| Question | Answer |
| Tranexamic Acid - Actions | Anti-fibrinolytic which reduces the breakdown of blood clots |
| Chlorphenamine - Dosage | IV 10mg (1ml) given slowly over 1 minute |
| Glucose 10% - Cautions | Use large bore cannula into a large vein as glucose is an irritant |
| Benzylpenicillin (Pen G)- Dosage | IV- 1.2g dissolved with 20ml WFI- Given while on-route to hospital
IM- 1.2g dissolved with 4ml WFI- Slow injection- Given while on-route to hospital |
| 0.9% Sodium Chloride - Dosage | Flush 2ml-10ml PRN
Fluid challenge- 250ml repeated PRN max. Max dose 2 litres.
Refer to JRCALC |
| Ipratropium Bromide - Side effects | Headache, Nausea & vomiting, Dry mouth, Tachycardia/Arrhythmia, Chest tightness, Reaction |
| Glucose 10% - Side effects | None |
| Morphine Sulphate - Cautions | Severe renal or hepatic impairment-?small dose
Extreme care if pregnant
Caution with chest injury
If DIB caused by pain, it may improve after analgesia
Asthma, COPD
Head Injury-hypoxia or pain
Intoxication
Meds may potentiate effects |
| GTN - Contra-indications | Hypo tension (Systolic less than 90mmHg), Hypovolaemia, Head trauma, Cerebral haemorrhage, Viagra type medications, Unconscious pt. |
| Entonox - Dosage | Self administered 3-10 mins till effect is achieved. |
| Glucagon - Side effects | Nausea, vomiting, diarrhoea, Hypersensitivity, Hypokalaemia, Hypotension |
| Naloxone - Side effects | Pts dependant on opiates may have violent withdrawal symptoms. Better to titrate dose to reverse the effects but to keep pt groggy |
| Naloxone - Actions | Antagonism of the effects of opiate drugs |
| Aspirin- Presentation | 300mg tablet |
| Aspirin- Cautions | As the benefits outweigh the risk, can be given to pts with Asthma, Pregnancy, Kidney or liver failure, Gastric or duodenal ulcers, Current treatment with anticoagulants |
| Salbutamol - Indications | Acute asthma, Expiratory wheeze due to allergy/ anaphylaxis/ smoke inhalation or other lower airway cause. Exacerbation of COPD, SOB due to LVF |
| Benzylpenicillin (Pen G)- Actions | Broad spectrum antibiotic |
| Morphine Sulphate - Additional Infomation | Class A-CD-schedule 2 of the Misue of Drugs Regs 1985-must be stored and its prescription and admin documented properly
Unused morphine discarded in the presence of witness
Narcan can reverse the effects of morphine
Consider Metoclopramide |
| Glucose 10% - Dosage | Large bore IV cannula- 10 grams (100ml) Repeated after 5 mins. Max dose 30 grams |
| Entonox - Cautions | Pneumothorax, Poly trauma chest injuries |
| Entonox - Actions | Inhaled analgesic agent |
| Tranexamic Acid - Side effects | Rapid injection might cause hypotension |
| Entonox - Contra-indications | Severe head injuries, Decompression sickness (The bends), Violently disturbed psychiatric pts |
| Paracetamol - Actions | Analgesic and antipyretic properties |
| Atropine- Presentation | 1mg in 1ml |
| Clopidogrel - Cautions | As the benefits' outweigh the risk, can be given to pts with Pregnancy, Renal impairment, NSAIDs |
| Salbutamol - Presentation | Nebules containing 2.5mg /2.5ml or 5mg/2.5ml |
| Metoclopramide - Indications | Treatment of nausea or vomiting in pts aged 20 and above. Prevention of nausea and vomiting following Morphine |
| Glucose Oral Gel - Dosage | Buccal route- 10grams repeated every 5 mins. No Limit. |
| 0.9% Sodium Chloride - Actions | Increases vascular fluid volume which raises cardiac output and improves perfusion |
| Furosemide - Contra-indications | Pre comatose state secondary to liver cirrhosis, Severe renal failure with anuria |
| Clopidogrel - Contra-indications | Active bleeding, Known allergy, Liver impairment, Breastfeeding |
| Glucagon - Dosage | IM- 1mg (1 vial). Single dose. |
| Hydrocortisone - Dosage | Asthma and Adrenal crisis- SLOW IV (over 2 mins) 100mg single dose
Anaphylaxis - SLOW IV (over 2 mins) 200mg single dose |
| Ipratropium Bromide - Contra-indications | None in emergency setting |
| Metoclopramide - Actions | Antiemetic which acts centrally as well as on the GI tract |
| Salbutamol - Contra-indications | None in emergency situation |
| Diazepam - Side effects | Respiratory depression, Hypotension, Drowsiness, Confusion |
| Diazepam - Contra-indications | None |
| Adrenaline- Presentation | Pre Filled syringe or ampule containing 1mg in 1ml (1:1000)
