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182 Cards in this Set

  • Front
  • Back

Adrenaline: Indications

Cardiac Arrest




Anaphylaxis




Life threatening asthma with failing ventilations and continued deterioration despite nebuliser therapy .





Adrenaline: Actions

Sympathomimetic that stimulates alpha and beta adrenergic receptors.




Enhances myocardial and cerebral blood flow during CPR.




CPR becomes more effective due to increased peripheral resistance which improves perfusion pressures.



Adrenaline: Actions cont....



Reverses allergic manifestations of acute anaphylaxis.




Relieves bronchospasm in acute sever asthma.

Adrenaline: Contra-indications

Do not give repeat doses in hypothermic patients.

Adrenaline: Cautions

Severe hypertension may occur in patients on beta blockers- half doses unless profound hypotension.




Half dose for patients on tricyclic antidepressants.

Adrenaline: Dose

Cardiac arrest- 1mg every 3-5 mins no max




Anaphylaxis/ asthma- 500mcgm every 5 mins no max

Amiodarone: Indications

Shockable rhythms if unresponsive to defib.

Amiodarone: Actions

Antiarrhythmic; lengthens cardiac action potential and therefore effective refractory period.




Prolongs QT interval.



Blocks sodium and potassium channels in cardiac muscle.




Acts to stabilise and reduce electrical irritability of cardiac muscle.

Amiodarone: Contra-indications

None in context of cardiac arrest.

Amiodarone: Dose

3rd Shock- 300mg


5th Shock- 150mg




Max 450mg

Aspirin: Indications

Adults with:


Clinical or ECG evidence suggestive of MI or ischaemia.

Aspirin: Actions

Anti-platelet reduces clot formation.




Analgesic, anti-pyretic and anti-inflammatory.

Aspirin: Contra- indications

Haemophilia or other blood clotting disorders.




Active GI bleed.



Children under 16 yrs.




Known hypersensitivity.




Severe hepatic disease.

Aspirin: Cautions

Pregnancy




Asthma




Current treatment with anticoagulants




Kidney/ liver failure




Gastric or duodenal ulcer



Aspirin: Dose

300mg oral

Atropine: Indications

Absolute bradycardia heart rate <40 bpm




Systolic BP below for expected age




Inadequate perfusion causing confusion




Paroxysmal ventricular arrhythmias requiring suppression

Atropine: Contra-indications

Do not administer to hypothermic patients

Atropine: Actions

May reverse effects of vagal overdrive




May increase HR by blocking vagal activity in sinus brady or in 3rd degree




Enhances AV conduction

Atropine: Dose

600mcgm 3-5 mins max 3 mg

Benzylpenicillin: Indications

Suspected menigococcal disease with:




Non- blanching rash (petechial or purpuric)


&


S+S of menigococcal septicaemia.

Benzylpenicillin: Action

Broad spectrum antibiotic

Benzylpenicillin: Contra- indications

Severe allergy to penicillin more than a simple rash

Benzylpenicillin: Dose

IV: 1.2gm in 19.2ml WFI



IM: 1.2gm in 3.2ml WFI

Chlorphenamine: Indications

Severe anaphylaxtic reactions




Symptomatic allergic reactions falling short of anaphylaxis but causing pt distress.

Chlophenamine: Actions

Antihistamine that blocks the effects of histamine release during a hypersensitivity reaction.




Anticholinergic properties

Chlophenamine: Contra-indications

Known hypersensitivity




Children under 1

Chlophenamine: Cautions

Hypotension




Epilepsy




Prostatic disease




Glaucoma




Hepatic disease



Chlophenamine: Dose

IV- 10mg




Oral- 4mg

Clopidogrel: Indications

Acute STEMI-




In pts not already taking clopidogrel


Receiving thrombolytic treatment


Anticipated thrombolytic treatment


Anticipated PPCI

Clopidogrel: Actions

Inhibits platelet aggregation

Clopidogrel: Contra-indications

Breast feeding




Active pathological bleed eg peptic ulcer




Known allergy




Severe liver impairment

Clopidogrel: Cautions

Pregnancy




Renal impairment




NSAIDs

Clopidogrel: Dose

Thrombolysis: 300mg




PPCI: 600mg

Dexamethasone: Indications

Moderate- Severe croup

Dexamethasone: Actions

Corticosteriod that reduces subglottic imflammation

Dexamethasone: Cautions

Do not cause distress to pt due to upper airway compromise

Dexamethasone: Dose

1mnth- 12 mnths: 2mg




18mnths- 6 yrs: 4mg



Diazepam: Indications

Fits longer than 5 mins + still fitting




Repeated fits- not secondary to uncorrected hypoxia or hypoglycaemia




Status epilepticus




Eclamptic fits (>2-3 mins)




Symptomatic cocaine toxicity (severe hypertension, chest pain or fitting).

