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Drug Class of CEFTRIAXONE
Antibiotic
Pharmacology of CEFTRIAXONE
Ceftriaxone is third generation cephalosporin atibiotic with a bactericidal action
Metabolosm of CEFTRIAXONE
Ceftriaxone is excreted as a variety of active and inactive metabolites from the body through urine, bile and faeces.
Indications for CEFTRIAXONE
● Suspected meningococcal septicaemia (with a non-blanching petechial AND/OR purpuric rash)
Contraindications for CEFTRIAXONE
● KSAR to cephalosporin drugs
● Known anaphylaxis or severe allergic reaction to penicillin based drugs - (isolated minor drug rash attributed to penicillin does not contraindicate lthe use of ceftriaxone)
Precautions for CEFTRIAXONE
● Nil
Side effects of CEFTRIAXONE
● Nausea and/or vomiting
● Pain at the IM administration site
Presentation of CEFTRIAXONE
● Vial (powder), 1 g ceftriaxone (Rocephin®)
Onset of CEFTRIAXONE
30 seconds (IV)
60 seconds (IM)
Duration of CEFTRIAXONE
5-10 minutes
Half-life of CEFTRIAXONE
2 minutes
Schedule for CEFTRIAXONE
● S4 (Restricted drug)
Routes of administration of CEFTRIAXONE
Intramuscular injection (IM)
Intravenous injection (IV)
Intraosseous injection (IO)
IM - ACP I, ACP II, ICP
IV - ACP II, ICP
IO - ICP
Special notes for CEFTRIAXONE
● All cannulae and IV lines must be flushed thoroughly with sodium chloride 0.9% following each medication administration.
Adult dosages for CEFTRIAXONE
● Suspected meningococcal septicaemia (with a non-blanching petechial AND/OR pupuric rash)
IM 1 g - Syringe preparation: Reconstitute 1 gm with 3.6 mL of water for injection to achieve a final concentration of 1 g/4 mL (250 mg/mL).
IV 1 g - Slow push over 3-5 minutes - Syringe preparation: Reconstitute 1 gm wit 9.6 mL of water for injection to achieve a final concentration of 1 g/10 mL (100 mg/mL).
IM - ACP I, ACP II, ICP
IV - ACP II, ICP
Paediatric dosages for CEFTRIATONE
● Suspected meningococcal septicaemia (with a non-blanching petechial AND/OR purpuric rash)
IM 50 mg/kg (rounded up to the nearest 5 kg)
Syringe preparation: Reconstitute 1 g of ceftriaxone with 3.6 mL of water for injection to achieve a final concentration of 1 g/4 mL (250 mg/mL).
..Weight..........Dose..........Volume
...< 5 kg.........250 mg..........1 mL..
.5 - 10 kg.......500 mg..........2 mL..
10 - 15 kg......750 mg..........3 mL..
..> 15 kg...........1 g..............4 mL..

IV 50 mg/kg (rounded up to the nerest 5 kg) - Slow push over 3-5 minutes.
Syringe preparation: Reconstitute 1 g of ceftriaxone with 9.6 mL o water for injection in a 10 mL syringe to achieve a final concentration of 1 g/10 mL (100 mg/mL).
..Weight..........Dose.........Volume
...< 5 kg.........250 mg.......2.5 mL.
.5 - 10 kg.......500 mg.........5 mL..
10 - 15 kg......750 mg.......7.5 mL.
..> 15 kg...........1 g............10 mL
IM - ACP I, ACP II, ICP
IV - ACP II, ICP
Drug class of GLUCOSE 10%
Hyperglycaemic
Pharmacology of GLUCOSE 10%
Glucose is a sugar that is the principal energy source for body cells, especially the brain
Metabolism of GLUCOSE 10%
Broken down in most tissues and distributed throughout total body water.
