QAS DTP PARA.docx

ADRENALINE (Sympathomimetic) Indications: Anaphylaxis OR severe allergic reaction Severe life-threatening bronchospasm OR silent chest Cardiac arrest Bradycardia with poor perfusion (CCP) Croup (moderate to severe)(CCP) Shock unresponsive to adequate fluid resuscitation(CCP) Contraindications:...

ADRENALINE (Sympathomimetic) Indications: Anaphylaxis OR severe allergic reaction Severe life-threatening bronchospasm OR silent chest Cardiac arrest Bradycardia with poor perfusion (CCP) Croup (moderate to severe)(CCP) Shock unresponsive to adequate fluid resuscitation(CCP) Contraindications: Nil Precautions: Hypertension Hypovolaemic shock Concurrent MAOl therapy Quetiapine toxicity Side Effects: Anxiety Hypertension Palpitations/tachyarrhythmias Pupil dilation Dosage: Anaphylaxis and Bronchospasms IM – 500 microg, Repeat 5-minute intervals, No max dose Dosage: Cardiac arrest IV – 1mg, Repeat 3–5 minute intervals, No max dose AMIODARONE (Anti-arrhythmic) Indications: Cardiac arrest Sustained conscious VT (CCP) Contraindications: Tricyclic antidepressant overdose Precautions: Nil Side Effects: Hypotension Bradycardia Nausea and/or vomiting Peripheral paraesthesia Dosage: IV – 300mg slow push over 1-2 minutes, Repeat once 150mg in refractory to five DCCS ASPIRIN (Antiplatelet) Indications: Suspected ACS Acute cardiogenic pulmonary oedema Contraindications: Allergy and/or adverse drug reaction Bleeding or clotting disorders Current GI bleeding or peptic ulcers Patients under 18 years Precautions: Pregnancy History of Gl bleeding or peptic ulcers Concurrent anticoagulant therapy Possible aortic aneurysm or any other condition that may require surgery Side Effects: Epigastric pain or discomfort Nausea Vomiting Gastritis GI bleeding NSAID induced bronchospasm Dosage: PO – 18 years and older 300mg chewed, water if possible. CEFTRIAXONE (Antibiotic) Indications: Suspected meningococcal septicaemia (with a non-blanching petechial AND/OR purpuric rash) Contraindications: Absolute: Allergy AND/OR Adverse Drug Reaction to cephalosporin antibiotics Known immediate OR severe hypersensitivity to penicillin OR carbapenem based drugs Relative (requires consultation with the QAS Clinical Consultation & Advice Line): Patients less than 1 month of age Precautions: Any allergy or hypersensitivity to penicillin or carbapenem - (isolated minor drug rash attributed to penicillin does not contraindicate the use of ceftriaxone) Side Effects: Pain and/or inflammation at the injection site Dosage: IM – 2g (2 x 1g IM injections) Single dose *Syringe preparation: Reconstitute two separate vials each containing 1g of ceftriaxone with 2.4 mL of water for injection or lidocaine 1% (lignocaine 1%) in a 3 mL syringe to achieve a final concentration of 1 g/3 mL.* IV – 2g Slow push over 5 minutes Single dose *Syringe preparation: Reconstitute 2g of ceftriaxone with 18.8 mL of water for injection in a 20 mL syringe to achieve a final concentration of 2 g/20 mL. Ensure syringe is appropriately labelled.