Adrenaline 1:1000 (ADM)

Presentation:

Adrenaline 1:1000 (ADM)

Indications:

1. Anaphylaxis

2. Life threatening asthma with failing ventilation and continued deterioration despite nebuliser therapy

Adrenaline 1:1000 (ADM)

Contraindications:

Adrenaline 1:1000 (ADM)

Cautions:

1. Severe hyertension may occur in patients taking beta-blockers and half doses should be administered unless there is rofound hypotension

2. For atients taking tricyclic antidepressants (e.g. amitriptyline, imipramine) half doses should should be administered for anaphylaxis

Adrenaline 1:1000 (ADM)

Administration & Concentration:

Administered IM in the antero-lateral aspect of the thigh or upper arm

Can be administered SC in asthma

Concentration 1 mg in 1 ml

Adrenaline 1:1000 (ADM)

Dose: adult (> 12 years)

Adrenaline 1:1000 (ADM)

Dose: 6 years - < 12 years

250 micrograms (0.25 ml), once only

Not indicated in asthma

Adrenaline 1:1000 (ADM)

Dose: 6 months - < 6 years

120 micrograms (0.12 ml), once only

Not indicated in asthma

Adrenaline 1:1000 (ADM)

Dose: < 6 months

50 micrograms (0.05 ml), once only

Not indicated in asthma

Adrenaline 1:1000 (ADM)

Actions:

1. Reverses allergic manifestations of acute anaphylaxis

2. Relieves bronchospasm in acute severe asthma

Chlorphenamine (CPH)

Presentation:

Chlorphenamine (CPH)

Actions:

An antihistamine that blocks the effect of histamine released during a hypersensitivity (allergic) reaction

Also has anticholinergic properties

Chlorphenamine (CPH)

Indications:

1. Severe anaphylactic reactions, secondary to IM adrenaline

2. Symptomatic allergic ractions falling short of anaphylaxis but causing patient distress

Chlorphenamine (CPH)

Contraindications:

1. Known hypersensitivity

2. Children < 1 year

Chlorphenamine (CPH)

Administration & Concentration:

Administered by slow IV injection, over 1 minute

Concentration 10 mg in 1 ml

Chlorphenamine (CPH)

Dose: adult (> 12 years)

Chlorphenamine (CPH)

Dose: 6 years - < 12 years

Chlorphenamine (CPH)

Dose: 1 year - 6 years

Chlorphenamine (CPH)

Cautions:

1. Hypotension

2. Epilepsy

3. Glaucoma

4. Hepatic disease

Chlorphenamine (CPH)

Side Effects:

1. Sedation

2. Dry mouth

3. Headache

4. Blurred vision

5. Psychomotor impairment

6. GI disturbance

7. Transient hypotension

8. Convulsions (rare)

SDHB-PGTC

The elderly are more likely to suffer side effects

Due to the sedative and psychomotor side effects, anyone receivingchlorphenamine should be advised against driving or undertaking any other complex psychomotor skills

Hydrocortisone (HYC)

Presentation:

1. Ampoule containing 100 mg hydrocortisone as either sodium succinate or sodium phosphate in 1 ml

2. Solu-cortef, a powder for reconstitution with up to 1 ml of water

Hydrocortisone (HYC)

Actions:

Hydrocortisone (HYC)

Indications:

1. Severe or life-threatening asthma - where call to hospital time is > 30 minutes

2. Anaphylaxis

3. Addisonian crisis

Hydrocortisone (HYC)

Contraindications:

Hydrocortisone (HYC)

Cautions:

None relevant to a single dose

If a patient is likely to require thrombolysis IM administration of any drug shouldbe avoided

Hydrocortisone (HYC)

Side Effects:

Hydrocortisone (HYC)

Administration & Concentration:

Administered IV, IO, or IM where IV access cannot be obtained

Administer by slow IV injection over a minimum of 2 minutes to avoid side effects

It is better to administer hydrocortisone if there is any doubt about previous steroid administration

Concentration 100 mg in 1 ml or 100 mg in 2 ml

Hydrocortisone (HYC)

Dose: adult (> 12 years)

Hydrocortisone (HYC)

Dose: 11 years

140 mg (1.4 ml if 100 mg/ 1ml or 2.8 ml if 100 mg/ 2 ml)

4 mg/ kg

Hydrocortisone (HYC)

Dose: 10 years

130 mg (1.3 ml if 100 mg/ 1ml or 2.6 ml if 100 mg/ 2 ml)

