2-5mins max by 10min

Front 22

Contraindications for:
Salbutamol

Back 22

Hypersensitivity
Cardiogenic pulmonary oedema

Front 23

Management/dose for:
Salbutamol

Back 23

MDI/Spacer: 4 puffs with 4 breaths per puff every 4 minutes

Nebulised: One nebule (5mg/2.5ml) in 8l/pm of O2. 1.5ml saline added to make 4ml.

Repeat as clinically needed

Front 24

Contraindications for:
Glucagon

Back 24

Hypersensitivity
Known pheocromocytoma

Front 25

Management/dose for:
Glucagon

Back 25

IM injection:
Adult
1mg in 1ml IM; rpt after 10mins if unable to obtain IV access in pt still <GCS & <BSL
Paediatric
5yrs: 0.5mg in 0.5ml
6-12yrs: 1mg in 1ml
Single dose only

Front 26

Indications for:
Glucagon

Back 26

For demonstrated hypoglycemia where oral glucose cannot be administered & IV access cannot be obtained in a safe & timely manner.
ACS in known diabetic
ACS of unknown medical origin where BSL <4mmol

Front 27

Contraindications for:
GTN Spray

Back 27

Hypersensitivity
Hypotension <90mmHg
Erectile dysfunction Rx in <24hrs

Front 28

Management/Dose for:
GTN Spray

Back 28

Cardiac chest pain:
0.4mg (1spray) sublimgually. If pain persists >5min & BP maintained, consider additional spray to max 3.
Acute pulmonary oedema:
0.4mg (1 spray) sublimgually every 5 mins to max 3.

For long transport times, further doses of nitrates may be given every 30mins where indicated & criteria met

Front 29

Indications for:
GTN Spray

Back 29

Chest pain of presumed cardiac origin, not relieved by rest, oxygen & reassurance, with systolic BP >90mmHg
Acute Pulmonary Oedema w/ systolic BP >90mmHg

Front 30

Description of:
GTN Spray

Back 30

Spray bottle contains 200x 0.4mg atomised sprays
Causes the relaxation of vascular smooth muscle, resulting in:
Vasodilation
Peripheral pooling & reduced venous return
Reduced left ventricular/diastolic pressure (preload)
Reduced systemic vascular resistance (after load)
Reduced myocardial energy & O2 requirements
Relaxes coronary arty spasms

Front 31

Contraindications for:
Naloxone

Back 31

Responsive patients with adequate respirations who are protecting their airway

Front 32

Indications for:
Naloxone

Back 32

Reversal of respiratory depression in a suspected narcotic overdose

Front 33

Description of:
Naloxone

Back 33

0.4mg (400mcg) in 1ml vial
Pure narcotic antagonist; competitive inhibitor of opioid receptors
Prevents/reverses effects of narcotics inc. respiratory depression, sedation & hypotension.
In absence of opioids, exhibits essentially no pharmacological effects

Front 34

Contraindications for:
Paracetamol

Back 34

Known hypersensitivity
Used paracetamol within last 4 hours

Front 35

Management/dose for:
Paracetamol

Back 35

Adults: 1-2 tablets with water
Children: 7-12, 0.5-1 tablet
<7 - as per direction on bottle

Front 36

Indications for:
Paracetamol

Back 36

Headache
Minor pain/ache
Fever

Front 37

Description of:
Paracetamol

Back 37

500mg tablets OR 125mg/5ml suspension
PO analgesia for relief of mild/moderate pain/fever
Onset: 20-30mins
Oral use only

Front 38

Description of:
Ondansetron

Back 38

4mg in 2ml ampoules
Anti-nausea & anti-emetic
Selective 5-HT3 receptor antagonist blocking serotonin centrally in the chemoreceptor trigger zone (CTZ) & peripherally on vagus nerve terminals
Onset of action up to 30mins

Front 39

Indications for:
Ondansetron

Back 39

Moderate to severe nausea
Active vomiting
Prophylaxis for eye & spinal injury

Front 40

Management/dose for:
Ondansetron

Back 40

Adults: 4mg in 2ml IM or slow IV/IO; rpt after 30mins if req'd.

Paediatrics: IM (single dose only)
2-5yrs; 1mg in 0.5mls
6-9yrs; 2mg in 1mls
10-12yrs; 3mg in 1.5mls
>12 or >40kg; 4mg in 2mls

Front 41

Contraindications for:
Ondansetron

Back 41

>2yrs of age
Hypersensitivity

Front 42

Description of:
Midazolam

Back 42

15mg in 3ml (5mg/ml)
A water soluble benzodiazepine that has anxiolytic, sedative & anticonvulsive characteristics. These are based on its bond with receptors in the CNS; it's action to increase the inhibitory effect of the GABA neurotransmitter on the GABA receptors & subsequent membrane threshold.
Lipid soluble in physiological pH & reaches CNS quickly

Front 43

Indications for:
Midazolam

Back 43

Seizures
Disturbed/abnormal behaviour
Combative TBI patients
Back pain due to muscular spasms
[[Performing RSI & maintaining intubation] CCP ONLY]