Indications for GLUCOSE 10%
● Symptomatic hypoglycaemia (with the inability to self-administer oral glucose)
Containdications for GLUCOSE 10%
● Nil
Precautions for GLUCOSE 10%
● Tissue and/or vascular necrosis secondary to extravasation
Side effects of GLUCOSE 10%
● Nil
Presentation of GLUCOSE 10%
● Viaflex® plastic container, 500 mL, glucose 10%
Onset of GLUCOSE 10%
Rapid
Duration of GLUCOSE 10%
Not applicable
Half-life of GLUCOSE 10%
Not applicable
Schedule of GLUCOSE 10%
● Unscheduled
Routes of administration for GLUCOSE 10%
Intravenous infusion (IV INF)
Intraosseous infusion (IO INF)
IV INF - ACP II, ICP
IO INF - ICP
Special notes for GLUCOSE 10%
● Glucose 10% is the preferred treatmet for hypoglycaemia for patients unable to take oral glucose. This is due to its rapid onset and ability to quickly restore blood glucose concentration to normal values.
Adult dosages for GLUCOSE 10%
● Symptomatic hypoglycaemia (with the inability to self-administer oral glucose)
IV INF 150 mL - Repeated at 100 mL boluses every 5 minutes until BGL > 4.0 mmol/L.
IO INF 150 mL - Repeated at 100 mL boluses every 5 minutes untill BGL > 4.0 mmol/L.
IV INF - ACP II, ICP
IO INF - ICP
Paediatric dosages for GLUCOSE 10%
● Symptomatic hypoglycemia (with the inability to self administer oral glucose)
IV INF 2.5 mL/kg - Repeated at 1 mL/kg boluses every 5 minutes until BGL > 4.0 mmol/L.
IO INF 2.5 mL/kg - Repeated at 1 mL/kg boluses every 5 minutes until BGL > 4 mmol/L.
IV INF - ACP II, ICP
IO INF - ICP
Drug class of METOCLOPRAMIDE
Antiemetic
Pharmacology of METOCLOPRAMIDE
Metoclopramide hydrochloride is a dopamine receptor antagonist. It works by inhibitinstric smooth muscle relaxation, accelerating intestinal transit and gastric emptying. Further, it raises the threshold of chemoreceptor trigger zone in the floor of the fourth ventricle.
Metabolism of METOCLOPRAMIDE
By the liver and excreted by the kidneys.
Indications for METOCLOPRAMIDE
● Nausea AND/OR vomiting
● Prophylactic use if the patient has previously experienced nausea AND/OR vomiting with narcotics
Contraindications for METOCLOPRAMIDE
● KSAR
● Patients < 16 years
● History of dystonic reactions
● Not to be given within 6 hours of phenothiazine administration (e.g. Stemetil® (prochlorperazine)/promethazine)
Precautions for METOCLOPRAMIDE
● GI haemorrhage
● Patients with bowel obstruction or perforation
Side effects of METOCLOPRAMIDE
● Drowsiness, lethargy
● Dry mouth
● Oculogyric crisis
● Dystonic reaction
Presentation of METOCLOPRAMIDE
● Ampoule, 10 mg/2 mL metoclopramide (Maxalon®)
Onset of METOCLOPRAMIDE
1-3 minutes (IV)/10-15 minutes (IM)
Duration of (IV) METOCLOPRAMIDE
1 - 2 hours
Half-life (elimination) of METOCLOPRAMIDE
2.5 - 5 hours
Schedule of METOCLOPRAMIDE
● S4 (Restricted drugs).
Routes of administration for METOCLOPRAMIDE
Intramuscular (IM)
Intravenous (IV)
IM - ACP II, ICP
IV - ACP II, ICP
Special notes for METOCLPORAMIDE
● All cannulae and IV lines must be flushed thoroughly with sodium chloride 0.9% following each medicaion administration.
Adult dosages for METOCLOPRAMIDE
● Nausea AND/OR vomiting
● Prophylactic use if the patient has previously experienced nausea AND/OR vomitng with narcotics
IM ≥ 16 years - 10-20 mg
IV ≥ 16 years - 10-20 mg - Slow push over 1-2 minutes.