4 mg/ kg

Hydrocortisone (HYC)

Dose: 9 years

110 mg (1.1 ml if 100 mg/ 1ml or 2.2 ml if 100 mg/ 2 ml)

4 mg/ kg

Hydrocortisone (HYC)

Dose: 8 years

100 mg (1 ml if 100 mg/ 1ml or 2 ml if 100 mg/ 2 ml)

4 mg/ kg

Hydrocortisone (HYC)

Dose: 7 years

92 mg (0.92 ml if 100 mg/ 1ml or 1.8 ml if 100 mg/ 2 ml)

4 mg/ kg

Hydrocortisone (HYC)

Dose: 6 years

82 mg (0.82 ml if 100 mg/ 1ml or 1.6 ml if 100 mg/ 2 ml)

4 mg/ kg

Hydrocortisone (HYC)

Dose: 5 years

74 mg (0.74 ml if 100 mg/ 1ml or 1.5 ml if 100 mg/ 2 ml)

4 mg/ kg

Hydrocortisone (HYC)

Dose: 4 years

66 mg (0.66 ml if 100 mg/ 1ml or 1.3 ml if 100 mg/ 2 ml)

4 mg/ kg

Hydrocortisone (HYC)

Dose: 3 years

57 mg (0.57 ml if 100 mg/ 1ml or 1.1 ml if 100 mg/ 2 ml)

4 mg/ kg

Hydrocortisone (HYC)

Dose: 2 years

49 mg (0.49 ml if 100 mg/ 1ml or 0.98 ml if 100 mg/ 2 ml)

4 mg/ kg

Hydrocortisone (HYC)

Dose: 18 months

45 mg (0.45 ml if 100 mg/ 1ml or 0.9 ml if 100 mg/ 2 ml)

4 mg/ kg

Hydrocortisone (HYC)

Dose: 12 months

39 mg (0.39 ml if 100 mg/ 1ml or 0.78 ml if 100 mg/ 2 ml)

4 mg/ kg

Hydrocortisone (HYC)

Dose: 9 months

36 mg (0.36 ml if 100 mg/ 1ml or 0.72 ml if 100 mg/ 2 ml)

4 mg/ kg

Hydrocortisone (HYC)

Dose: 6 months

31 mg (0.31 ml if 100 mg/ 1ml or 0.62 ml if 100 mg/ 2 ml)

4 mg/ kg

Hydrocortisone (HYC)

Dose: 3 months

24 mg (0.24 ml if 100 mg/ 1ml or 0.48 ml if 100 mg/ 2 ml)

4 mg/ kg

Hydrocortisone (HYC)

Dose: 1 month

18 mg (0.18 ml if 100 mg/ 1ml or 3.6 ml if 100 mg/ 2 ml)

4 mg/ kg

Hydrocortisone (HYC)

Dose: birth

14 mg (0.14 ml if 100 mg/ 1ml or 0.28 ml if 100 mg/ 2 ml)

4 mg/ kg

Ipratropium bromide (IPR)

Presentation:

1. Nebules containing 250 micrograms ipratropium bromide in 1 ml

2. Nebules containing 500 micrograms ipratropium bromide in 2 ml

Ipratropium bromide (IPR)

Actions:

1. Ipratropium bromide is an antimuscarinic bronchodilator drug. It may provide short term relief in acute asthma but beta 2 agonists generally work more quickly. Ipratropium should be considered in acute severe or life threatening asthma or in cases of acute asthma or COPD which fail to improve with standard therapy (including salbutamol).

2. Ipratropium bromide is considered of greater benefit in:

a. children suffering acute asthma

b. adults suffering with COPD

Ipratropium bromide (IPR)

Indications:

1. Acute severe or life threatening asthma (given concurrent with first dose of salbutamol)

2. Acute asthma unresponsive to salbutamol

3. Exacerbation of COPD, unresponsive to salbutamol

Ipratropium bromide (IPR)

Contraindications:

Ipratropium bromide (IPR)

Administration & Concentration:

Nebulised with 6-8 L oxygen per minute, once only - may be mixed in the same nebuliser as salbutamol

Concentration 250 mg in 1 ml or 500 micrograms in 2 ml

Ipratropium bromide (IPR)

Dose: adult (> 12 years)

Ipratropium bromide (IPR)

Dose: 2 years - 12 years

Ipratropium bromide (IPR)

Dose: 1 month - 2 years

Ipratropium bromide (IPR)

