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221 Cards in this Set
- Front
- Back
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Adrenaline 1:1,000
INDICATIONS |
Anaphylaxis, life threatening asthma
Suspect anaphylaxis: -Acute onset(minutes to hours) -85% have Urticaria and/or angio-oedema (swelling of face. Eyelids, lips, tongue) AND Airway compromise – eg. laryngeal oedema -Breathing compromise – eg. Stridor, wheezing -Circulatory compromise – eg. Hypotension and shock, syncope, pronounced tachycardia -Some pts may have GI oedema, abdo pain, nausea and diarrhoea |
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Adrenaline 1:1,000
CODE |
ADM
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Adrenaline 1:1,000
ADULT DOSE |
500 mcg in 0.5ml - Every 5 mins if indicated
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Adrenaline 1:1,000
ROUTE |
IM - Antero-lateral aspect of thigh or upper arm
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Adrenaline 1:1,000
PRESENTATION |
1mg in1ml ampoule
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Adrenaline 1:1,000
ACTION |
Relieves allergic reactions and bronchospasm. Sympathimometic that stimulates both alpha- and beta-adrenergic receptors.
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Adrenaline 1:1,000
CAUTIONS |
Adrenaline 1:1,000
CAUTIONS -Beta blockers – give half doses to avoid severe hypertension - Tricyclic anti-depressents (amitriptyline, imipramine) give half doses for anaphylaxis |
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Adrenaline 1:1,000
CONTRAINDICATIONS |
Avoid repeat dose in hypothermia
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Adrenaline 1:10,000
INDICATIONS |
Cardiac Arrest
-VF/PVT (Shockable) shock as soon as seen, give adrenaline after 3rd shock during ongoing CPR and Every 3-5 mins of cardiac arrest, ie. After alternate shocks. -Asystole/PEA (Unshockable) give 1mg adrenaline as soon as IV access is gained and Every 3-5 mins of cardiac arrest, ie. After alternate shocks. -Reversible causes of Cardiac arrest (4 H’s, 4 T’s) Hypoxia, Hypvolaemia, Hypothermia, Hyperkalaemia, Tension pneumothorax, Tamponade, Toxicity, Thromboembolism |
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Adrenaline 1:10,000
CODE |
ADX
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Adrenaline 1:10,000
ADULT DOSE |
1 mg in 10ml
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Adrenaline 1:10,000
ROUTE |
IV
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Adrenaline 1:10,000
PRESENTATION |
1mg in 10ml pre-filled syringe
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Adrenaline 1:10,000
ACTION |
Sympathimometic that stimulates both alpha- and beta-adrenergic receptors, enhancing mycocardial/cerebro blood flow during CPR as peripheral resistance is enhanced
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Adrenaline 1:10,000
CAUTIONS |
None in cardiac arrest
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Adrenaline 1:10,000
CONTRAINDICATIONS |
Avoid repeat dose in hypothermia
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Amiodorone Hydrochloride
INDICATIONS |
VF or PVT
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Amiodorone Hydrochloride
CODE |
AMO
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Amiodorone Hydrochloride
ADULT DOSE |
300 mg in 10ml
VF/PVT shock as soon as seen, give amiodarone after 3rd shock during ongoing CPR |
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Amiodorone Hydrochloride
ROUTE |
IV
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Amiodorone Hydrochloride
PRESENTATION |
300mg in 10ml pre-filled syringe
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Amiodorone Hydrochloride
ACTION |
-Class 3 Anti-arrhythmic, lengthens cardiac action potential & QT interval.