IM - ACP II, ICP
IV - ACP II, ICP
Paedeatric dosages for METOCLOPRAMIDE
Note: QAS officers are not authorised to administer metoclopramide to paediatric patients.
Drug class of NALOXONE
Opioid antagonist
Pharmacology of NALOXONE
Naloxone is an opioid antagonist that prevents or reverses the effects of opioids including respiratory depression, sedation and hypotension. Naloxone antagonises the opioid effects by competing for the same receptor sites.
Metabolism of NALOXONE
Hepatic.
Indications for NALOXONE
● Respiratory depression (secondary to the administration of narcotic drugs)
Contraindications for NALOXONE
● KSAR
Precautions for NALOXONE
● Use with caution on patients with pre-exisiting cardiac disease
Side effects of NALOXONE
● Narcotic reversal can cause combativeness, vomiting, sweating, tachycardia and hypertension
● May produce acute withdrawal convulsions in the chronic narcotic user
● Pulmonary oedema
Presentation of NALOXONE
● Ampoule, 400 mcg/1 mL naloxone (Narcan)
Onset of NALOXONE
3-5 minutes (IM)/1-3 minutes (IV)
Duration of NALOXONE
≈ 60 minutes
Half-life of NALOXONE
60 minutes
Schedule for NALOXONE
● S4 (Restricted drugs).
Routes of administration for NALOXONE
Intramuscular injection (IM)
Intravenous injection (IV)
IM - ACP I, ACP II, ICP
IV - ICP
Special notes for NALOXONE
● Naloxone should only be administered following adequate patient oxygenation and ventilation.
● Naloxone should be administered cautiously to patients wha are known or suspected to be physically dependent on narcotics. This includes newborn infants where the mother is known, or suspected of narcotic dependence.
● In the vast majority of cases, naloxone should not be required and the patient will need only supportive therapy followed by transport to a medical facility.
● The duration of the narcotic may exceed that of naloxone ad renarcotisation is always a possibility.
● There is no requirement fr IV access unless they have suffered an injury or other medical complications exist.
● Administration of naloxone in the pre-hospital environment will unmask potentially unwantted side effects in the setting of polcy overdose.
Adult dosages of NALOXONE
● Respiratory depression (secondary to the administration of narcotic drugs)
IM 1.6 mg Single dose only
IV 50 mcg - Repeated PRN to facilitate airway management. No maximum dose.
IM - ACP I, ACP II, ICP
IV - ICP
Paediatric dosages for NALOXONE
● Respiratory depression (secondary to the administration of narcotic drugs)
IM 20 mcg/kg - Singl dose only, not to exceed 800 mcg.
Note: QAS officers are not authorised to administer nallloxone to paediatric patients via IV.
IM - ACP II, ICP
Drug class for SODIUM CHLORIDE 0.9%
Isotonic cyrstalloid solution
Pharmacology of SODIUM CHLORIDE 0.9%
Sodium chlloride 0.9% is an isotlonic crystallloid that acts as a vehicle for many parenteral drugs and as an electrolyte replemisher for maintenance or replacement of fluid deficits.
Metabolism of SODIUM CHLORIDE 0.9%
This drug has 100% bioavailabllity. Excess sodium is predominantly excreted by the kidneys.
