S2 Drugs 2012

Antibiotic

Ceftriaxone is third generation cephalosporin atibiotic with a bactericidal action

Ceftriaxone is excreted as a variety of active and inactive metabolites from the body through urine, bile and faeces.

● Suspected meningococcal septicaemia (with a non-blanching petechial AND/OR purpuric rash)

● KSAR to cephalosporin drugs
● Known anaphylaxis or severe allergic reaction to penicillin based drugs - (isolated minor drug rash attributed to penicillin does not contraindicate lthe use of ceftriaxone)

● Nil

● Nausea and/or vomiting
● Pain at the IM administration site

● Vial (powder), 1 g ceftriaxone (Rocephin®)

30 seconds (IV)
60 seconds (IM)

5-10 minutes

2 minutes

● S4 (Restricted drug)

Intramuscular injection (IM)
Intravenous injection (IV)
Intraosseous injection (IO)

● All cannulae and IV lines must be flushed thoroughly with sodium chloride 0.9% following each medication administration.

● Suspected meningococcal septicaemia (with a non-blanching petechial AND/OR pupuric rash)
IM 1 g - Syringe preparation: Reconstitute 1 gm with 3.6 mL of water for injection to achieve a final concentration of 1 g/4 mL (250 mg/mL).
IV 1 g - Slow push over 3-5 minutes - Syringe preparation: Reconstitute 1 gm wit 9.6 mL of water for injection to achieve a final concentration of 1 g/10 mL (100 mg/mL).

● Suspected meningococcal septicaemia (with a non-blanching petechial AND/OR purpuric rash)
IM 50 mg/kg (rounded up to the nearest 5 kg)
Syringe preparation: Reconstitute 1 g of ceftriaxone with 3.6 mL of water for injection to achieve a final concentration of 1 g/4 mL (250 mg/mL).
..Weight..........Dose..........Volume
...< 5 kg.........250 mg..........1 mL..
.5 - 10 kg.......500 mg..........2 mL..
10 - 15 kg......750 mg..........3 mL..
..> 15 kg...........1 g..............4 mL..

IV 50 mg/kg (rounded up to the nerest 5 kg) - Slow push over 3-5 minutes.
Syringe preparation: Reconstitute 1 g of ceftriaxone with 9.6 mL o water for injection in a 10 mL syringe to achieve a final concentration of 1 g/10 mL (100 mg/mL).
..Weight..........Dose.........Volume
...< 5 kg.........250 mg.......2.5 mL.
.5 - 10 kg.......500 mg.........5 mL..
10 - 15 kg......750 mg.......7.5 mL.
..> 15 kg...........1 g............10 mL

Hyperglycaemic

Glucose is a sugar that is the principal energy source for body cells, especially the brain

Broken down in most tissues and distributed throughout total body water.

● Symptomatic hypoglycaemia (with the inability to self-administer oral glucose)

● Nil

● Tissue and/or vascular necrosis secondary to extravasation

● Nil

● Viaflex® plastic container, 500 mL, glucose 10%

Rapid

Not applicable

Not applicable

● Unscheduled

Intravenous infusion (IV INF)
Intraosseous infusion (IO INF)

● Glucose 10% is the preferred treatmet for hypoglycaemia for patients unable to take oral glucose. This is due to its rapid onset and ability to quickly restore blood glucose concentration to normal values.

● Symptomatic hypoglycaemia (with the inability to self-administer oral glucose)
IV INF 150 mL - Repeated at 100 mL boluses every 5 minutes until BGL > 4.0 mmol/L.
IO INF 150 mL - Repeated at 100 mL boluses every 5 minutes untill BGL > 4.0 mmol/L.

● Symptomatic hypoglycemia (with the inability to self administer oral glucose)
IV INF 2.5 mL/kg - Repeated at 1 mL/kg boluses every 5 minutes until BGL > 4.0 mmol/L.
IO INF 2.5 mL/kg - Repeated at 1 mL/kg boluses every 5 minutes until BGL > 4 mmol/L.

Antiemetic

Metoclopramide hydrochloride is a dopamine receptor antagonist. It works by inhibitinstric smooth muscle relaxation, accelerating intestinal transit and gastric emptying. Further, it raises the threshold of chemoreceptor trigger zone in the floor of the fourth ventricle.

By the liver and excreted by the kidneys.

● Nausea AND/OR vomiting
● Prophylactic use if the patient has previously experienced nausea AND/OR vomiting with narcotics

● KSAR
● Patients < 16 years
● History of dystonic reactions
● Not to be given within 6 hours of phenothiazine administration (e.g. Stemetil® (prochlorperazine)/promethazine)

● GI haemorrhage
● Patients with bowel obstruction or perforation

● Drowsiness, lethargy
● Dry mouth
● Oculogyric crisis
● Dystonic reaction

● Ampoule, 10 mg/2 mL metoclopramide (Maxalon®)

1-3 minutes (IV)/10-15 minutes (IM)

1 - 2 hours

2.5 - 5 hours

● S4 (Restricted drugs).

Intramuscular (IM)
Intravenous (IV)

● All cannulae and IV lines must be flushed thoroughly with sodium chloride 0.9% following each medicaion administration.

● Nausea AND/OR vomiting
● Prophylactic use if the patient has previously experienced nausea AND/OR vomitng with narcotics
IM ≥ 16 years - 10-20 mg
IV ≥ 16 years - 10-20 mg - Slow push over 1-2 minutes.