* CLOPIDOGREL (Antiplatelet) Indications: Patients with STEMI (as defined by the relevant QAS CPP); AND ⁃ who have been accepted for pPCI (as an adjunct medication to aspirin and heparin) and the receiving interventional cardiologist is requesting clopidogrel administration, OR ⁃ who have received Tenecteplase (and have been administered aspirin and enoxaparin) Contraindications: Allergy AND/OR Adverse Drug Reaction Patients contraindicated for pre-hospital fibrinolysis administration Current clopidogrel OR ticagrelor therapy Patients < 18 years Active bleeding (excluding menses) Prior intracranial haemorrhage Precautions: Severe renal impairment Side Effects: Haemorrhage Dosage: accepted for pPCI PO – ≥ 18 years - 600 mg. Swallowed with a small quantity of water. Dosage: received Tenecteplase PO – ≥ 18 years - 300 mg. Swallowed with a small quantity of water. DROPERIDOL (Antidopaminergic - used as antiemetic & antipsychotic) Indications: Acute behavioural disturbances (with a SAT Score ≥ 2) Contraindications: Absolute Allergy and/or drug reaction Parkinson’s disease Known Lewy body dementia Previous dystonic reaction to Droperidol Patients < 8 years Relative contraindication Relative – (requires consultation with the QAS Clinical Consultation & Advice Line) Suspected sepsis Precautions: Hypo perfused state Concurrent use of CNS depressants Side Effects: Vasodilation/hypotension Extrapyramidal effects e.g. dystonic reactions (rare) Dosage: IM/IV – QAS Clinical Consultation and Advice Line consultation and approval required in all patients ≥ 65 years OR 13 – 15 years. 13 – 15 years – 0.1 – 0.2mg/kg. Single max dose 10mg. May be repeated once at 15 mins. Total max dose 20 mg. 16 years to < 65 years – 10mg. May be repeated once at 15 mins. Total max dose 20mg. ≥ 65 years – 5mg. May be repeated once at 15 mins. Total max dose 10mg. ENOXAPARIN (Anticoagulant) Indications: Patients with STEMI (as defined by the relevant QAS coronary artery reperfusion checklist) who have received QAS Tenecteplase (as an adjunct medication to aspirin and clopidogrel) Contraindications: Allergy AND/OR Adverse Drug Reaction Patients contraindicated for pre- hospital fibrinolysis administration Precautions: Renal/ Hepatic impairment Low bodyweight (women < 45 kg and men < 57 kg) Older people Side Effects: Haemorrhage Thrombocytopenia Dosage: IV – Loading dose - 30 mg. To be administered 15 mins prior to SUBCUT maintenance dose (listed below). SUBCUT – Maintenance dose - 1 mg/ kg. Single dose only, not to exceed 100 mg. To be administered 15 mins following IV enoxaparin loading dose (listed above). FENTANYL (Narcotic analgesic) Indications: Significant pain Autonomic dysreflexia (Greater than 160 systolic BP) Sedation (CCP) Induction for Rapid Sequence Intubation (RSI) (CCP) Contraindications: Allergy and/or adverse drug reaction Precautions: Hypotension Respiratory tract burns, depression and/or failure Known narcotics addiction Current MAOl therapy Side Effects: Boy Does He Need Pain Relief Man Bradycardia Drowsiness Hypotension Nausea and/or vomiting Pinpoint pupils Respiratory depression Muscular rigidity Dosage: Significant pain – IM Greater than 70 years or frail: 25 – 50 microg, Repeat 50 microg 10 minutes, Max dose 100 microg Less than 70 years: 25 – 100 microg, Repeat 50 microg 10 minutes, Max dose 200 microg Dosage: Significant pain or Autonomic dysreflexia Greater than 70 years or frail: 25 – 50 microg, Repeat 50 microg 10 minutes, Max dose 100 microg Less than 70 years: 50 – 100 microg, Repeat up to 100 microg 10 minutes, Max dose 200 microg Greater than 70 years or frail: 25 microg, Repeat 25 microg 5 minutes, Max dose 100 microg Less than 70 years: 25 – 50 microg, Repeat 50 microg 5 minutes, Max dose 200 microg GLUCAGON (Hyperglycaemic) Indications: Symptomatic hypoglycaemia (Inability to self-administer oral glucose) Refractory anaphylaxis with persistent hypotension/shock (unresponsive to 3 x IM adrenaline injections and adequate fluid challenges) Contraindications: Allergy AND/OR Adverse Drug Reaction Precautions: Nil Side Effects: Nil Dosage: Symptomatic hypoglycaemia IM – 1 mg, Single dose only Dosage: Refractory anaphylaxis with persistent hypotension/shock IM – 1 mg, Single dose only ( administered if unable to achieve IV access) IV – 1 mg, Single dose only *Syringe preparation: Reconstitute 1 mg of glucagon with 1 mL of water for injection in a 3 mL syringe to achieve a final concentration of 1 mg/1 ml. * GLUCOSE GEL (Hypoglycaemia) Indications: Symptomatic hypoglycaemia (with the ability to sell-administer oral glucose) Contraindications: Unconsciousness Patients with difficulty swallowing Patients less than 2 years of age Precautions: Nil Side Effects: Nausea and/or vomiting Diarrhoea Dosage: PO – 15 g. Repeated once at 15 mins if BGL < 4.0 mmol/L. Total max dose 30 g. GLUCOSE 10% (Dehydration/ ?) Indications: Symptomatic hypoglycaemia (with the inability to self-administer oral glucose) Contraindications: Nil Precautions: Hyperglycaemia Side Effects: Nil Dosage: IV/ INF – 15 g (150 mL). Repeated at 100 mL (10 g) boluses every 5 mins until BGL > 4.0 mmol/L. GLYCERYL TRINITRATE (GTN) (Vasodilator) Indications: Cardiac arrest Contraindications: 2 Heads, 2 Hearts, 1 Dick Allergy and/or adverse drug reaction Acute CVA Head Trauma HR less than 50 or higher than 150 bpm Less than 100 Systolic BP Viagra in the previous 24 hrs - Phosphodiesterase 5 inhibitor medication Precautions: Inferior AMI Cerebral vascular disease Risk of hypotension and/or syncope Intoxication Viagra in past 4 days - Phosphodiesterase 5 inhibitor medication Side Effects: Dizziness Hypotension Syncope Reflex tachycardia Vascular headaches Dosage: SUB – 400microg Repeat 5 minute intervals No max dose HEPARIN (Anticoagulant) Indications: Patients with STEMI (as defined by the relevant QAS coronary artery reperfusion checklist) who have been accepted for pPCI (as an adjunct medication to aspirin AND EITHER ticagrelor OR clopidogrel) Critical care patients requiring anticoagulation during interfacility transport Contraindications: Absolute: Allergy AND/OR Adverse Drug Reaction Patients < 18 years Active bleeding (excluding menses) OR clotting problem (haemophilia) Prior intracranial haemorrhage Current use of anticoagulants (e.g. warfarin) Relative: (requires consultation with the accepting interventional cardiologist OR RSQ Clinical Coordinator (as appropriate) prior to administration) Uncontrolled hypertension (systolic BP > 180 mmHg AND/OR diastolic BP > 110 mmHg at any stage during current acute episode) Known cerebral disease, in particular a malignant intracranial neoplasm OR arteriovenous malformation Ischaemic stroke OR TIA within the last 3 months History of significant closed head/ facial trauma within last 3 months History of major trauma OR surgery (including laser eye surgery) within last 6 weeks Precautions: Renal impairment Side Effects: Haemorrhage Thrombocytopenia Dosage: IV – 5,000 units (or dose requested by the accepting interventional cardiologist) Single dose only. HYDROCORTISONE (Corticosteroid) Indications: Asthma (excluding mild) Acute exacerbation of COPD (evidence of respiratory distress) Refractory anaphylaxis with persistent wheeze (unresponsive 3xIM adrenaline) Suspected or at risk of an acute adrenal insufficiency (crisis) Contraindications: Allergies and/or ADR Precautions: Hypertension Side Effects: Nil Dosage: Asthma/ COPD/ Adrenal insufficiency IM – 100 mg, Single dose IV – 100 mg, Slow push over 1 