Diazepam : Actions

Central nervous system depressant, acts as an anticonvulsant and sedative.

Diazepam: Contra- indications

None

Diazepam: Cautions

Resp depression




Alcohol, antidepressants or other CNS depressants- side effects more likely




Recent does by cares ( max cumulative dose)

Diazepam: Dose

Rectal- 10mg no repeat max 10mg




20mg no repeat max 10mg




IV- 10mg, every 5 mins, repeat 10 mg, max 20mg

Entonox: Indications

Moderate- sever pain




Labour pains

Entonox: Actions

Inhaled analgesic

Entonox: Contra- indications

Severely disturbed psyc pts




Head injury with LOC




Diving in last 24hrs (bends)

Entonox: Cautions

Suspects pneumothorax, pneumomediastinum or pneumoperitonem, eg polytrauma,penetrating torso inj.

Entonox: Dose

PRN, 3-5 mins to be effective




5-10 max effect

Furosemide: Indications

Pulmonary oedema 2nd to LVF

Furosemide: Actions

Potentate diauretic with a rapid onset (within 30 mins) short lasting.

Furosemide: Contra-indications

Pre-comatose state secondary to liver cirrhosis



Sever renal failure with anuria



Under 18!!

Furosemide: Cautions

Hypokalaemia (low potassium) could induce arrhythmias




Pregnancy




Hypotensive pt

Furosemide: Dose

IV: 40-50mg

Glucagon: Indications

Hypoglycaemia with BM <4




Clinically suspected hypo where oral glucose not available




Unconscious pt where hypo likely cause

Glucagon: Actions

Hormone that induces the conversion of glycogen to glucose in the liver, therefore increases blood sugar levels

Glucagon: Contra-indications

Low glycogen store ( glucagon used recently)




Hypoglycaemic seizures (use IV glucose 10%)

Glucagon: Cautions

Avoid IM if thrombolysis required

Glucagon: Dose

IM: 1mg no repeat

Glucose 10%: Indications

Hypoglycaemia with BM <4




Clinically suspected hypo where oral glucose not possible




Unconscious pt where hypo likely cause

Glucose 10%: Actions

Reversal of hypo

Glucose 10%: Contra-indications

None

Glucose 10%: Cautions

Use a wide bore cannula into large vein- glucose 10% can irritate vein

Glucose 10%: Dose

10gms, repeat every 5 mins, 10 gms, Max dose 30gms

Glucose 40%: Indications

Hypo with BM <4, where there is no risk of chocking or aspiration

Glucose 40%: Actions

Rapid increase of blood glucose by buccal absorption

Glucose 40%: Contra-indications

None

Glucose 40%: Cautions

Pts with LOC where aspiration or chocking a possibility. Soak a gauze, place it between the lip and the gum.

Glucose 40%: Dose

10gms, repeat every 5 mins, 10gms, no max

GTN: Indiactions

Cardiac chest pain due to angina or MI




Acute pulmonary oedema

GTN: Actions

Potent vasodilator....




Dilation of coronary arteries/ relief of coronary spasm




Dilation of systemic veins resulting in lower pre-load




Reduce BP

GTN: Contra-indications

Viagra within last 24hrs




Hypotension systolic <90




Hypovolaemia




Head trauma




Cerebral haemorrhage




Unconscious

GTN: Cautions

None

GTN: Dose

SL: 400-800 mcgm, repeat 5-10 mins, no max

Heparin: Indications

STEMI where heparin is required to as adjunctive therapy with reteplase or tenecteplase to reduce risk of re-infarction.