Pre Filled syringe or ampule containing 1mg in 10ml (1:10000) |
| Salbutamol - Dosage | 5mg Nebulised with 6-8l O2, given every 5 mins. No Limit. |
| Furosemide - Presentation | Ampoules containing 50mg/5ml or 40mg/2ml
Prefilled syringe containing 80mg |
| Chlorphenamine - Cautions | Hypotension, Epilepsy, Glaucoma, Hepatic or Prostatic disease |
| Glucagon - Contra-indications | Low glycogen stores (recent use of glucagon), Hypoglycaemic seizures- IV Glucose 10% is preferred |
| Tranexamic Acid - Cautions | None |
| Clopidogrel - Side effects | Dyspepsia (indigestion), Abdo pain, Diarrhoea, Bleeding |
| Glucagon - Presentation | 1mg powder in vial made up with WFI |
| GTN - Cautions | None |
| 0.9% Sodium Chloride - Presentation | Various presentations of flushes and packs/bags |
| Tranexamic Acid - Presentation | Vial containing 500mg in 5ml |
| Ipratropium Bromide - Dosage | 0.5mg with 6-8 litres O2, single dose |
| Tranexamic Acid - Dosage | IV- 1gram given slowly over 10 mins |
| Paracetamol - Cautions | None |
| Atropine- Side effects | Dry mouth, blurred vision, dilated pupils, Confusion, hallucinations, Tachycardia, urine retention |
| Diazepam - Dosage | IV- 10mg given slowly, titrated to response, further 10mg given after 5 mins. Max 20mg
Rectal- Single tube. If dose given PR and then IV access gained, single dose can be given IV |
| Paracetamol - Side effects | None |
| Adrenaline- Actions | A sympathomimetic that stimulates both alpha and beta adrenergic receptors. Therefore myocardial and cerebral blood flow is enhanced, due to increased peripheral resistance which improves perfusion pressures |
| Benzylpenicillin (Pen G)- Contra-indications | Known Severe penicillin allergy (more than simple rash) |
| Metoclopramide - Presentation | Ampoule containing 10mg in 2ml |
| Naloxone - Contra-indications | Neonates born to opiate addicted mothers - can produce serious withdrawal effects. Emphasis on BVM and O2 |
| Ipratropium Bromide - Actions | Antimuscarinic bronchodilator. May provide short term relief in acute asthma, but beta 2 agonists (salbutamol) work quicker
Considered of greater benefit in children and adults with COPD |
| Amiodarone- Actions | Anti-arrhythmic- lengthens cardiac action potential- prolongs QT interval on ECG
Blocks sodium and potassium channels in cardiac muscle
Acts to stabilise and reduce electrical irritability of cardiac muscle |
| Hydrocortisone - Presentation | Ampoule containing 100mg in 1ml vial
Ampoule containing 100mg for reconstitution with up to 2ml WFI |
| Aspirin- Indications | Adults with clinical or ECG evidence of MI or ischemia |
| Glucagon - Cautions | Avoid IM administration of a drug if thrombolysis is required |
| Amiodarone- Contra-indications | None in cardiac arrest |
| Naloxone - Cautions | None |
| Tranexamic Acid - Indications | Pts with time critical injury where significant internal or external haemorrhage is suspected |
| Hydrocortisone - Cautions | None relevant to a single dose. Avoid IM administration if pt likely to need thrombolysis |
| Diazepam - Cautions | Respiratory depression, Doses given by carers, If pt has used alcohol or other medications |
| Adrenaline- Indications | Cardiac Arrest, Anaphylaxis, Life threatening asthma with failing ventilation and continued deterioration, despite nebuliser therapy |
| Aspirin- Contra-indications | Known allergy, Children under 16, GI Bleeding, Haemophilia, Severe hepatic disease |
| Glucose 10% - Indications | Hypoglycaemia where oral glucose administration is not possible due to reduced LOC |
| Glucose 10% - Presentation | 500ml bag of 10% glucose (50 grams) |
| Hydrocortisone - Actions | Glucocorticoid drug that reduces and suppresses the immune response |
| Chlorphenamine - Actions | Antihistamine, anticholinergic (relaxes smooth muscles) properties |
| Glucose Oral Gel - Presentation | Plastic tube containing 25 grams 40% oral gel. |
| Ipratropium Bromide - Indications | Acute severe or life threatening asthma, Acute asthma unresponsive to salbutamol. COPD unresponsive to salbutamol |
| Clopidogrel - Dosage | 300mg oral tablet. Single dose |
| Glucose Oral Gel - Cautions | Reduced LOC, Soaking gauze swab and placing in between lip and gum may help absorption |
