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Naloxone Adult dose for analgesic overdose?
Dilute 1ml with 3mls Nacl which 1ml=100mcg
IV- 1ml every 2mins
IM- 1ml every 5 mins
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Naloxone Adult dose for a suspected Narcotic Overdose?
1ml or 400mcg IM or IV every 2 mins to a max dose of 2mg or 5 doses if inadequate clinical response.
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Adrenaline action?
- Stimulates the alpha & Beta subdivision of the sympathetic nervouse system to cause fight or flight.
- Alpha stimulations causes peripheral vasoconsrtricion, it raises the perfusion pressure of vital organs during cardia arrest.
- Beta 1 stimulation causes increased myocardial excitablity withtachycardia and increased myocardial contractility.
- Beta 2 causes bronchial dilation.
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Naloxone Adult dose for ETORPHINE or BUPRENORPHINE reversal
- 5ml or 2mg undiluted IV or IM bolus dose
- Can be repeated every 5 mins until adequate clinical response.
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Naloxone Adverse Effects.
- Can cause vomiting, sweating, tachycardia & hypertension.
- In patients with cardia disease VT, Vf and Pulmonary Oedemamay ocassionally occur particularly in patients with inadequate ventilation and high carbon dioxide levels.
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Naloxone can reverse which drugs?
- Buprenorphine
- Codeine
- Di-Gesic
- Lomitil
- Fentanyl
- Heroin
- Methadone
- Morphine
- Pethidine
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Naloxone Paediatric dose for Suspected Narcotic Overdose
- .25ml/kg undiluted Naloxone as a bolus IV or IM
- Each bolus dose nust not exceed the adult done of 400mcg.
- Can be repeated every 2 mins up to 2mg if inadequate clinical response
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Naloxone peadiatric dose for analgesic overdose.
- Dilute 1ml (400mcg) with 3ml Nacl.
- IV .5ml as a bolus and repeat every 2mins until adequate clinical response
- IM 0.5ml initial boluse and repeat every 5 mins
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Morphine Type
Opioid Analgesic
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Morphine use
- Pain Management
- Pulmonary Oedema
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Morphine Adverse effects
- Decreased LOC
- Hypotension
- Respiritory depression
- Nausia and Vomiting
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Morphine Coontraindications
- Altered LOC
- Patient is poorly perfused
- Women in Labour
- Known Allergy
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Morphine Adult dose for Pain
- Initial regimen
- IV. 5ml(5mg) as an initial bolus
- Repeat 2.5ml- 5ml as required every 2 mins until pain is relieved or max dose of 0.5ml/kg
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Morphine Persistant or recurrent pain
The initial pain regimen can be repeated after 30 mins
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Morphine IM dose for pain
0.5ml-2ml (5mg-20mg) of undiluted to a max of 20mg
Dose should be halved with smaller than average pts, CAL and general debility.
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IV Morphine dose for Paediatrics for Pain
- 0.1ml/gk of diluted Morphine
- Repeat every 5mins until either pain is relieved or max of 4 doses
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Morphione paediatric Persistant or recurrant pain
Initial regimen can be repeated after 30 mins 01.ml/kg every 5mins to max of 4 doses
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Morphine Paediatric dose for IM
0.025ml/kg of undiluted morphine. dose must not exceed the adult dose
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Morphine min age for administration
6mths
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Maxalon Action
- Supresses vomiting by acting on both the chemoreceptor trigger zone and stomach.