Heparin: Actions

Anticoagulant

Heparin: Contra-indications

Haemophilia or other haemorrhagic disorders




Thrombocytopenia




Recent cerebral haemorrhage




Severe hypertension




Severe liver disease




Oesophageal varices




Peptic ulcer




Major trauma




Recent eye surgery or to NS




Acute bacterial endocarditis




Spinal or epidural anaesthesia

Heparin: Cautions

None

Heparin: Dose

IV: with reteplase- 5,000




IV: with tenecteplase- <67 kg, 4,000


> 67 kg, 5,000




Further 1,000 bolus maybe required if heparin infusion has not started within 45 mins of original bolus.



Hydrocortisone: Indications

Severe or life threatening asthma (hosp time >30)




Anaphylaxis




Adrenal crisis

Hydrocortisone: Actions

Glucocorticoid drugs that reduces inflammation and suppressed the immune response

Hydrocortisone: Contra-indications

Known allergy

Hydrocortisone: Cautions

None relevant to single dose




Avoid IM if thrombolysis needed

Hydrocortisone: Dose

Asthma + Adrenal crisis:


IV: 100mg




Anaphylaxis:


IV:200mg

Ibuprofen: Indications

Mild- moderate pain/ high temp




Soft tissue injuries

Ibuprofen: Actions

Analgesic




Anti-inflammatory




Anti-pyretic

Ibuprofen: Contra-indications

Dehydration




Renal insufficiency




Hypovolaemia




GI disturbance




Pregnant

Ibuprofen: Cautions

Asthma- can cause bronchoconstriction




Elderly- if not used NSAIDs recently

Ibuprofen: Dose

400mg, repeat 8hrs, max 1.2gms

Ipratropium: Indications

Acute severe- life threatening asthma




Acute asthma unresponsive to salbutamol




Exacerbation of COPD, unresponsive to salbutamol

Ipratropium: Actions

Antimuscarinic bronchodilator.

Ipratropium: Contra-indications

None

Ipratropium: Cautions

Glaucoma




Pregnancy/ breast feeding




Prostatic hyperplasia




COPD neb 6 mins

Ipratropium: Dose

500mcgm no repeat

Metoclopramide: Indications

Treatment/ prevention of nausea or vomiting in adults over 20yrs old




Treatment/ prevention of nausea or vomiting following morphine

Metoclopramide: Actions

Anti-emetic that acts centrally and in the GI tract

Metoclopramide: Contra-indications

Renal failure




Adrenal cancer




GI obstruction, recent GI surgery




Under 20 yrs old

Metoclopramide: Cautions

Avoid IM if thrombolysis needed.




Avoid in drug over dose.

Metoclopramide: Dose

10mg, no repeat

Misoprostol: Indications

Postpartum haemorrhage within 24hrs of delivery, bleeding from uterus uncontrolled by uterine massage.




Miscarriage with life threatening bleeding and confirmed diagnosis.




Both syntometrine and ergometrine are contra-indicated in hypertension

Misoprostol: Actions

Stimulates contraction of the uterus




Onset of action 7-10 mins

Misoprostol: Contra-indications

Known hypersensitivity




Active labour




Possible multiple pregnancy/ suspected fetus in utero

Morphine: Indications

Pain associated with MI




Severe pain as a component of a balanced analgesic regimen





Morphine: Actions

Strong opioid analgesic




Produces sedations, euphoria and analgesia. May depress resp and induce hypotension




Histamine release may contribute to vasodilating effects= urticaria and bronchoconstriction can occur.

Morphine: Contra-indications

Under 1yrs old




Actual systolic BP<90




Head injury with reduced GCS <9




Resp depression < 10 resp per min




Known hypersensitivity









Morphine: Cautions

Severe renal or hepatic impairment




Extreme caution in pregnancy




Chest injuries with resp difficulty, exp if resp inhibited by pain




COPD, Asthma




Head injury




Acute alcohol intoxication




Medications

Morphine: Dose

IV: 10mg, repeat 5 mins, max 20mg




IM: 10mg, repeat 60 mins, max 20mg




Oral: 20mg, repeat 60 mins, max 40mg

Naloxone: Indications

Opioid OD with resp, CVS and CNS depression




OD of either opioid analgesic or compound analgesic




Unconscious pt associated with resp depression of unknown cause, where opioid OD possible




Reversal of resp and CNS depression in neonate following maternal opioid drug use during labour