minute, Single dose Dosage: Refractory anaphylaxis with persistent wheeze IM – 200 mg, Single dose IV – 200 mg, Slow push over 1 minute, Single dose IBUPROFEN (Non-steroidal anti-inflammatory drug [NSAID]) Indications: Moderate pain due to acute inflammation and tissue injury Contraindications: Allergy and/or adverse drug reaction to any NSAID or aspirin Concurrent NSAID therapy Current Gl bleeding or peptic ulcers Dehydration and/or hypovolaemia Renal impairment NSAID induced asthma Heart failure Pregnancy ACE inhibitor or ARB therapy Patients under 13 years or over 65 years of age Patients taking anticoagulant medications Diuretic treatment Precautions: Asthma Hepatic dysfunction History of Gl bleeding or peptic ulcers Side Effects: Nausea Pain or discomfort in the upper abdomen (Dyspepsia) GI bleeding Dizziness Dosage: PO – 200 – 400 mg (Can not administered within 6 hours of previous dose) IPRATROPIUM BROMIDE (Anticholinergic agent) Indications: Moderate bronchospasms (Unresponsive to initial QAS salbutamol NEB) Severe bronchospasm Contraindications: Allergy AND/OR ADR Patients < 1 years old Precautions: Glaucoma Side Effects: DDP Dilated pupils Dry mouth Palpitations Dosage: NEB – 500 microg, Repeat 20 minute intervals, Max dose 1.5 mg METHOXYFLURANE (Analgesic [at low dose]) Indications: Pain Contraindications: Allergy and /or adverse drug reaction Patients less than 1 year of age History of significant liver or renal disease History of malignant hyperthermia Precautions: ALOC Intoxicated or drug affected patients Cardiovascular instability Respiratory depression Side Effects: ALOC Cough Renal/hepatic failure Dosage: INH – 3mL, 1 Repeat after 20 minutes, Max dose 6mL MORPHINE (Narcotic analgesic) Indications: Significant pain Autonomic dysreflexia (Greater than 160 systolic BP) Sedation (CCP) Contraindications: Allergy and/or adverse drug reaction Kidney disease Precautions: Hypotension Respiratory tract burns, depression or failure Known narcotics addiction Concurrent MAOl therapy Cardiac chest pain Side Effects: Boy Does He Need Pain Relief Bradycardia Drowsiness Hypotension Nausea and/or vomiting Pinpoint pupils Respiratory depression Dosage: Significant pain Greater than 70 years or frail: 2.5 – 5 mg, Repeat 5 mg 10 minutes, Max dose 10 mg Less than 70 years: 2.5 – 10 mg, Repeat 5 mg 10 minutes, Max dose 20 mg Dosage: Significant pain or Autonomic dysreflexia Greater than 70 years or frail: 2.5 – 5 mg, Repeat 5 mg 10 minutes, Max dose 10 mg Less than 70 years: 2.5 – 10 mg, Repeat 5 mg 10 minutes, Max dose 20 mg Greater than 70 years or frail: 2.5 mg, Repeat 2.5 mg 5 minutes, Max dose 10 mg Less than 70 years: 2.5 – 5 mg, Repeat 5 mg 5 minutes, Max dose 20 mg NALOXONE (opioid antagonist) Indications: Respiratory depression (secondary to the administration of narcotic drugs) Contraindications: Allergy AND/OR Adverse Drug Reaction The newly born patient Precautions: Use with caution on patients with pre-existing cardiac disease Side Effects: Narcotic reversal can cause combativeness, vomiting. sweating. tachycardia and hypertension May produce acute withdrawal convulsions in the chronic narcotic user Pulmonary oedema Dosage: IM – 1.6 mg. single dose only. *Draw up 2 Ampoules (0.8 mg/ 2mL) in 3ml syringe x 2* Ampoule: 400 microg/ mL = 0.4 mg/ mL 0.4mg/ mL x 4 = 1.6 mg/ 4mL ONDANSETRON (Anti-emetic 5-HT3 antagonist) Indications: Significant nausea and/or vomiting Contraindications: Absolute Allergy and/or drug reaction Congenital long QT syndrome Current apomorphine