AP2

Pancreatic Hormone

Vial containing 1 international unit of glucagon - as a dry powder with a syringe of 1ml diluting solution. 

Causes the liver to metabolise store of glycogen to glucose resulting in the increase of blood glucose level. (provided liver glycogen is available) 

IM 15-20 minutes

Treatment of hypoglycaemia, BGL <4mMol/L - when oral or IV glucose cannot be administered. 

• (Very Rare)
• Nausea and Vomiting
• Very occasional hypersensitivity

Known Hypersensitivity

• Adult (>20kg) 1 international unit IM
• Paeditric (<20kg) 1/2 international unit IM
• Single dose only. 

Eat carbohydrates. Re-check BGL. 

Nitrate smooth muscle relaxant and vasodilator

600mcg sublingual tablet.

• Arterial and venous vasodilation
• Dilation of collateral coronary vessels

• Relieve cardiac pain of ischemic origin 
• Relieve pulmonary oedema

• Hypotension
• headache
• flushing of skin
• occasionally breadycardia

• Do not administer if systolic BP < 90
• Do not administer if HR <50bpm
• Do not administer if Sildenafil (viagra) or vardenafil (levitra) has been taken in the last 24 hours.
• Following the last dose of Tadalafil (cialis) do not administer within 4-5days and in the elderly and those with renal impairment or 3-4days in all other patients.
• Known hypersensitivity. 

• 600mcg tablet --> sublingual 
• Repeat x 1 if necessary 
• (of the patient systolic BP 90-100 or if the patient has never used any nitrate medication before give 1/2 tablet --> 300mcg) 

600mcg tablet --> sublingual Repeat x 1 if necessary (of the patient systolic BP 90-100 or if the patient has never used any nitrate medication before give 1/2 tablet --> 300mcg)

Tablet should fizz under the tongue - bottle needs to be dated when opened and discarded after 3 months. 

Anti-cholenergic bronchodilator 

1ml plastic nebule containing 250mcg ipratropium bromide

• Bronchodilator
• blocks vagal reflexes which mediate bronchoconstriction
• possibly more effective when used in combination with salbutamol
• Onset - 3-5 minutes
• Duration 2-4 hours

Bronchospasm of any cause - used as an adjunct to salbutamol. 

Rare with single use - occasional urinary retention

Care with patients with glaucoma

• Adult - 500mcg mixed with 1st/3rd/5th... dose of salbutamol.
• or 4 x 21mcg (4 puffs) with MDI

• Paediatrics - 250mcg mixed with 1st/3rd/5th ... dose of salbutamol
• or 2 x 21mcg (2 puffs) with MDI 

For mild - moderate respiratory distress, no hypoxia and familiar with use. 

Volatile inhalation anaesthetic and analgesic agent. 

3ml bottle

• Central Nervous system depressant
• Onset: 3-5 minutes
• Offset: 3-5 minutes 

Pain of all origins. 

• Altered consciousness 
• renal dysfunction
• jaundice 
• (all rare with once only ambulance use)

• Depressed LOC (GCS <13)
• Known hypersensitivity

• Renal disease
• Diabetes
• anti-biotic or barbiturate use
• caution if unable to self administer

• 3mls self administered (inhaled) using penthrox inhaler with up to 8lpm of oxygen
• Repeat x 1 as required

Dose should not exceed 6ml /day or 15mls/week

Antiemetic

10mg in 2ml ampoule 

• Antiemetic - acting centrally on the brain stem increasing gastric emptying
• Onset - 3-15mins IV
• Duration - 30 minutes

• Prevent vomiting when:
• when narcotic analgesic is to be administered
• high spinal injury
• serious eye injury
• suspected ischemic chest pain

Treat nausea and vomiting

• (Uncommon with usual dose) Occasionally
• drowsiness
• lethargy
• dry mouth
• oculogyric crisis/facial spasms
• speech difficulties

•  Known hypersensitivity (previous reaction)
• GI bleeding

• Adult - 10mg IV over 2 minutes
• or 10mg IM

Paediatrics not used. 

Single dose only.