-Blocks potassium and sodium channels |
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Amiodorone Hydrochloride
SIDE EFFECTS |
bradycardia
vasodiation & hypotension, bronchospasm, arrhythmias – Torsades de pointes |
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Amiodorone Hydrochloride
CONTRAINDICATIONS |
None in cardiac arrest
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Aspirin
INDICATIONS |
Adults with suspected MI, central chest pain of possible cardiac origin
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Aspirin
CODE |
ASP
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Aspirin
ADULT DOSE |
300 mg (in MI regardless of any previous does taken that day)
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Aspirin
ROUTE |
ORL (Chewed or dissolved in water)
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Aspirin
PRESENTATION |
300mg tablets
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Aspirin
ACTION |
Anti-platelet (analgesic, anti-pyretic, anti-inflammatory)
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Aspirin
CAUTIONS |
-As the likely benefits of a single dose in MI outweigh the potential risks Aspirin may be given to patients with Asthma, Pregnancy, Kidney/Liver failure/GI ulcer
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Aspirin
SIDE EFFECTS |
-Gastric bleeding
-Asthmatic wheezing |
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Aspirin
CONTRAINDICATIONS |
Non cardiac chest pain
-Known allergy. -On anti-coagulants -Children < 16-Reyes Syndrome -Haemophilia -Clotting disorders |
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Atropine Sulphate
INDICATIONS |
-Symptomatic Hypotensive Bradycardia <40
-Hypotension -Organophosphate poisoning |
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Atropine Sulphate
CODE |
ATR
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Atropine Sulphate
ADULT DOSE |
600 mcg in 6ml
Every 3-5 mins (max 5 mg – 8 doses) |
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Atropine Sulphate
ROUTE |
IV
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Atropine Sulphate
PRESENTATION |
1mg in10mls pre –filled syringe
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Atropine Sulphate
ACTION |
--May reverse effects of vagal overdrive.
-May increase heart rate by blocking vagal activity in sinus bradycardia, second or third degree heart block. -Enhances A-V conduction. |
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Atropine Sulphate
CAUTIONS |
None
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Atropine Sulphate
SIDE EFFECTS |
-Dry mouth, visual blurring and pupil dilation.
- Confusion and occasional hallucinations. - Tachycardia, and in the elderly, retention of urine may occur. -Do not use small (<100 micrograms) doses -risk of paradoxical bradycardia. |
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Atropine Sulphate
CONTRAINDICATIONS |
Hypothermia
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Benzylpenicillin
INDICATIONS |
Meningococcal septicaemia
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Benzylpenicillin
CODE |
BPN
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Benzylpenicillin
ADULT DOSE |
9 – Adult - 1.2 g in 20ml WFI – IV
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Benzylpenicillin
ROUTE |
Benzylpenicillin
ROUTE IV slow push - (can also be given IM, check dosage) IO if <7 yrs |
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Benzylpenicillin
PRESENTATION |
600mg powder ampoule
Dissolve in WFI |
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Benzylpenicillin
ACTION |
Broad spectrum antibiotic
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Benzylpenicillin
CAUTIONS |
If no IV access in adults use IM route – check JRCALC for dosage
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Benzylpenicillin
SIDE EFFECTS |
Diarrhoea, Vomiting as a previous reaction to penicillin is NOT a contraindication to Benpen in Meningitis.
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Benzylpenicillin
CONTRAINDICATIONS |
Genuine Penicillin allergy including LOC, DIB/swelling, rash.
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Diazemuls
INDICATIONS |
Fitting > 5 mins and still fitting, or if fitting in rapid succession with no time for full recovery. Status epilepticus.
Tonic = Stiff phase Clonic = saking convulsive phase Tonic Clonic = stiffening followed by convulsions Status Epilepticus - seizure does not stop, fits recur one after another |
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Diazemuls
CODE |
DZM
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Diazemuls
ADULT DOSE |
10 mg in 2ml (repeat after 5 mins - 20mg max dose)
Only one repeat dose in children |
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Diazemuls
ROUTE |
IV (first choice in adults preferred over PR)
Titrate and administer slowly |
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Diazemuls
PRESENTATION |
10mg in 2ml ampoule
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Diazemuls
ACTION |
Central nervous system depressant, anti-convulsant and sedative
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Diazemuls
CAUTIONS |
Respiratory depression esp with alcohol, anti-depressants or CNS suppressants.
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Diazemuls
SIDE EFFECTS |
-Respiratory depression, Hypotension may occur - if so, keep pt flat or wait for 10 mins before extrication.
- Confusion, unsteadiness. |
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Diazemuls
CONTRAINDICATIONS |
None
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Diazepam
INDICATIONS |
Fitting > 5 mins and still fitting, or if fitting in rapid succession with no time for full recovery. Status epilepticus.
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Diazepam
CODE |
DZP
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Diazepam
ADULT DOSE |
10 mg in 2.5ml (repeat after 5 mins - 20mg max dose)
Only one repeat dose in children |
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Diazepam
ROUTE |
PR – (preferred in children 2.5cm deep, 5cm in adults)
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Diazepam
PRESENTATION |
10mg in 2.5ml tube
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Diazepam
ACTION |
Central nervous system depressant, anti-convulsant and sedative
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Diazepam
CAUTIONS |
Respiratory depression esp with alcohol, anti-depressants or CNS suppressants.