Cautions:

1. Glaucoma (protect the eyes from mist)

2. Pregnancy and breastfeeding

Ipratropium bromide (IPR)

Side Effects:

1. Headache

2. Nausea and vomiting

3. Dry mouth

4. Difficulty in passing urine and. or constipation

5. Tachycardia/ arrhythmia

6. Paroxysmal chest tightness

7. Allergic reaction

HNDD-TPA

Naloxone Hydrochloride (NLX)

Presentation:

Naloxone Hydrochloride (NLX)

Actions:

Naloxone Hydrochloride (NLX)

Indications:

1. Respiratory depression, depression of cardiovascular system and CNS associated with opioid overdose

2. Accidental overdose of opioid drugs e.g. morphine, nalbuphine

3. Overdose of some common analgesics containing opioid substances produce respiratory depression, which is reversed by naloxone

4. Unconsciousness associated with respiratory depression of unknown cause, where opioid overdose is a possibility

Naloxone Hydrochloride (NLX)

Contraindications:

Naloxone Hydrochloride (NLX)

Side Effects:

Naloxone Hydrochloride (NLX)

Administration & Concentration:

In respiratory arrest or depression where the urgency of the situation outweighs the need for a controlled effect, undiluted naloxone can be administered IV as a bolus, or IM in the antero-lateral aspect of the thigh or upper arm where IV access is not possible

The half life of naloxone is short and doses may need to be repeated every 2-3 minutes

Where a controlled effect is desired naloxone can be diluted for administration titrated to effect

Concentration 400 micrograms in 1 ml

Naloxone Hydrochloride (NLX)

Dose: adult (> 12 years)

1. 400 micrograms IV (1 ml) or 800 micrograms IM (2 ml) in respiratory arrest or severe respiratory depression, to a maximum of 10 mg

2. 800 micrograms naloxone diluted in 8 ml WFI or SCP for IV injection titrated to response

Naloxone Hydrochloride (NLX)

Dose: 11 years

1. Initial dose 352 micrograms (0.88 ml)

2. subsequent dose 3.5 mg (8.8 ml)

100 micrograms/ kg

Naloxone Hydrochloride (NLX)

Dose: 10 years

1. Initial dose 320 micrograms (0.80 ml)

2. subsequent dose 3.2 mg (8 ml)

100 micrograms/ kg

Naloxone Hydrochloride (NLX)

Dose: 9 years

1. Initial dose 288 micrograms (0.72 ml)

2. subsequent dose 2.8 mg (7.2 ml)

100 micrograms/ kg

Naloxone Hydrochloride (NLX)

Dose: 8 years

1. Initial dose 260 micrograms (0.65 ml)

2. subsequent dose 2.6 mg (6.5 ml)

100 micrograms/ kg

Naloxone Hydrochloride (NLX)

Dose: 7 years

1. Initial dose 232 micrograms (0.58 ml)

2. subsequent dose 2.3 mg (5.8 ml)

100 micrograms/ kg

Naloxone Hydrochloride (NLX)

Dose: 6 years

1. Initial dose 208 micrograms (0.52 ml)

2. subsequent dose 2.1 mg (5.2 ml)

100 micrograms/ kg

Naloxone Hydrochloride (NLX)

Dose: 5 years

1. Initial dose 184 micrograms (0.46 ml)

2. subsequent dose 1.8 mg (4.6 ml)

100 micrograms/ kg

Naloxone Hydrochloride (NLX)

Dose: 4 years

1. Initial dose 164 micrograms (0.41 ml)

2. subsequent dose 1.6 mg (4.1 ml)

100 micrograms/ kg

Naloxone Hydrochloride (NLX)

Dose: 3 years

1. Initial dose 144 micrograms (0.36 ml)

2. subsequent dose 1.4 mg (3.6 ml)

100 micrograms/ kg

Naloxone Hydrochloride (NLX)

Dose: 2 years

1. Initial dose 124 micrograms (0.31 ml)

2. subsequent dose 1.2 mg (3.1 ml)

100 micrograms/ kg

Naloxone Hydrochloride (NLX)

Dose: 18 months

1. Initial dose 112 micrograms (0.28 ml)

2. subsequent dose 1.1 mg (2.8 ml)

100 micrograms/ kg

Naloxone Hydrochloride (NLX)

Dose: 12 months

1. Initial dose 100 micrograms (0.25 ml)

2. subsequent dose 1 mg (2.5 ml)