- Accelerates gastric emptying by stimulating the motility of the stomach and upper GIT
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Maxalon uses
- Vomiting
- Prophylaxis to prevent vomiting in either eye or spinal injuries in adults
- Prophalaxis if the patients airway may be compromised due to vomiting
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Maxalon adverse effects
- Drowsiness, lethergy and dry mouth
- Extrapyranidal stimulation rarely results in spasm of facial muscles, trismus, speech difficulties and unnatural body positioning
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Maxalon contraindications
Previous adverse reaction or allergy
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Maxalon dose
2ml or 10mg IM or IV Slowly
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Hartmanns type
crystalloid solutuion
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Hartmans Action
Following intravenious infusion it is distributed throughout the extracellular fluid space. Approx 25% of the volume stays in the intravascular space
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Hartmanns use
- Fluid replacement
- Dehydration
- Diving emergencies
- Hypovolaemia trauma-adult and Paed
- Hypovolaemia non trauma
- Meningococcyl Septicaemia
- Hyperglycaemia
- Burns
- Flush for drugs
- TKVO in limb realignment and or difficult extrication
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Hartmanns Adverse effects
- Excess administration can cause Pulmonary Oedema
- Over infusion will cause coagulpathy,hypothermia and acidosis in the trauma patient
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Hartmanns dose for Adult Trauma Hypovolaemia
- 100-200mls aliquots to maintain a radial pulse
- For traumatic brain injuries maintain a radial pulse >90mmhg
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Hartmans Doe Paediatric Trauma Hypovolaemia
5ml/kg which can be repeated if any of the key signs of shock remain
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Hartmanns dose Non Trauma Hypovolaemia
1ltr Stat dose
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Hartmanns dose paediatric Non trauma hypoglycaemia
20mls/kg rapis bolus infusion
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Hartmanns dose for Adult and Paed Hyperglycaemia
20mls/kg up to 1ltr rapid bolus infusion
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Hartmanns dose for Adult dehydration and diving emergencies
- 10mls/kg rapid infusion up to 1 ltr
- Then 10mls /kg every hour while signs of dehydration persists or with diving emergencies
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Hartmanns dose Burns
Volume = BSA x Weight(kg) to be given over 4hrs from time of burn
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Hartmanns dose for flush for drugs
20-30ml To Flush drugs for ADULT ONLY
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Hartmanns dose Meningococcyl Septicaemia Adult
1ltr rapid bolus infusion for Adults
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Hartmanns Meningococcal septicaemia Dose for Paed
20mls/kg rapis bolus infusion
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Fentanyl Type
A Liquid-soluble synthetic short acting analgesic
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Fentanyl Action
- Potent analgesic
- Effective drug for intranasal use because it is rapidly absorbed across mucous membranes
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Fentanyl Use
Management of moderate to severe pain in patients aged 1 and above
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Fentanyl adverse effects
- Respiritory depression
- Hypotension
- Nausia and vomiting
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Fentanyl contraindications
- Altered LOC
- Patient is poorly perfused
- Pervious known allergy or advese effect
- Bleeding nose or occluded nasal passages
- Women in labour
- Patient <1yr old
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Fentanyl Dose Adult
Initial dose 180mcg-240mcg pending on patients size
- To give 180mcg
- 0.4ml =120mcg
- 0.3ml =90mcg
- To Give 240mcg
- 0.4ml =120mcg
- 0.3ml = 90mcg
- 0.3ml = 90mcg
WAIT 5 MINS
Subsequent Doses: - 0.2ml (60mcg) - up to 0.4ml (120mcg) every 5 mins pending on response
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Fentanyl Dose for Advanced age,Smaller than average size and general debility
Initial dose of 120mcg or 0.3ml (90mcg) then 0.2ml (60mcg)
- Subsequent dose
- 0.2ml every 5 mins depending on response
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Fentanyl dose Paeds aged 1-5 years
- Initial dose 30mcg or
- 1 spray of 0.2ml or 60mcg allowing for 30mcg deadspace
- Subsquent dose
- Aged 1-3 = 0.1ml or 30mcg at 10min intervals depending on response
- Aged 4-5 =0.1ml or 30mcg at 5 min intervals
May only be repeated to a max of 2 doses
For Persisitant pain 30 mcg can be given and repeated after 10 mins
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Fentanyl dose for 6 to 15 years
Initial dose of 60mcg or 75mcg
- To administer 60 mcg = 0.3ml or 90mcg allowing for deadspace of 30mcg
- To Administer 75mcg = 0.35ml or 105mcg
- Subsequent dose
- 0.1ml or 30mcg at 5 min intervals depending on response
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Midazolam Type
Anti-convulsant and minor tranquilliser
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Midazolam Action
Reduces seizure activity and has a tranquillising and amnesic effect
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Midazolam Uses for P1
To control seizures
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Midolam Adverse effects
- Upper airway obsrtruction due to depression of consciousness
- Respiritory and cardiovascular depression
Vital signs must be carefully monitiredand equipment to support respiration must be available. Apnea can occur in elderly and Pts with respiritory disease. Adverse effect are in crease with opiates and alcohol
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Midazolam Adult dose for fitting IM
- 1.5mls or (7.5mg) by IM injection.