therapy Patients less than 2 years Relative First trimester pregnancy Precautions: Hepatic impairment Elderly patients Intestinal obstruction Risk factors for QT interval prolongation or cardiac arrhythmias Side Effects: Common (> 1%) Headache Constipation Rare (< 0.1%) Hypersensitivity reactions and anaphylaxis ECG changes Dosage: PO/SUB – 4 – 8mg, Max dose 8 mg, Can not be given within 8 hrs of previous dose IV – 4 – 8mg, Slow push over 2-3 minutes, Max dose 8 mg, Can not be given within 8 hrs of previous dose OXYGEN (Gas) Indications: A wide range of conditions resulting in, or potentially resulting in systemic AND/OR localised hypoxia or hypoxaemia Contraindications: Known paraquat poisoning with SpO2 equal to or greater than 88% History of bleomycin therapy with SpO2 equal to or greater than 88% Precautions: Patients with paraquat poisoning or bleomycin lung injury may be harmed by supplemental oxygen. Avoid oxygen unless the patient is hypoxaemia - target 88-92%. Prolonged administration to premature neonates. Newly born infants will have low Sp02 for the first 10 minutes following birth - refer to CPG: Resuscitation - Newly born. Patients with cyanotic heart disease may have saturation targets between 75% to 85%. A BVM will not supply adequate oxygen unless IPPV is provided. The use of high flow oxygen in an attempt to protect against subsequent hypoxaemia in the event of deterioration has the potential to delay the recognition of such a deterioration. This may provide a false reassurance that the patient is stable. Side Effects: Hypoventilation in some COPD patients with hypoxic drive Drying of airway mucous membranes Dosage: Intra-arrest/ CO or Cyanide poisoning/ Preoxygenation for RSI INH – Administer 100% 02 Dosage: Paraquat toxicity/ Bleomycin treatment/ Obesity/ COPD/ Cystic fibrosis Neuromuscular disease INH – Titrate oxygen to achieve SpO2 88-92% Dosage: All other presentations NOT listed above INH – Titrate oxygen to achieve Sp02 92-96% PARACETAMOL (Analgesic, Antipyretic) Indications: Mild to Moderate pain Fever Contraindications: Allergy and/or adverse drug reaction Patients less than 1 month Precautions: Hepatic dysfunction Soluble tablets Patients with sodium restriction (heart failure, chronic kidney disease) Phenylketonuria (PKU) Side Effects: Nausea Dosage: PO – 0.5 – 1g, Can not administered within 4 hours of previous dose, Repeat 4 hrs, Max dose 4g in 24 hours SALBUTAMOL (Beta-adrenergic agonist) Indications: Bronchospasm Suspected hyperkalaemia (CCP) Contraindications: Allergy AND /OR ADR Patients < 1 years old Precautions: Acute pulmonary oedema Ischaemic heart disease Side Effects: Metabolic acidosis Anxiety Tachyarrhythmias Tremors Hypokalaemia Dosage: Bronchospasm MDI – 12 puffs (1.2 mg) Repeat 10 minutes, No max dose NEB – 5 mg, Repeat PRN, No max dose SODIUM CHLORIDE 0.9% (Isotonic crystalloid solution) Indications: Inadequate tissue perfusion/shock Hypovolaemia Significant burns (Total Body Surface Area greater than 20% for adults or greater than 10% for paediatrics) Dilute drugs (IM, IV or IO administration) Flush Contraindications: Nil Precautions: Patients with acute and/or history of heart failure Pre-existing renal failure Uncontrolled haemorrhage (unless associated with severe head injury) Side Effects: Excessive administration will result in fluid overload Dosage: Inadequate tissue perfusion or shock/ Hypovolaemia IV/INF – PRN - titrate according to the indication and the patient's physiological response to