Anti-convulsant and sedative agent

• 5mg in 5ml ampoule
• 15mg in 3ml ampoule

• Anticonvulsant - reduces seizure activity
• Minor tranquilliser 
• Muscle relaxant
• Onset: (IV) 1-5 mins   Duration 2-3 hours
• Onset (IM) 2-5 mins    Duraiton ?2-3 hours

• Status Epilepticus - in a patient who has continual or prolonged seizures. 
• sedation to manage airway, RSI, sedation of previously intubated patient
• Adjunct to analgesia for injuries where significant muscle spasm is present
• To manage agitated and combative patients
• To manage autonomic hyperreflexia 

• Depression of level of consciousness which may lead to:
• respiratory depression
• loss of airway control
• hypotension

Known hypersensitivity

• Haemodynamic instability
• respiratory depression

• Adult Dose: 0.1mg/kg IM repeat x 1 after 10 minutes as necessary 
• Up to 0.1mg/kg IV over 2minutes until fitting ceases. Repeat is fitting continues or recurs. 

• Paeds Dose: 0.1mg/kg IM - repeat x1 after 10 minutes as necessary. 
• Up to 0.1mg/kg IV over 2 minutes until fitting ceases. Repeat if fitting continues or recurs. 

Narcotic analgesic (S8) 

10mg in 1 ml ampoule

• Decreases pain perception and anxiety. 
• Vasodilation
• Onset: (IV) 2-5 minutes = Duration: 1-2 hours
• Onset: (IM) 5+ minutes = Duration: 2-3 hours

• To relieve severe pain
• Acute pulmonary oedema
• RSI
• Sedation of previously intubate patient
• Chest pain

• Nausea and vomiting
• Drowsiness 
• Respiratory depression
• Hypotension
• Dependence
• Bradycardia

• Depressed Level of consciousness (GCS<13) --> pain relief only
• Respiratory Depression --> pain relief only
• BP <770mmHg --> pain relief only
• BP <90mmHg --> APO
• Acute Asthma attacks

• Known Hypersensitivity
• Elderly patients (may be sensitive) 
• Patients with COPD
• Hypovolaemic patients (hypovolaemia should be corrected BEFORE morphine administration)
• Patients with systolic BP 70-90mmHg
• Children under 1 year old
• Pain management in labour

• Adult: Up to 0.05mg/kg IV over 2 minutes
• May be repeated at 5 minute intervals (up to a maximum of 3x maximum  calculated dose) until pain is managed. UNLESS pt BP <90mmHg [half calculated dose and fluids]
• Paeds: Up to 0.05mg/kg IV over 2 minutesMay be repeated at 5 minute intervals (up to a maximum of 3x maximum  calculated dose) until pain is managed. UNLESS pt BP <70mmHg [half calculated dose and fluids]
• Use with caution if under 1 y/o
• Morphine can be used alternatively with Ketamine 

• Pain relief ONLY (NOT FOR ISCHEMIC CHEST PAIN) 
• If no IV is available
• No hypotension
• Patient contact is estimated >20 minutes

• (Pain relief only) NOT FOR CHEST PAIN
• 0.1 mg/kg
• Repeat x1 after 30-45 minutes as required

• IV use only!
• hypovolemic patients must be receiving fluids
• up to half calculated (0.05mg/kg) given SLOWLY
• may be repeated as required with great care, and with appropriate interval b/w dose.
• No further doses if BP drops 10mmHg or more with half dose (even if remains >70mmHg) 

• 0.05mg/kg IV over 2 minutes
• May be repeated x 1 after 10 minutes if required. 

• a) 0.05 mg/kg IV SLOWLY
• b) Adult : 10mg IV fast push (dose adjusted for weight, age and BP) --> Paeds: 0.05mg/kg rapid push = repeat x 1 if required.

• A drug of dependence - must be checked by both members.
• Under the Drugs of Dependence Act, recording and accounting for its use is a legal requirement
• The unused portion of the dose must be appropriately disposed of and its disposal recorded. 
• Side effects may be reversed by Naloxone, although it is desirable to avoid unless absolutely necessary 
• Advanced age may be a better indicator of dose size than weight in the elderly. 

Narcotic antagonist 

• Reverses the effects of narcotic analgesics.
• Onset (IV) 1-2 minutes
• Duration 30-45 minutes
• IM - unknown, but suspected to be longer than IV. 

• Coma
• drug overdose and poisoning
• Use in situations where there is significant decrease in level of consciousness where there is hypoventilation, and/or loss of protective reflexes and where overdose of narcotics cannot be excluded. 

• may precipitate acute withdrawal syndrome in narcotic addicts
• occasional aggressive behaviour following reversal
• nausea and vomiting

known hypersensitivity

• AP : 800mg IM --> single dose only
• Paeds IM --> 0.01mg/kg. 

