Drug Indications - JRCALC 2013 EEAST

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  1. 0.9% Sodium Chloride
    • * Adults for medical conditions without haemorrhage.
    • * Adults for medical conditions with haemorrhage.
    • * Trauma related haemorrhage in adults and children.
    • * Burns in adults and children
    • * Crush injury in adults.
    • * Children suffering medical conditions.
  2. Salbutamol
    • * Acute asthma attack where normal inhaler therapy has failed to relieve symptoms.
    • * Expiratory wheezing associated with allergy, anaphylaxis, smoke inhalation or other lower airway cause.
    • * Exacerbation of chronic obstructive pulmonary disease (COPD)
    • * Salbutamol is indicated in instances of shortness of breath in patients with severe breathing difficulty due to left ventricular failure (secondary treatment)
  3. Tranexamic Acid
    * Patients with time critical injury where significant internal / external haemorrhage is suspected.  (SBP <90mmHg, HR <110)
  4. Oxygen
    • * Children with significant illness or injury
    • * Adults with critical illness requiring high levels of supplemental oxygen.
    • * Adults requiring moderate levels of supplemental oxygen if the patient is hypoxemic.
    • * Patients with COPD and other conditions requiring controlled or low-dose oxygen therapy.
    • * Conditions for which patients should be monitored closely but oxygen therapy is not required unless the patient is hypoxemic.
  5. Naloxone Hydrochloride
    • * Opioid overdose producing respiratory, cardiovascular and central nervous system depression.
    • * Overdose of either opioid analgesic e.g. dextropropoxyphene, codeine, or a compound analgesic .
    • * Unconsciousness, associated with respiratory depression of unknown cause, where opioid overdose is a possibility.
    • * Reversal of respiratory and central nervous system depression in neonate following maternal opioid use during labour.
  6. Morphine Sulphate
    • * Pain associated with suspected myocardial infarction (analgesic of first choice)
    • * Severe pain as a component of a balanced analgesia regimen.
    • * The decision about which analgesia and which route should be guided by clinical judgement.
  7. Midazolam
    Buccal Midazolam can be used as an anticonvulsant for grand-mal convulsions lasting more than five minutes, as they may not stop spontaneously. Ambulance paramedics and technicians can administer the patient’s own prescribed Midazolam provided they are competent to administer buccal medication and are familiar with midazaolam’s indications, actions and side effects. Those that are not familiar with the use of this medication should use rectal PR or IV diazepam instead. NB if the child continues fitting 10 minutes after their first dose of anticonvulsant, they should receive IV diazepam for any further anticonvulsant treatment. If it is not possible to gain vascular access for the second dose of medication, no further drug treatment should be used, even if this means that the child continues to fit i.e. do not give a second dose of buccal or rectal medication. Where grand-mal convulsion continues ten minutes after the second anticonvulsant, senior medical advice should be sought.
  8. Metoclopramide
    • * The treatment of nausea and vomiting in adults aged 20 and over.
    • * Prevention and treatment of nausea and vomiting following administration of morphine sulphate.
  9. Ipratropium Bromide
    • * Acute severe asthma or life threatening asthma.
    • * Acute asthma unresponsive to Salbutamol
    • * Exacerbation of chronic obstructive pulmonary disease (COPD), unresponsive to Salbutamol.
  10. Hydrocortisone
    • * Severe or life threatening asthma – where call to hospital time is >30 minutes.
    • * Anaphylaxis
    • * Adrenal Crisis (including Addisonian crisis) – sudden severe deficiency of steroids (occurs in patients on long-term steroid therapy for whatever reason) producing circulatory collapse with or without hypoglycaemia.
    • Administer Hydrocortisone to:
    • 1. Patients in established adrenal crisis.
    • 2. Steroid-dependant patients who have become unwell to prevent them having an adrenal crisis – if in doubt, it’s better to administer hydrocortisone.
  11. Glyceryl Trinitrate
    • * Cardiac chest pain due to angina or myocardial infarction
    • * Acute cardiogenic pulmonary oedema.
  12. Glucose 40% Oral Gel
    Known or suspected hypoglycaemia in a conscious patient where there is no risk of chocking or aspiration.
  13. Glucose 10%
    • * Hypoglycaemia (Blood glucose >4.0 millimoles per litre) especially in known diabetics.
    • * Clinically suspected hypoglycaemia where oral glucose administration is not possible.
    • * The unconscious patient, where hypoglycaemia is considered a likely cause.
  14. Glucagon
    • * Hypoglycaemia (blood glucose <4.0 millimoles per litre), especially in known diabetics.
    • * Clinically suspected hypoglycaemia where oral glucose administration is not possible.
    • * The unconscious patient, where hypoglycaemia is considered a likely cause.
  15. Furosemide
    Pulmonary oedema secondary to left ventricular failure.
  16. Entonox
    Moderate to severe pain
  17. Diazepam
    • * Fits for longer than 5 minutes and STILL FITTING
    • * Repeated fits – not secondary to an uncorrected hypoxia or hypoglycaemic cause.
    • * Status epilepticus
    • * Eclamptic fits (initiate treatment if fit lasts >2-3 minutes or if it is recurrent)
    • *Symptomatic cocaine toxicity (Severe chest pain, hypertension or fitting)
  18. Clopidogrel
    • * In patients not already taking Clopidogrel
    • * Receiving thrombolytic treatment
    • * Anticipated thrombolytic treatment.
    • * Anticipated primary percutaneous coronary intervention (PPCI)
  19. Chlorphenamine
    • * Severe anaphylactic reactions (when indicated, should follow initial treatment with IM adrenaline).
    • * Symptomatic allergic reactions falling short of anaphylaxis but causing patient distress e.g. severe itching.
  20. Benzylpenicillin (Penicillin G)
    • Suspected meningococcal disease in the presence of:
    • 1. A non blanching rash (the classical, haemorrhagic non-blanching rash (may be petechial or pururic) – seen in approximately 40% of children

    • And
    • 2. Signs/symptoms suggestive of meningococcal meningitis and septicaemia guideline for signs/symptoms)

    Unless there are delays in hospital transport, where it may be given without the rash.
  21. Atropine
    • Symptomatic bradycardia in the presence of ANY of these signs:
    • * Absolute bradycardia (Pulse <40 beats per minute)
    • * Systolic blood pressure below expected for age
    • * Paroxysmal ventricular arrhythmias requiring suppression.
    • * Inadequate perfusion causing confusion etc. NB hypoxia is the most common cause of bradycardia in children, therefore interventions to support ABC and oxygen therapy should be first line therapy.
  22. Aspirin
    * Clinical or ECG evidence suggestive of myocardial infarction or ischemia.
  23. Amiodarone
    • Cardiac arrest
    • * Shockable rhythms: if unresponsive to defibrillation administer amiodarone after the 3rd shock and an additional bolus depending on age to unresponsive VF or pulseless VT following the 5th shock.

    • Pulsed VT
    • Wide complex pulsed tachycardia's, with signs of severe compromise with a hospital time >30 minutes, clinical advice should be sought prior to administration.
  24. Adrenaline
    • Cardiac Arrest
    • Anaphylaxis
    • Life threatening asthma with failing ventilation and continued deterioration despite nebuliser therapy.
  25. Co-Codamol
    Mild to severe pain, non cardiac in origin.
  26. Oral Morphine
    Severe Pain
  27. Paracetamol
    Relief from mild to moderate pain and/or high temperature in children
Card Set:
Drug Indications - JRCALC 2013 EEAST
2013-10-12 06:41:01

Drug indications for drugs used by EEAST listed in JRCALC 2013
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