treatment. Dosage: Significant burns (TBSA greater than 20%) IV/INF – mL/hr to be infused = 15 mL/ hr x TBSA (nearest 10%). If greater than 100 kg additional 200 mL/hr Dosage: Dilute drugs or Flush IM/IV/IO – As authorised on individual DTPs TENECTEPLASE (Thrombolytics) Indications: Patients with STEMI who meet the criteria for pre-hospital Tenecteplase administration (as defined by the relevant QAS coronary artery reperfusion checklist) Contraindications: Allergy AND/OR Adverse Drug Reaction to any of: Tenecteplase, enoxaparin OR clopidogrel Patients < 18 OR > 75 years Uncontrolled hypertension (Systolic BP > 180mmHg AND/OR diastolic BP > 110mmHg at any stage during current acute episode) Left BBB identified on 12-lead ECG Current OR history of thrombocytopenia Active Tuberculosis Known cerebral disease, in particular a malignant intracranial neoplasm OR arteriovenous malformation Prior intracranial haemorrhage Ischaemic stroke OR Transient Ischaemic Attack (TIA) within last 3 months History of significant closed head OR facial trauma within last 3 months Suspected aortic dissection (including new neurological symptoms) History of major trauma OR surgery (including laser eye surgery) within last 6 weeks Internal bleeding (e.g. gastrointestinal (GI) / urinary tract bleed) within last 6 weeks (excluding menses) Bleeding OR clotting disorder (e.g. haemophilia) Current use of anticoagulants (e.g. warfarin) Non-compressible vascular punctures Prolonged (> 10 minutes) cardiopulmonary resuscitation (CPR) Known to be pregnant OR delivered within the last 2 weeks History of serious systemic disease (e.g. advanced /terminal cancer, severe liver OR kidney disease) Resident of an aged care facility requiring significant assistance with activities of daily living Acute myocardial infarction in the setting of trauma Precautions: Nil Side Effects: Haemorrhage Post-administration dysrhythmias Dosage: IV – Weight calculated dose (as listed below) administered into a pre-existing IV line containing sodium chloride 0.0% over 10 seconds. Patient weight (kg) Tenecteplase dose to be administered (mg) Corresponding volume of reconstituted solution (mL) < 60 30 6 ≥ 60 - <70 35 7 ≥ 70 - < 80 40 8 ≥ 80 - < 90 45 9 ≥ 90 50 10 TICAGRELOR (Antiplatelet) Indications: Patients with STEMI (as defined by the relevant QAS coronary artery reperfusion checklist) who have been accepted for pPCI (as an adjunct medication to aspirin and heparin) AND the receiving interventional cardiologist is requesting ticagrelor administration Contraindications: Allergy AND/OR Adverse Drug Reaction Patients currently taking ticagrelor OR clopidogrel Patients less than 18 years of age Active bleeding (excluding menses) Prior intercranial haemorrhage History of hepatic impairment Precautions: Concurrent medication known to induce bradycardia (e.g. B blocker, calcium channel blocker, digoxin) Symptomatic bradycardia (HR less than 60) Side Effects: Haemorrhage Bradycardia Dosage: PO – 18 years and over 180mg Just need to know Ppci and Fibrinolysis Drugs: Primary Percutaneous Coronary Intervention(Ppci) - is a procedure to open the heart artery which has blocked. • Clopidogrel (Antiplatelet) • Enoxaparin (Anticoagulant) • Heparin (Anticoagulant) Fibrinolysis - Is the process of removing (lyzing) the clot formed by activation of haemostatic pathways, either in physiological response to vascular trauma or in pathological thrombosis (which degrades fibrin thrombi). • Tenecteplase (Thrombolytics) MEDICAL CARDIAC PAIN RESPIRATORY