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Diazepam
SIDE EFFECTS |
Diazepam
SIDE EFFECTS -Respiratory depression, Hypotension may occur - if so, keep pt flat or wait for 10 mins before extrication. -Confusion, unsteadiness. |
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Diazepam
CONTRAINDICATIONS |
None
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Entonox
INDICATIONS |
Moderate - severe pain – labour pain
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Entonox
CODE |
NOO
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Entonox
DOSE |
As much as is required in the acute setting
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Entonox
ROUTE |
Self administered – (3-5 mins to take effect)
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Entonox
PRESENTATION |
Blue and white cylinder with disposable filter and mouthpiece
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Entonox
ACTION |
Inhaled analgesic agent
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Entonox
CAUTIONS |
Invert cylinder in low temps
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Entonox
SIDE EFFECTS |
Nausea, dizzyness
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Entonox
CONTRAINDICATIONS |
-Head injury with impaired LOC
-decompression sickness or diving last 24hrs -violently disturbed psychiatric pts |
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Furosemide
INDICATIONS |
Pulmonary oedema secondary to Left Ventricular Failure
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Furosemide
CODE |
FRM
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Furosemide
ADULT DOSE |
40 mg in 2ml – slow push over 2 mins
Use secondary to nitrates |
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Furosemide
ROUTE |
IV
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Furosemide
PRESENTATION |
40mg in 2ml ampoule
Administer slowly over 2 mins |
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Furosemide
ACTION |
Potent diuretic with rapid 30 min onset and short duration
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Furosemide
CAUTIONS |
-Hypokalaemia (Low K) can induce arrhythmias
-Pregnancy |
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Furosemide
SIDE EFFECTS |
-Hypotension
-GI disturbances |
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Furosemide
CONTRAINDICATIONS |
-Pre-comatose state secondary to Liver cirrhosis.
-Severe renal failure with anuria. -Children < 16 yrs |
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Glucagon
INDICATIONS |
Hypoglycaemia (where oral glucose cannot be administered. Eg. < LOC)
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Glucagon
CODE |
GLU
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Glucagon
ADULT DOSE |
1 mg in 1ml
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Glucagon
ROUTE |
IM - Antero-lateral aspect of thigh or upper arm
(NOT IV as very high risk of vomiting) |
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Glucagon
PRESENTATION |
1mg powder ampoule
Dissolve in 1ml WFI pre filled syringe |
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Glucagon
ACTION |
Glucagon hormone induces conversion of liver glycogen to glucose thereby raising the blood glucose level.
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Glucagon
CAUTIONS |
Avoid IM if thrombolysis needed
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Glucagon
SIDE EFFECTS |
Nausea & vomiting
Diarrhoea |
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Glucagon
CONTRAINDICATIONS |
-No glycogen stores (eg. recent use of glycogen, hypoglycaemic children)
-Give oral glucose or IV Glucose 10% instead |
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Glucose Gel 40%
INDICATIONS |
Hypoglycaemia
-Hypoglycaemia definition = blood glucose <4.0 mmolL (but symptoms may be present at higher levels) -After 5-10 mins check blood glucose is > 5.0 mmolL -Non diabetics maintain a range from 3.0 – 5.6 mmolL -Diabetic pts who are fully recovered with BM > 5.0 mmolL & in the care of a responsible adult may be left at home with GP/999 advice |
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Glucose Gel 40%
CODE |
GLG
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Glucose Gel 40%
ADULT DOSE |
23g up to 69g
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Glucose Gel 40%
ROUTE |
ORL – raid absorption through buccal mucosa
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Glucose Gel 40%
PRESENTATION |
23g tubes
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Glucose Gel 40%
ACTION |
Raises BM
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Glucose Gel 40%
CAUTIONS |
Soak gauze/rub on gums if unconscious/no gag reflex
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Glucose Gel 40%
SIDE EFFECTS |
None
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Glucose Gel 40%
CONTRAINDICATIONS |
No gag reflex
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Glucose 10%
INDICATIONS |
Hypoglycaemia (where oral glucose cannot be administered eg. < LOC)
-Hypoglycaemia definition = blood glucose <4.0 mmolL (but symptoms may be present at higher levels) -After 5-10 mins check blood glucose is > 5.0 mmolL -Non diabetics maintain a range from 3.0 – 5.6 mmolL -Diabetic pts who are fully recovered with BM > 5.0 mmolL & in the care of a responsible adult may be left at home with GP/999 advice |
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Glucose 10%
CODE |
GLX
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Glucose 10%
ADULT DOSE |
10 g in 100ml - Repeated after 5 mins to max 300ml. If NO response after 200ml – rapid transport to ED with pre-alert.