100 micrograms/ kg

Naloxone Hydrochloride (NLX)

Dose: 9 months

1. Initial dose 88 micrograms (0.22 ml)

2. subsequent dose 880 micrograms (2.2 ml)

100 micrograms/ kg

Naloxone Hydrochloride (NLX)

Dose: 6 months

1. Initial dose 78 micrograms (0.19 ml)

2. subsequent dose 800 micrograms (2 ml)

100 micrograms/ kg

Naloxone Hydrochloride (NLX)

Dose: 3 months

1. Initial dose 60 micrograms (0.15 ml)

2. subsequent dose 600 micrograms (1.5 ml)

100 micrograms/ kg

Naloxone Hydrochloride (NLX)

Dose: 1 month

1. Initial dose 44 micrograms (0.11 ml)

2. subsequent dose 440 micrograms (1.1 ml)

100 micrograms/ kg

Naloxone Hydrochloride (NLX)

Dose: birth

1. Initial dose 200 micrograms (0.5 ml), IM only

Subsequent doses not indicated

Salbutamol (SLB)

Presentation:

1. Nebules containing 2.5 mg salbutamol in 2.5 ml

2. Nebules containing 5 mg salbutamol in 2.5 ml

Salbutamol (SLB)

Actions:

Salbutamol (SLB)

Indications:

1. Acute asthma attack where normal inhaler therapy has failed to relieve symptoms

2. Expiratory wheezing associated with allergy, anaphylaxis, smoke inhalation or other lower airway cause

3. Exacerbation of COPD

4. Shortness of breath due to LVF (secondary treatment)

Salbutamol (SLB)

Contraindications:

Salbutamol (SLB)

Side Effects:

1. Tremor

2. Palpitations

3. Tachycardia

4. Headache

5. Feeling of tension

6. Peripheral vasodilatation

TPT-HFP

Salbutamol (SLB)

Cautions:

1. Hypertension

2. Angina

3. Late pregnancy

4. Overactive thyroid

HALO

Severe hypertension may occur in patients on beta blockers and half doses should be used unless there is profound hypotension

Salbutamol (SLB)

Administration & Concentration:

1. Nebulised with 6-8 L oxygen per minute

2. In acute severe or life threatening asthma ipratropium bromide should be given concurrently witht he first dose of salbutamol. In acute asthma or COPD not unresponsive to salbutamol, ipratropium may be given concurrently with a later dose of salbutamol

3. Salbutamol provides initial relief, severe attacks will require steroid and further nebulisation. Do not be lulled into a false sense of security by an initial improvement

Concentration 2.5 mg in 2.5 ml or 5 mg in 2.5 ml 

Salbutamol (SLB)

Dose: adult (> 12 years)

5 mg (5 ml if 2.5 mg/ 2.5 ml or 2.5 ml is 5 mg/ 2.5 ml)

If there is no improvment in peak flow after 5 minutes, further doses can be given

In severe attacks nebulisation may need to be repeated - there is nolimit on the maximum dose of salbutamol. Repeat doses should be discontinued if side effects are becoming significant.

Salbutamol (SLB)

Dose: 6 years - 12 years

5 mg (5 ml if 2.5 mg/ 2.5 ml or 2.5 ml is 5 mg/ 2.5 ml)

If there is no improvment in peak flow after 5 minutes, further doses can be given

In severe attacks nebulisation may need to be repeated - there is no limit on the maximum dose of salbutamol. Repeat doses should be discontinued if side effects are becoming significant.

Salbutamol (SLB)

Dose: 12 months - 6 years

2.5 mg (2.5 ml if 2.5 mg/ 2.5 ml or 1.25 ml if 5 mg/ 2.5 ml)

If there is no improvement in peak flow after 5 minutes, further doses can be given

In severe attacks nebulisation may need to be repeated - there is no limit on the maximum dose of salbutamol. Repeat doses should be discontinued if side effects are becoming significant

Salbutamol (SLB)

Dose: < 12 months

2.5 mg (2.5 ml if 2.5 mg/ 2.5 ml or 1.25 ml if 5 mg/ 2.5 ml)

Salbutamol is less effective in children < 12 months and a single dose of 2.5 mg should be administered only

Oxygen (OXG)

Presentation:

Oxygen (OXG)

Contraindications:

Oxygen (OXG)

Cautions:

1. Oxygen increases the fire hazard at an incident

2. Defibrillation - ensure pads are firmly applied to reduce the risk of spark