Naloxone: Actions

Antagonism of the effects of opioid drugs

Naloxone: Contra-indications

Neonates born to opioid addicted mothers- BVM

Naloxone: Cautions

None

Naloxone: Dose

IV: 400mcgms, repeat every 3 mins, max 4400mcgm

Ondansetron: Indications

Treatment/ prevention of opioid induced nausea or vomiting




Treatment for nausea or vomiting





Ondansetron: Actions

Anti-emetic that blocks 5HT receptors both centrally and in the GI tract

Ondansetron: Contra-indications

Known hypersensitivity




Under 1 month old

Ondansetron: Cautions

Breast feeding




Pregnancy




Hepatic impairment




QT interval prolongation

Ondansetron: Dose

IV: 4mg, no repeat

Oxygen: Indications

Critical illnesses requiring high levels of supplemental O2




Serious illnesses requiring moderate levels of O2 if pt is hypoxaemic




COPD and other conditions requiring controlled or low dose O2

Oxygen: Actions

Essential for cell metabolism. Adequate tissue oxygenation is essential for normal physiological function




O2 assists reversing hypoxia, raises concentration of inspired O2



Oxygen: Contra-indications

Explosive environments

Oxygen: Cautions

O2 increased fire hazard




De fibrillation- ensure pads are firmly applied to avoid spark hazard

Oxygen: Dose

High levels of O2 with critical illness: 94-98%


Cardiac arrest


Major trauma


Anaphylaxis


Major pulmonary haemorrhage


Sepsis


Shock


Active convulsion


Hypothermia

Oxygen: Dose cont.....

Moderate levels of O2: 94-98%




<85%= 10- 15 Ltrs


>85-93%=2-6 Ltrs (nasal)


>85-93%= 5-10 Ltrs (mask)




Acute hypoxaemia


Deterioration of lung fibrosis or other interstitial disease


Acute asthma


Acute heart failure


Pneumonia


PE
Sickle cell


Severe anaemia

Oxygen: Dose cont......

Controlled or low dose O2= 88-92% at 4 ltrs




COPD
Exacerbation of cystic fibrosis


Chest wall disorders





Oxygen: Dose cont.....

No O2, only if become hypoxaemic- 94-98%




<85%= 10-15 ltrs


>85-93%= 2-6 ltrs (nasal)


>85-93%= 5-10 ltrs (mask)




MI


CVA


Abdo pain


Headache


OD


GI bleed


Glycaemic emergencies

Paracetamol: Indications

Mild to moderate pain relief/ high temp




As part of a balanced analgesic regimen for severe pain (IV)

Paracetamol: Actions

Anti-pyretic




Analgesic

Paracetamol: Contra- indications

Known allergy




Exceeded max cumulative dose in 24hrs




Taken within last 4hrs

Paracetamol: Cautions

None

Paracetamol: Dose

Oral: 1mg, every 4-8 hrs, Max 4gms

Reteplase: Indications

STEMI, 12 hr of symptom onset where PPCI not readily available

Reteplase: Actions

Activates the fibrinolytic system, inducing the break up of intrvascular thrombi and emboli

Reteplase: Contra-indications

See local trust checklist

Reteplase: Caution

None

Reteplase: Dose

>18 first dose 10 units, second dose 10 units




2nd does give after 30 mins

Salbutamol: Indications

Acute asthma attack where inhalors have failed




Expiratory wheeze associated with allergy, anaphylaxis, smoke inhalation or other low airway cause




Excerbation of COPD




SOB in pts with LVF

Salbutamol: Actions

Selective beta2 adrenoreceptor stimulant.




Relaxant effect on smooth muscle in medium and small airways which are in spasm during asthma attck

Salbutamol: Contra-indications

None



Salbutamol: Cautions

Hypertension


Angina


Late pregnancy


Overactive thyroid


Severe hypertension may occur in pts on beta blockers= half doses




COPD 6 mins

Salbutamol: Dose

Neb: 5mg, every 5 mins, no max

Sodium Chloride 0.9%: Indications

Medical conditions with/without haemorrhage




Trauma related haemorrhage




Burns




Limb crush injuries




Flush

Sodium Chloride 0.9%: Actions

Increases vascular fluid volume which consequently raises cardiac output and improves perfusion

Sodium Chloride 0.9%: Contra-indications

None

Sodium Chloride 0.9%: Cautions

None

Sodium Chloride 0.9%:Dose

General medical conditions with/without haemorrhage & Penetrating torso =


250ml, repeat 250ml, PRN, max 2 ltrs




Sepsis=


1ltr, repeat 1 ltr, 30mins, max 2 ltrs




Burns= 1ltr




Crush injury= 2 ltrs

Syntometrine: Indications

Postpartum haemorrhage within 24hrs of delivery where bleeding from uterus is uncontrolled by uterine massage




Miscarriage with life threatening bleeding and a confirmed diagnosis

Sodium lactate compound- Contra-indications

Diabetic hyperglycaemic ketoacidotic coma, pre-coma.