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Glucose 10%
ROUTE |
IV
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Glucose 10%
PRESENTATION |
50g in 500ml (10%)
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Glucose 10%
ACTION |
Raises Blood Glucose
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Glucose 10%
CAUTIONS |
None
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Glucose 10%
SIDE EFFECTS |
None
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Glyceryl Trinitrate
INDICATIONS |
-Cardiac chest pain due to MI, Angina.
-Acute cardiogenic pulmonary oedema (secondary to LVF) |
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Glyceryl Trinitrate
CODE |
GTN
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Glyceryl Trinitrate
ADULT DOSE |
400mcg per spray - 1-2 sprays
Again after 5-10 mins if systolic BP > 90mmHg |
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Glyceryl Trinitrate
ROUTE |
SL
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Glyceryl Trinitrate
PRESENTATION |
400mcg per spray
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Glyceryl Trinitrate
ACTION |
Potent vasodilator, dilation of coronary arteries/coronary spasm, dilation of systemic veins reducing pre-load, reduced BP
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Glyceryl Trinitrate
SIDE EFFECTS |
Headache, flushing, dizziness, postural hypotension, Tachycardia
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Glyceryl Trinitrate
CONTRAINDICATIONS |
-Hypotension (actual or estimated systolic BP <90mmHg).
-Hypovolaemia -Head trauma, Brain injury, -Viagra (Sildenafil) within 24hr -Unconscious, |
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Hydrocortisone
INDICATIONS |
-Anaphylaxis
-Life threatening asthma where time to hosp >30mins -Addisonian crisis |
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Hydrocortisone
CODE |
HYC
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Hydrocortisone
ADULT DOSE |
200 mg in 2ml
IM or IV – Slow push |
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Hydrocortisone
ROUTE |
IM IV – Slow push
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Hydrocortisone
PRESENTATION |
100mg in 1ml ampoule
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Hydrocortisone
ACTION |
Glucocorticoid drug that reduces inflammatory & immune response
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Hydrocortisone
CAUTIONS |
Avoid IM if thrombolysis needed
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Hydrocortisone
SIDE EFFECTS |
Burning, itching sensation in the groin if administered too quickly.
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Hydrocortisone
CONTRAINDICATIONS |
Known allergy
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Ipratropium Bromide
INDICATIONS |
-Acute. Life threatening asthma
-COPD |
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Ipratropium Bromide
CODE |
IPR
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Ipratropium Bromide
ADULT DOSE |
500 mcg ( 2 nebules) Once Only!
Concurrently with Salbutamol |
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Ipratropium Bromide
ROUTE |
Neb
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Ipratropium Bromide
PRESENTATION |
250mcg in 1ml nebule
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Ipratropium Bromide
ACTION |
AntimuscarinicBronchodilator where Salbutamol (beta agonist) fails to work. Considered more beneficial in acutely asthmatic children and adults with COPD.
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Ipratropium Bromide
CAUTIONS |
Glaucoma – protect they eyes from mist
pregnancy |
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Ipratropium Bromide
SIDE EFFECTS |
-Headache, nausea & vomiting
-Tachycardia/Arrhythmia |
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Ipratropium Bromide
CONTRAINDICATIONS |
None in Emergency
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Metoclopramide
INDICATIONS |
Nausea & vomiting in adults >20 years (esp. after morphine)
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Metoclopramide
CODE |
MTC
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Metoclopramide
ADULT DOSE |
10 mg in 2ml (Give 2 mins before Morphine)
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Metoclopramide
ROUTE |
IV
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Metoclopramide
PRESENTATION |
10mg in 2ml ampoules
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Metoclopramide
ACTION |
Anti-emetic, acts on CNS and GI tract
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Metoclopramide
CAUTIONS |
-Avoid IM if thrombolysis needed
-Never mix in same syringe as Morphine |
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Metoclopramide
SIDE EFFECTS |
Monitor vital signs carefully PR, BP, RR, EGC
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Metoclopramide
CONTRAINDICATIONS |
-Age < 20 years
-1st trimester pregnancy, drug overdose, Renal failure, GI obstruction |
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Morphine Sulphate
INDICATIONS |
Severe pain, MI
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Morphine Sulphate
CODE |
MOR
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Morphine Sulphate
ADULT DOSE |
5 mg in 5ml (titrate as needed) Ensure Naloxone available.