Front 44

Management/dose for:
Midazolam

Back 44

Seizure/sedation in non-TBI
Adult:
IM: 5-10mg (repeat once after 20mins if req'd & no IV)
IV: 1-5mg TTE every 2-3mins to max of 15mg
Paediatric:
IM: 2.5-5mg (as per adult)
IV: 0.1mg to max bolus of 5mg TTE 2-3min to max of 15mg

Combative TBI
Adult: IV 1mg every 3min to max of 5mg
Paediatric: IV 0.1mg/kg up to 1mg bolus every 3min to max of 5mg

Back pain due to muscular spasms (adult only):
IM: 2.5mg-5mg
IV: 1mg every 2-3min to max of 5mg

Front 45

Contraindications for:
Midazolam

Back 45

Hypersensitivity

Front 46

Description of:
Ketamine

Back 46

200mg in 2ml

Ketamine freely soluble in water & methylalcohol; soluble in alcohol

Rapid acting dissociative anaesthetic

Onset of action: IV(1min); IM(5-10min)

Produced dissociative state characterised by trance w/ eyes open but non-responsive, nystagmous, profound anaelgesia, normal pharyngeal/laryngeal reflexes, normal or slightly enhanced skeletal muscle tone, mild cardiovascular & respiratory stimulation & occasionally a transient & minimal respiratory depression.

Front 47

Indications for:
Ketamine

Back 47

Severe unrelieved pain (after use of methoxyflurane/fentanyl) of traumatic origin (i.e. broken bones, burns)

Second line agent when others ineffective

Front 48

Management/dose for:
Ketamine

Back 48

IV (adult only): 200mg in 2ml = 10mg/ml
Initial: 10-20mg (1-2ml of diluted solution). Rpt 10mg(1ml)
Interval: 2-3min intervals as needed

IM
Initial: 1mg/kg. Rpt 0.5mg/kg (half initial dose)
Interval: 5-10min intervals as needed

Large adult: 100kg > 100mg > 1ml
Normal adult: 75kg > 75mg > .75ml
Small adult: 50kg > 50mg > .5ml
8yrs: 25kg > 25mg > .25ml

Front 49

Contraindications for:
Ketamine

Back 49

<3mths old
Pain from non-trauma origin
Active cardiovascular disease (i.e. CCF or HTN)
Active psychiatric condition

Front 50

Description of:
Saline (IV crystalloid solutions)

Back 50

Normal saline (NaCL 0.9%) in 1L bag
10ml plastic vial
Sterile isotonic crystalloid solution

Front 51

Indications for:
Saline (IV crystalloid solutions)

Back 51

Volume expansion/fluid replacement for treatment of shock (i.e. hypovolaemic) & cardiac arrest

Front 52

Management/dose for:
Saline (IV crystalloid solutions)

Back 52

Fluid therapy (shock):
Adult: 500ml bolus to max of 2L w/ reassess per infusion
Small/elderly: 250ml bolus to max 1L w/reassess per infusion
Paediatric: 20ml/kg over 5-10min. 1x rpt only.

Cardiac arrest:
20ml/kg bolus as reversible cause of hypovolaemia

KVO: 20 drops (=1ml)/min

Front 53

Contraindications for:
Saline (IV crystalloid solutions)

Back 53

Circulatory overload

Front 54

Description of:
Fentanyl

Back 54

Fentanyl citrate (sublimaze): 100mcg in 2ml (50mcg/ml) IV/IO

Fentanyl: 600mcg in 2ml (300mcg/ml) IN only

Short acting synthetic narcotic analgesic

Front 55

Indications for:
Fentanyl

Back 55

Pain

Front 56

Management/dose for:
Fentanyl

Back 56

IV/IO:
Adult: 10-25mcg titrated to effect every 5min
Paed: 1mcg/kg TTE every 5min; max bolus 25mcg

Dilute 100mcg in 2ml w/ 8ml saline to make 10mcg/ml or w/ 18ml saline to make 5mcg/ml

IN (repeated at 10mins)
<5yr/<20kg: 1x 0.05ml (15mcg): Rpt 1x0.05ml (15mcg)
6-10yr/21<30kg: 1x 0.1ml (30mcg): Rpt 1x.1ml (30mcg)
IN (repeated at 5mins)
11<15yr/31<40kg: 1x0.15ml (45mcg): Rpt 1x0.15ml (45mcg)
Small/elderly/frail: 2x0.2ml (120mcg): Rpt 1x0.2ml (60mcg)
Adult: 3x0.2ml (180mcg): Rpt 1x0.2ml (60mcg)

Front 57

Contraindications for:
Fentanyl

Back 57

Hypersensitivity
<2yrs (for IV)
Occluded nasal passages

Front 58

Description: Amiodarone

Back 58

150mg in 3ml ampoule
Class III anti-dysrhythmic, prolongs action-potential & refractory period of atrial/nodal/ventricular tissue.
Immediate onset, peak <10min, duration 30-60min

Front 59

Indications for:
Amiodarone

Back 59

Cardiac arrest w/ persistent/shock resistant VF/VT (post 3 consecutive shocks only)

Front 60

Management/Dose for:
Amiodarone

Back 60

Adult: 300mg in 6ml IV/IO once only (2x ampoules)
Paediatric: 5mg/kg IV/IO once only

Front 61

Contra-indications:
Amiodarone

Back 61

None (CCP only)