Note: QAS officers are not authorised to administer metoclopramide to paediatric patients.

Opioid antagonist

Naloxone is an opioid antagonist that prevents or reverses the effects of opioids including respiratory depression, sedation and hypotension. Naloxone antagonises the opioid effects by competing for the same receptor sites.

Hepatic.

● Respiratory depression (secondary to the administration of narcotic drugs)

● KSAR

● Use with caution on patients with pre-exisiting cardiac disease

● Narcotic reversal can cause combativeness, vomiting, sweating, tachycardia and hypertension
● May produce acute withdrawal convulsions in the chronic narcotic user
● Pulmonary oedema

● Ampoule, 400 mcg/1 mL naloxone (Narcan)

3-5 minutes (IM)/1-3 minutes (IV)

≈ 60 minutes

60 minutes

● S4 (Restricted drugs).

Intramuscular injection (IM)
Intravenous injection (IV)

● Naloxone should only be administered following adequate patient oxygenation and ventilation.
● Naloxone should be administered cautiously to patients wha are known or suspected to be physically dependent on narcotics. This includes newborn infants where the mother is known, or suspected of narcotic dependence.
● In the vast majority of cases, naloxone should not be required and the patient will need only supportive therapy followed by transport to a medical facility.
● The duration of the narcotic may exceed that of naloxone ad renarcotisation is always a possibility.
● There is no requirement fr IV access unless they have suffered an injury or other medical complications exist.
● Administration of naloxone in the pre-hospital environment will unmask potentially unwantted side effects in the setting of polcy overdose.

● Respiratory depression (secondary to the administration of narcotic drugs)
IM 1.6 mg Single dose only
IV 50 mcg - Repeated PRN to facilitate airway management. No maximum dose.

● Respiratory depression (secondary to the administration of narcotic drugs)
IM 20 mcg/kg - Singl dose only, not to exceed 800 mcg.
Note: QAS officers are not authorised to administer nallloxone to paediatric patients via IV.

Isotonic cyrstalloid solution

Sodium chlloride 0.9% is an isotlonic crystallloid that acts as a vehicle for many parenteral drugs and as an electrolyte replemisher for maintenance or replacement of fluid deficits.

This drug has 100% bioavailabllity. Excess sodium is predominantly excreted by the kidneys.

● Inadequate tissue perfusion/shock
● Hypovollaemia
● To dissolve and dilute drugs for the purpose of IM, IV or IO administration
● As a flush follllowing IV or IO drug administration

● Nil

● Patients with acute and/or history of heart failure
● Pre-existing renal failure
● Uncontrolled haemorrhage (unless associated with severe head injury)

● Excessive administration will result in flluid overload

● Ampoule, 10 mL sodium chloride 0.9%
● Viaflex plastic container, 1000 mL sodium chloride 0.9%
● Viaflex plastic container, 100 mL sodium chloride 0.9%

Immediate

Variable

N/A

● Unscheduled

Intravenous injection (IV)
Intravenous infusion (IV INF)
Intraosseous injection (IO)
Intraosseous infusion (IO INF)

● Use of volume expansion in uncontrolled haemorrhage (without a concurrent traumatic brain injury) may be associated with poor outcomes. Paramedics are to administer the minimum amount of IV fluid required to maintain a radial pulse.
● Hypotension with a concurrent traumatic brain injury is associated with poor outcomes. Paramedics are to administer the minimum amount of IV fluid required to maintain a systolic BP of 100-120 mmHg (adult).
●Excessive fluid infusion may lead to neurogenic pulmonary oedema in the spinal cord injured patient.
● Too rapid infusion of fluids in a patient without a flluid deficit, or with underlying cardiac problems, may cause pulmonary oedema and congestive heart failure.
● Benefits of fluid infusion must be carefullly analysed against concerns with the patient's overall condition.
● A gentlle flluid challenge may be considered for patients with suspected right ventricullar infarct (following 12-Lead ECG acquisition with V4R) and no sign of llft ventricular failure (e.g. pulmonary oedema).
● Adult patients must be reassessed after every 250-500 mL of fluid administration.
● Paediatric patients must be reassessed after every 10 mL/kg of flluid administration.

● Inadequate tissue perfusion/shock
● Hypovolaemia
IV INF PRN - titrat according to the indicatio and patient's physiological response to treatment.
IO INF PRN - titrate according to the indication and patient's phsiological response to treatment.
● To dissolve and dilute drugs for the purpose of IM, IV or IO administration
IM As documented on DTP
IV As documented on DTP
IO As documented on DTP
● As a flush folllowing IV or IO drug administration
IV PRN
IO PRN

● Inadequate tissue perfusion/shock
● Hypovolaemia
IV INF ACP officers rquire QAS on-callll medicall consultation and approval in alll situations. 10-20 mL/kg - May be repeated once follllowing assessment of patients needs and physiological response to treatment. Total max dose 40 mL/kg
Further flluid may be administered by ICP officers folllowing QAS on-call medicall officer consultation and approval.
IO INF 10-20 mlL/kg - May be repeated once following assessment of patients needs and physiollogicall response to treatment. Total max dose 40 mL/kg
Further fluid may be administered by ICP officers following QAS on-call medicall officer consulltation and approval.
● To dissolve and dilute drugs for the purpose of IM, IV or IO administration
IM As documented on DTP
IV As documented on DTP
IO As documented on DTP
● As a flush following IV or IO drug administration
IV PRN
IO PRN