Neonates


Sodium lactate compound- Cautions

Limb crush injuries- if sodium chloride is available




Renal and liver failure

Syntometrine: Actions

Stimulates uterine contraction




Onset 7-10 mins

Syntometrine: Contra-indications

Hypertension and severe pre-eclampsia




Known hypersensitivity



Severe cardiac, liver or kidney disease




Active labour




Possible multiple pregnancy/ suspected fetus in utero

Syntometrine: Catuions

None

Syntometrine: Dose

IM: 500mcgm ergometrine and 5 units of oxytocin

Tenecteplase: Indiacations

STEMI with 6hrs of symptom onset where PPCI not readily available

Tenecteplase: Actions

Activates fibrinolytic system , inducing the breaking up of intrvascular thrombi and emboli

Tenecteplase: Contra-indications

See trust checklist

Tenecteplase: Cautions

None

Tenecteplase: Dose

<60kg= 6,000 units


60-69 kg= 7,000 units


70-79 kg= 8,000 units


80-89 kg= 9,000 units


>90 kg= 10,000 units

Tranexamic Acid: Indications

Pts with time critical injury where significant internal/external haemorrhage is suspected




Injured pts fulfilling step 1 or 2 of trauma triage protocol

Tranexamic Acid: Actions

Ainti-fibrinolytic which reduces the breakdown of blood clots.

Tranexamic Acid: Contra-indications

Bleeding has stopped




If interventions delay transport to hospital



Isolated head injury

Tranexamic Acid: Cautions

None

Tranexamic Acid: Dose

IV: 1gm

Anti-epileptics

Carbamazepine




Valporates




Phenytoin

GI- Regulate stomach acid

Cimetidine

Ranitidine


Famotidine


Nizatidine


GI- Inhibit acid secretion

Omeprazole




Lansoprazole

GI

Magnesium + Aluminium hydroxide


Calcium carbonate


Sodium bicarbonate

Calcium channel blockers- Hypertension

Amlodipine


Diltiazem


Felodipine


Nicardipine


Nifedipine


Verapamil

Beta blockers (*lol's)

Atenolol


Bisprolol


Propanolol


Oxprenolol

SSRI's- antidepressant

Fluoxetine


Citalopram


Trazodone


Paroxetine


Venlafaxine

Benzodiazepines- (*am)

Diazepam


Flurazepam


Lorazepam


Temazepam


Triazolam

Tricyclic antidepressant

Amitriptyline


Trimipramine


Lofepramine


Dozepin

Nitrates- angina

Isosorbide dinitrate


Mononitrate


Ismo


Ismo retard


Angikat


Isodur


Nitrolingual


Glutrin


Nitromin

Anti-diabetic- Sulphonyureas

Tolbutaminde

Gliclazide


Chlorpropamide


Anti-diabetics- Biguanides

Metformin

Anti-diabetics- a-glucosidase

Acarbose

ACE inhibitors- Hypertension

Ramipril


Perindopril


Lisinporil


Enalapril


Captopril

Statins- Cholesterol

Simvastatin




Atorvastatin




Pravastatin




Rosuvastatin

Antibotics- Sulphonamides

Trimethoprim




Co-trimoxazole

Antibotics- Penicillins

Phenoxymethylpenicillin




Benzylpenicillin




Amoxycillin




Flucloxacillin




Ampicillin.

Antibotics- Cephalosporins

Cefaclor




Cefalexin




Cefradine

Antibotics- Tetracyclines

Oxytetracycline




Tetracycline




Doxycycline




Lymecycline

Antibotics-Macrolides

Erythromycin




Clarithromycin




Azithromycin



Viagra

Sildenafil




Alprostadil




Tadalafil




Vardenafil

Diuretics- Hypertension and Oedema

Bendroflumethiazide




Furosemide




Bumetanide




Amiloride