Slow IV every 5 mins max 20 mg 1mg per minute |
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Morphine Sulphate
ROUTE |
IV (takes 2 – 20mins to take effect)
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Morphine Sulphate
PRESENTATION |
10mg in 1ml ampoules
NB DILUTE WITH 9ml WFI to make 10mg in 10 ml. |
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Morphine Sulphate
ACTION |
Opiate Analgesic
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Morphine Sulphate
CAUTIONS |
aution in pregnancy, chest injury, asthma, COPD, head injury, acute alcohol intoxication, antidepressants, tranquilisers
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Morphine Sulphate
SIDE EFFECTS |
-Nausea, Vomiting, Drowsiness
-Respiratory depression & Hypotension -Pupillary constriction. |
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Morphine Sulphate
CONTRAINDICATIONS |
-Children < 1yr
- Respiratory depression (adult <10 breaths/child <20 breaths) -Hypotension actual nor estimated BP <90mmHg -Head injury – GCS < 12. Renal/liver disease. Hypersensitivity to morphine. |
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Naloxone Hydrochloride
INDICATIONS |
Opiate overdose or suspected overdose
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Naloxone Hydrochloride
CODE |
NLX
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Naloxone Hydrochloride
ADULT DOSE |
400 mcg in 1ml (if no response give futher doses every 2-3 mins – max 10mg – 25 doses)
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Naloxone Hydrochloride
ROUTE |
IV (IM if IV inaccessible)
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Naloxone Hydrochloride
PRESENTATION |
400mcg in1ml ampoule
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Naloxone Hydrochloride
ACTION |
Opioid antagonist
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Naloxone Hydrochloride
CAUTIONS |
Max dose = 10 mg (25 doses at 400 mcg)
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Naloxone Hydrochloride
SIDE EFFECTS |
Violent narcotic withdrawal, titrate to reverse respiratory depression, whilst leaving pt in a groggy state.
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Naloxone Hydrochloride
CONTRAINDICATIONS |
Neonates of opioid addicted mothers, BVM instead
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Oxygen
INDICATIONS |
-Cardiac symptoms
-GCS<15 -CO poisoning -trauma, -sickle cell disease -hypoxia with SpO2 <94% - COPD with SpO2 <88%. |
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Oxygen
CODE |
OXG
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Oxygen
ADULT DOSE |
-Trauma MI etc, GIVE FULL FLOW UNTIL VITAL SIGNS NORMAL, then aim for 94-98%.
-COPD titrate to SpO2 88-92% for therapy ( 28% mask), but in an emergency give full flow aiming for 94 – 98% UNTIL VITAL SIGNS NORMAL |
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Oxygen
ROUTE |
Inhalation
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Oxygen
PRESENTATION |
Gas bottle with regulator
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Oxygen
ACTION |
Assists in reversing hypoxia when ventilation is adequately supported
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Oxygen
CAUTIONS |
Fire hazard.
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Oxygen
SIDE EFFECTS |
In patients with COPD there is a risk that even moderately high doses of inspired oxygen can produce increased carbon dioxide levels which may cause respiratory depression and this may lead to respiratory arrest.
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Oxygen
CONTRAINDICATIONS |
Explosive environments.
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Salbutamol
INDICATIONS |
-Asthma
-COPD exacerbations -SOB due to LVF -anaphylactic wheezing |
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Salbutamol
CODE |
SLB
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Salbutamol
ADULT DOSE |
5 mg (2 nebules )
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Salbutamol
ROUTE |
Neb
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Salbutamol
PRESENTATION |
2.5mg in 2.5ml nebules
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Salbutamol
ACTION |
Selective Beta2-adrenoreceptor stimulant drug. Relaxes smooth muscle in small and medium airways.