| Atropine- Actions | May reverse the effects of vagal overdrive, May increase heart rate by blocking vagal nerve activity in bradycardia or second or third degree heart block, Enhances AV conduction |
| Glucose 10% - Actions | Reversal of hypoglycaemia |
| Entonox - Presentation | Nitrous oxide 50% and Oxygen 50%. Blue cylinder with white shoulders |
| Chlorphenamine - Indications | Severe anaphylactic reactions, reactions causing distress ie severe itching |
| Salbutamol - Cautions | Used in care with Hypertension, Angina, overactive thyroid, late pregnancy, severe hypertension may occur on pts on beta blockers use half doses. If COPD limit neb to 6 mins |
| Glucagon - Actions | A hormone that converts glycogen to glucose in the liver thereby raising blood sugar levels |
| Diazepam - Indications | Fits longer than 5 mins and still fitting, Repeated fits, Status epilepticus, Eclamptic fits (if fits last more than 2-3 mins) |
| Furosemide - Actions | Diuretic, rapid onset (within 30mins) and short duration |
| Paracetamol - Dosage | As described |
| Morphine Sulphate - Indications | Pain associated with MI, Severe pain |
| Hydrocortisone - Indications | Severe or Life-threatening asthma, where call to hospital time is greater than 30 mins
Anaphylaxis
Adrenal crisis |
| Atropine- Indications | Absolute bradycardia (less than 40bpm), Hypotension, ventricular arrhytmias, inadequate perfusion causing confusion (Note hypoxia is biggest cause of bradycardia in children. Give O2 first) |
| GTN - Presentation | Metered dose spray containing 0.4 mg per dose
Tablets containing 2,3 or 5 mg |
| Adrenaline- Contra-indications | Do not give repeated doses to hypothermic patients |
| Clopidogrel - Indications | STEMI |
| Glucose Oral Gel - Actions | Rapid increase of blood sugars due to buccal absorption |
| 0.9% Sodium Chloride - Cautions | None |
| Paracetamol - Indications | Relief of mild to moderate pain and/or high temp |
| Benzylpenicillin (Pen G)- Presentation | Ampoule containing 600mg Pen G as powder. To be dissolved in WFI |
| Morphine Sulphate - Actions | Strong opioid analgesic, severe musculoskeletal and soft tissue pain.
Produces sedation, euphoria and analgesia. It may both depress respiration and induce hypotension
Histamine is released and this may contribute to the vasodilatory effect. |
| Furosemide - Side effects | Hypotension, GI disturbance |
| Ipratropium Bromide - Cautions | Use with care in pts with Glaucoma, Pregnancy and breastfeeding, Prostatic hyperplasia |
| Aspirin- Actions | Anti-platelet action to reduce clot formation, Analgesic, Anti-pyretic, Anti-inflammatory |
| Amiodarone- Indications | Cardiac Arrest- Shockable rhythm |
| Clopidogrel - Actions | Inhibits platelet aggregation |
| Adrenaline- Cautions | Hypo tension may occur in pts on beta-blockers, therefore give half doses
For pts on tricyclic antidepressants, half doses used for anaphylaxis |
| Metoclopramide - Cautions | Avoid in cases of drug overdose |
| Adrenaline- Cardiac Arrest Dosage | Cardiac Arrest- 1:10000- IV- 1mg (10ml)- every 3-5 mins
Shockable rhythm - after 3rd shock then after every alternative (ie 5th, 7th etc)
Non Shockable rhythm- after IV access gained, then alternative loops |
| Glucose Oral Gel - Side effects | None |
| GTN - Dosage | 1-2 spray (0.4-0.8 mg). No limit on doses as long as BP above 90mmHg |
| Amiodarone- Side Effects | Bradycardia, Hypotension, Bronchospasm, Arrhythmias- Torsades de pointes |
| 0.9% Sodium Chloride - Side effects | Over infusion may precipitate pulmonary oedema and cause breathlessness |
| Morphine Sulphate - Side effects | Respiratory depression, Cardiovascular depression, Nausea and vomiting, Drowsiness, Pupil constriction |
| Amiodarone- Cautions | Administer into large vein as extravastion can cause burns |
| Aspirin- Side Effects | Gastric bleeding, Wheezing in some asthmatics |
| Furosemide - Indications | Pulmonary oedema secondary to LVF |
| Glucose Oral Gel - Indications | Hypoglycaemia where there is no risk of patient choking |
| Glucose Oral Gel - Contra-indications | None |
| Chlorphenamine - Contra-indications | Children less than 1 year, Known hypersensitivity |
| GTN - Indications | Cardiac chest pain due to angina or MI
Acute cardiogenic pulmonary oedema |
| Paracetamol - Contra-indications | Known allergy