- Repeat once after 5 mins
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Midazolam Adult dose for fitting IV
3 mls or 3mg of diluted Midazolam by IV slowly.If fitting continues repeat every 3 mins to a max of 15mg or 15ml
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Midazolam dose for fitting paed IM
0.03ml/kg or 0.15mg/kg repeat once after 5 mins
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Midazolam dose for fitting Pead IN
0.06ml/kg or .3mg/kg via a MAD. Repeat once after 10 mins
Each IN dose must not exceed the adult dose of 7.5mg or 1.5 ml
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Midazolam dose fior fitting paed IV
0.15ml/kg or 0.15mg/kg of diluted midazolam
Repeat every 3 mins to max of 3 doses or 0.45mg/kg
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Glucose 10% Type
Hypertonic sugar solution for IV use
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Glucose 10% Action
Principle energy source for body cells especially the brain
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Glucose 10% Use
Correction of hypoglycaemia
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Glucose adverse effects
- Tissue necrosis if extravasation from vein occurs
- May aggrivate brain damage in head injuriess and strokes
- May precipitate Werneicks encephalopathy in alcoholics with thiamine deficiency
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Glucose 10% Adult Dose
INitial dose of 150ml or 15g via a burette and then flush with 10ml Nacl.
If inadequate response and GCS < 15 after 3 mins, give 100mls or 10g titrating to patients state and then flush
Can be repeated once if no response
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Glucose 10% Paed dose
- Single dose of 5ml/kg or 0.5g/kg and then flush with 10ml Nacl
- Repeat once if no response
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Ondansetron type
Antiemetic and anit nauseant
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Ondansetron Action
Blocks central and peripheral 5-ht3 receptors
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Ondansetron uses
- Nausia and vomiting in adult where Maxalon is ineffective or contraindicated
- Nausia and vomiting in children
- Prophylazis to prevent vomiting in eye or spinal injuries
- Prophylaxis if the patients airway may be compromised due to vomiting
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Ondansetron Adverse effects
- Headache and or flushing
- Seizures and movement disorders
- visual disturbances
- hypersensativity including anaphylaxis
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Ondasetron Contraindications
- Previous known allergy or adverse reaction
- Paediatric patients under 2 years of age
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Ondansetron dose for Adult and Paed
- Age 2-7 = 1ml or 2mg IM or iIV
- Age 8 and above = 2ml or 4mg IM or IV
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Fexofenadine type
Antihistamine
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Fexofenadine action
Antagonises the action of histamine onH1 receptors
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fexofenadine use
Mild allergic reactions eg. rash/urticaria, allergic rhinitis
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Fexofenadine Adverse effects
- Headache
- Drowsieness
- Nausia
- Dry mouth
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Fexofenadine contraindication
- Known allergy or hypersensativity to fexofenadine
- Severe renal impairment
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Fexofenadine preparation
180mg tablet
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Fexofenadine Dose Adult and Paed
1 tablet daily
Not for children under 12
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Adrenaline Uses for P1
- Asthma if severe or extreme with decreased LOC or minimal air movement
- Sever croup in children with stridor at rest or any one of Altered LOC, Retractions or cyanosis
- Patients with moderates to severe allergies and anaphylaxis reactions
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Adrenaline Adverse effects
- Dysrythmias including VF
- Tachycardia
- Hypertensionn
- Pupilary dilation
- Anxiety
- Nausia and vomiting
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Adrenaline Dose for Adult IM in Asthma or anaphylaxis
- 0.5ml or 500mcg of adrenaline 1:1000 inthe lateral aspect of the thigh
- Can be repeated eery 5 mins
- Must be used for only extreme cases
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Adrenaline dose for Adult IV Asthma or Anaphylaxis
- 1ml or Adrenaline 1:10,000 or 100mcg every 60 secs.
- Must be used only for extreme and immediatly lifethreatening situations and when there are no delays in gaining IV access
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Adrenaline dose for Paed in Asthma or anaphylaxis IM
- 0.1ml/kg of adrenaline1:1000 or 10mcg/kg IM
- Repeat every 10 mins
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Adrenaline dose for Paed in Asthma or anaphylaxis IV
- 0.1ml/kg of adrenaline 1:1000 or 10mcg/kg over 3 mins.
- Can be repeated every 5 mins
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