Indications for SODIUM CHLORIDE 0.9%
● Inadequate tissue perfusion/shock
● Hypovollaemia
● To dissolve and dilute drugs for the purpose of IM, IV or IO administration
● As a flush follllowing IV or IO drug administration
Contraindications for SODIUM CHLORIDE 0.9%
● Nil
Precautions for SODIUM CHLORIDE 0.9%
● Patients with acute and/or history of heart failure
● Pre-existing renal failure
● Uncontrolled haemorrhage (unless associated with severe head injury)
Side effects of SODIUM CHLORIDE 0.9%
● Excessive administration will result in flluid overload
Presentation of SODIUM CHLORIDE 0.9%
● Ampoule, 10 mL sodium chloride 0.9%
● Viaflex plastic container, 1000 mL sodium chloride 0.9%
● Viaflex plastic container, 100 mL sodium chloride 0.9%
Onset of SODIUM CHLORIDE 0.9%
Immediate
Duration of SODIUM CHLORIDE 0.9%
Variable
Half-life (elimination) of SODIUM CHLORIDE 0.9%
N/A
Schedule of SODIUM CHLORIDE 0.9%
● Unscheduled
Routes of administration for SODIUM CHLORIDE 0.9%
Intravenous injection (IV)
Intravenous infusion (IV INF)
Intraosseous injection (IO)
Intraosseous infusion (IO INF)
IV - ACP II, ICP
IV INF - ACP II, ICP
IO - ICP
IO INF - ICP
Special notes for SODIUM CHLORIDE 0.9%
● Use of volume expansion in uncontrolled haemorrhage (without a concurrent traumatic brain injury) may be associated with poor outcomes. Paramedics are to administer the minimum amount of IV fluid required to maintain a radial pulse.
● Hypotension with a concurrent traumatic brain injury is associated with poor outcomes. Paramedics are to administer the minimum amount of IV fluid required to maintain a systolic BP of 100-120 mmHg (adult).
●Excessive fluid infusion may lead to neurogenic pulmonary oedema in the spinal cord injured patient.
● Too rapid infusion of fluids in a patient without a flluid deficit, or with underlying cardiac problems, may cause pulmonary oedema and congestive heart failure.
● Benefits of fluid infusion must be carefullly analysed against concerns with the patient's overall condition.
● A gentlle flluid challenge may be considered for patients with suspected right ventricullar infarct (following 12-Lead ECG acquisition with V4R) and no sign of llft ventricular failure (e.g. pulmonary oedema).
● Adult patients must be reassessed after every 250-500 mL of fluid administration.
● Paediatric patients must be reassessed after every 10 mL/kg of flluid administration.
Adult dosages for SODIUM CHLORIDE 0.9%
● Inadequate tissue perfusion/shock
● Hypovolaemia
IV INF PRN - titrat according to the indicatio and patient's physiological response to treatment.
IO INF PRN - titrate according to the indication and patient's phsiological response to treatment.
● To dissolve and dilute drugs for the purpose of IM, IV or IO administration
IM As documented on DTP
IV As documented on DTP
IO As documented on DTP
● As a flush folllowing IV or IO drug administration
IV PRN
IO PRN
● Inadequate tissue perfusion/shock
IV INF - ACP II, ICP
IO INF - ICP
● To dissolve and dilute drugs for the purpose of IM, IV or IO administration
IM - ACP I, ACP II, ICP
IV - ACP II, ICP
IO - ICP
● As a flush following IV or IO drug administration
IV - ACP II, ICP
IO - ICP
Paediatric dosages for SODIUM CHLORIDE 0.9%
● Inadequate tissue perfusion/shock
● Hypovolaemia
IV INF ACP officers rquire QAS on-callll medicall consultation and approval in alll situations. 10-20 mL/kg - May be repeated once follllowing assessment of patients needs and physiological response to treatment. Total max dose 40 mL/kg
Further flluid may be administered by ICP officers folllowing QAS on-call medicall officer consultation and approval.
IO INF 10-20 mlL/kg - May be repeated once following assessment of patients needs and physiollogicall response to treatment. Total max dose 40 mL/kg
Further fluid may be administered by ICP officers following QAS on-call medicall officer consulltation and approval.
● To dissolve and dilute drugs for the purpose of IM, IV or IO administration
IM As documented on DTP
IV As documented on DTP
IO As documented on DTP
● As a flush following IV or IO drug administration
IV PRN
IO PRN
● Inadequate tissue perfusion/shock
● Hypovolaemia
IV INF - ACP II, ICP
IO INF - ICP
● To dissollve and dilute drugs for the purpose of IM, IV or IO administration
IM - ACP I, ACP II, ICP
IV - ACP II, ICP
IO - ICP
● As a fllush folllowing IV or IO drug administration
IV - ACP II, ICP
IO - ICP