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Salbutamol
CAUTIONS |
Use with care in:
-Hypertension -Angina -overactive thyroids -Late pregnancy -Beta blockers (can cause severe hypertension) |
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Salbutamol
SIDE EFFECTS |
-Tremor Palpitations
-Tachycardia |
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Salbutamol
CONTRAINDICATIONS |
None in Emergency
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Sodium Chloride 0.9%
INDICATIONS |
-Hypovolaemia (alternative to sodium lactate)
-Dehydration -Diabetic hyperglycaemic ketoacidosis |
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Sodium Chloride 0.9%
CODE |
SCP
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Sodium Chloride 0.9%
ADULT DOSE |
250 ml
Max 2L |
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Sodium Chloride 0.9%
ROUTE |
IV
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Sodium Chloride 0.9%
PRESENTATION |
500ml bags
5 and 10ml ampoules |
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Sodium Chloride 0.9%
ACTION |
Crystalloid solution for fluid replacement
IV Flush |
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Sodium Chloride 0.9%
CAUTIONS |
Risk of circulatory overload, precipitation of heart failure (evidenced by increased breathlessness, wheezing and extended neck veins)
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Sodium Chloride 0.9%
SIDE EFFECTS |
Monitor vital signs carefully
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Sodium Chloride 0.9%
CONTRAINDICATIONS |
None
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Sodium Lactate
INDICATIONS |
-Hypovolaemia – blood and fluid loss
-Dehydration |
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Sodium Lactate
CODE |
SLC
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Sodium Lactate
ADULT DOSE |
250 ml - Max 2L
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Sodium Lactate
ROUTE |
IV
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Sodium Lactate
PRESENTATION |
500ml bags
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Sodium Lactate
ACTION |
Fluid volume replacement (contains sodium, potassium, lactate) diffuses rapidly into extra cellular space, useful for initial fluid replacement. 3 x blood volume lost is needed.
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Sodium Lactate
CAUTIONS |
Risk of circulatory overload, precipitation of heart failure (evidenced by increased breathlessness, wheezing and extended neck veins)
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Sodium Lactate
SIDE EFFECTS |
Monitor vital signs carefully
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Sodium Lactate
CONTRAINDICATIONS |
-Diabetic hyperglycaemic ketoacidosis or pre-coma- use NaCl 0.9% instead
-Isolated head injury (may increase ICP) ,can be given if pt has other significant trauma. |
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Heparin
INDICATIONS |
Thrombolysis
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Heparin
CODE |
HEP
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Heparin
CODE |
HEP
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Heparin
ADULT DOSE |
5,000 Units > 67 kg (5 ml)
4,000 Units < 67 kg (4 ml) Prior to TNK – flush well with saline |
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Heparin
ROUTE |
IV
|
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Heparin
PRESENTATION |
5,000 Units in 5ml
|
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Heparin
ACTION |
Adjunctive to TNK to prevent further clotting and reduce risk of reinfarction.
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Heparin
CAUTIONS |
See JRCAL – second Heparin dose to be given if Heparin INFUSION HAS NOT commenced within 45mins of originl bolus of Tenecteplase.
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Heparin
SIDE EFFECTS |
Bleeding – major or minor.
Arrythmias – ensure defibrillator available Hypotension – lay patient flat |
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Heparin
CONTRAINDICATIONS |
See JRCAL
|
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Tenecteplase
INDICATIONS |
MI within 6hr onset
SeeJRCLAC / WAST protocol checklist |
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Tenecteplase
CODE |
TNK
|
|
|
Tenecteplase
ADULT DOSE |
10,000 units
> 90 kg 10,000 units (10 ml) > 80kg 9,000 units (9ml) >70kg 8,000 units (8ml) >60kg 7,000 units (7ml) |
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Tenecteplase
ROUTE |
IV - Give Heparin first)
|
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Tenecteplase
PRESENTATION |
10,000 units for reconstitution with 10ml WFI
|
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Tenecteplase
ACTION |
Activates the Fibrinolytic system inducing break up of thrombi and emboli. (saves 4 in 100 lives)
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Tenecteplase
CAUTIONS |
See JRCAL CHECKLIST
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Tenecteplase
SIDE EFFECTS |
Major Bleeding, stroke in 1 pt in every 200
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Tenecteplase
CONTRAINDICATIONS |
Pregnancy, ulcers, stroke, brain disease, bleeding, liver/renal failure
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