• ICP: 0.4mg IM then 0.4mg IV increments fast push--> may repeat IV dose  x 3 (to max of 2mg) 
• Paeds - 0.01mg IV fast push (max 3 doses) 

ALL doses may be given IM or IV as situation demands. 

• IV may rapidly wear off - if pt likely to refuse tx an IM dose is highly recommended. 
• Special care is needed if long-acting agents are known or suspected to have been used. Larger IM dose and transport to hospital is recommended. 

0.9% sodium chloride solution - containing 151mMol sodium and 151mMol chloride per litre. 

• Plasma volume expander
• expands interstitial fluid volume
• plasma volume effect is only temporary as most of the saline moves out of the blood vessels quickly. 

• Initial fluid replacement, in volume depleted or dehydrated patients. Volume depletion may be due to loss of blood, plasma, fluid or electrolytes.
• Maintainance of hydration during prolonged patient contact time
• TKVO as IV route for drugs. 

Fluid overload

• IV FLUID RESUSCITATION: Adult: 10 ml/kg lV – then reassess patient
• Aim to keep BP at about 90mmHg systolic.

• Haemorrhagic hypovolaemia aim to keep BP 80-90 systolic.
• TBI aim for >100 systolic.

No limit on amount, dependent on condition of patient.

• Paediatric: 10 ml/kg lV or IO – then reassess patient
• Paediatric cardiac arrest: 20 ml/kg

Adult & Paed: Sepsis & Anaphylaxis 20mls/kg IV or IO

• TKVO: Adult and Paediatric:
• 10 drops per minute (30ml/hr with a standard drip set). 

• Treat super toxic organophosphate poisoning by relieving the symptoms of skeletal neuromuscular blocking that occurs during a chollinergic crisis. 
• Used in combination with atropine, in auto injector or with atropine separately administered 

• Hypotension, menthol like sensation, warm feeling to face. 
• Dull feeling to site of injection

• Adult - Up to 660mg IM over 30 minutes (3 doses via auto injector)
• Paeds - 220mg IM (1 dose only) 
• Preffered site is upper thigh
• Injector must be held in place for 10 seconds to ensure full dose administered. 

Potent anti-nausea and antiemetic 

• Potent, highly selective histamine receptor antagonist
• precise mode of action not known - likely to have actions peripherally and in CNS
• Maximum effect is approximately 10 minutes following IV administration. 
• Hepatic metabolism

for prevention and treatment of nausea and vomiting

Not recommened for use during pregnancy. 

• Uncommon:
• headache, flushing of skin, occasional reaction at site, drowsiness, anxiety and agitation, transient visual disturbance. 

Known hypersensitivity

• Adult: 4mg IV slowly over 2 minutes
• Paeds: 0.1mg IV (to a total of 4 mg) --> slowly over 2 mins
• May be administered IM if necessary
• May repeat x 1 if required after 10 mins

A simple analgesic/ antipyretic

• Antipyretic 
• Mild analgesic

• Pyrexia in children who have had or may have a febrile convulsion. 
• >38.0 degrees C

• Impaired renal function
• Impaired hepatic function

• Rare (none have been confirmed with casual use)
• dyspepsia, nausea, allergic and haematological  reactions

• Known or suspected allergy 
• previous paracetamol dose in the last 4 hours
• children who do not have a sufficient gag reflex to swallow measured dose
• Not to be given to children <1 month old

• 20mg/kg orally with syringe
• or if paracetamol has been given in the last 48 hours 15mg/kg
• Do not exceed 60mg/kg in 24 hours
• (patient should not be left at home if paracetamol is administered) 

sympathetic beta 2 receptor stimulant

• Bronchodilation
• Relaxation of involuntary muscle
• Moves K+ from extra-cellular to intra-cellular space
• Onset (neb) 5 minutes
• Max Effect: 1-50 minutes

• Bronchospasm of any cause
• emergency treatment of suspected hyperkalaemia

• Rare with nebulised therapeutic dose
• tachycardia
• tremors 
• hypotension 

Known hypersensitivity 

• Via nebuliser with O2 at 6-8lpm
• - Adult 5mg
• - Paed 2.5mg
• MDI with spacer (mild to moderate)
• - Adult = 10 x 100mcg (10 puffs)
• - Paed = 5 x 100mcg (5 puffs) 

• Moderate to severe bronchospasm or suspected hyperkalaemia give continued nebulised salbutamol.
• Significant hypoxia administer with 100% oxygen