Do not give if a paracetamol containing product has been given within 4 hrs, or 4grams with 24hrs |
| Ipratropium Bromide - Presentation | Nebules containing 0.25mg in 1 ml or 0.5mg in 2ml |
| Benzylpenicillin (Pen G)- Indications | Suspected meningococcal disease with non-blanching rash and S&S suggestive of meningococcal septicaemia |
| Clopidogrel - Presentation | Tablet containing 75mg or 300mg |
| Amiodarone- Dosage | 300mg IV/IO after 3rd shock- repeated 150mg after 5th shock |
| Adrenaline- Anaphylaxis and Life threatening Asthma Dosage | 1:1000- IM - 0.5ml- every 5 mins |
| Aspirin- Dosage | 300mg chewed. Can be given regardless of how much aspirin taken that day |
| 0.9% Sodium Chloride - Contra-indications | None |
| Glucagon - Indications | Hypoglycaemia where oral glucose administration is not possible due to reduced LOC |
| Metoclopramide - Side effects | Drowsiness and restlessness, Cardiac abnormalities, Diarrhoea, Rash |
| Morphine Sulphate - Dosage | Record pain score
May take 2-3mins-peak between 10-20mins
Diluted with saline 0.9%, to make a concentration of 10mg in 10ml (1mg/1ml)
IV/IO route, given slowly approx 2mg/min
IV 10mg repeated 5 mins. Max 20mg
Oral 20mg repeated 60mins-Max 40mg |
| Morphine Sulphate - Contra-indications | Child under 1 year
Adult RR less than 10, Child RR less than 20
Hypotension. Adult less than 90 sys. Child less than 80 sys. Preschool less than 70 sys
Head Injury with significantly impaired LOC (below P on AVPU, below 9 GCS)
Known hypersensitivity |
| Entonox - Indications | Moderate to severe pain, Labour pain |
| Furosemide - Cautions | Hypokalaemia (low potassium)can induce arrhythmias, Pregnancy, Hypotension |
| Morphine Sulphate - Presentation | IV- Ampoules containing 10mg in 1ml
Oral- Vials containing 10mg in 5ml |
| Benzylpenicillin (Pen G)- Cautions | None |
| Salbutamol - Side effects | Tremor, Tachycardia, Palpitations, Headache, Feeling of tension, Peripheral vasodilatation, Cramps, Rash |
| Naloxone - Indications | Opioid overdose producing respiratory, cardiovascular and central nervous system depression
Unconsciousness with respiratory depression of unknown cause
Reversal of respiratory or central nervous system depression in a neonate following maternal use |
| Paracetamol - Presentation | Oral solution- 120mg/5ml Used from 3 months to 5 years
250mg/5ml Used from 5 years upwards
Tablets- 500mg each |
| Tranexamic Acid - Contra-indications | Isolated head injury, Critical interventions required (they must be done first), Bleeding now stopped |
| Atropine- Contra-indications | Should not be used in Hypothermic pts |
| Hydrocortisone - Contra-indications | Known Allergy |
| Metoclopramide - Contra-indications | Age less than 20, Renal failure, Tumour on adrenal gland, GI obstruction , GI problems |
| Diazepam - Presentation | Ampoule containing 10mg in 2ml
Rectal tube containing 2.5mg, 5mg or 10mg |
| Furosemide - Dosage | IV- 50mg slowly over 5 mins. Single dose. Give GTN first. |
| Atropine- Dosage | 0.6 mg IV/IO - repeated 3-5 mins. Max dose 3mg |
| Naloxone - Dosage | IV - 0.4mg repeated every 3 mins. Max dose 4.4mg
IM-0.4mg repeated every 3 mins. Max dose 4.4mg. Vary injection site. |
| GTN - Actions | Potent vasodilator. Dilatation of coronary arteries/relief of coronary spasm. Dilations of systemic veins causing lower pre load. Reduced blood pressure |
| Metoclopramide - Dosage | IV- 10mg (2ml) given over 2 mins. Single dose |
| Naloxone - Presentation | Ampoule containing 0.4mg/1ml |
| Salbutamol - Actions | A selective beta2 adrenareceptor stimulant. Relaxes smooth muscle in the medium and smaller airways |
| Chlorphenamine - Presentation | Ampoule containing 10mg in 1ml |
| Amiodarone- Presentation | Pre filled syringe containing 300mg in 10ml |
| 0.9% Sodium Chloride - Indications | Adult and Child fluid therapy, Flush to confirm IV patency and/or following IV drug administration |
| Glucose 10% - Contra-indications | None |
| Chlorphenamine - Side effects | Sedation, Dry mouth, Headache, Blurred vision, Psychomotor impairment, GI disturbance, Hypotension, convulsions, Elderly more likely to suffer side effects, Warn against driving |
| Diazepam - Actions | Central Nervous System depressant (anticonvulsant and sedative) |
| Atropine- Cautions | None |
