NALOXONE.(narcan)
Indications
Known narcotic overdose or coma suspected to be due to narcotic overdose.
Respiratory depression as a result of overdose of Co-Proximal.
Respiratory depression as a result of administration of nubain.
Contraindications
None
Side effects
Rapid administration may lead to projectile vomiting and ventricular dysrhthmias.
Administration to people who are physically dependant on narcotics may cause an acute withdrawal syndrome.
In general the action of naloxone is shorter than that of the narcotic which it is reversing, thus the patient may fall back into a stupor or coma as the naloxone wears off. These patients must therefore be closely observed and the dose repeated if necessary.
Presentation
Pre-filled syringe 800mcg/2ml
Administration and dosage.
Over 6-adult 1st dose 800mcg .2nd dose 800mcg after 5mins .3rd dose 800mcg after 15mins.
Routes in order in cardiac arrest IM, IV, ET. General route I.M.
1 to six years 1st dose 200mcg. 2nd dose 400mcg after 5mins. 3rd dose 800mcg after 15mins. Routes in cardiac arrest in order IM, IV, IO.General route IM.
Under 1 year. 1st dose 100mcg. 2nd dose 200mcg after 5mins. 3rd dose 400mcg after 15mins.Routes in order in cardiac arrest IM. General route IM.
LIGNOCAINE
Where possible an ECG print out is required to confirm rhythm prior to drug administration

Indications
Patients over the age of 12 years presenting with ventricular tachycardia with a palpable pulse greater than 140bpm.
Contraindications
Known history of allergy to lignocaine or local anaesthetics.
Side effects
Hypotension,drowsiness, confusion, numbness and seizures in high doses.
Presentation
Prefilled syringe 100mg/5ml
Administration and dosage
VT. 100mg slowly over 1 minute.Repeat once after 15 mins if VT is not controlled.
Maximum cumulative dosage 200mg IV.

NALBUPHINE
HYDROCHLORIDE (NUBAIN)
Indications
Patients aged over 1 year who are suffering moderate to severe pain caused by illness, trauma or ischemic type chest pain, where the pain is not relieved by entonox, or where entonox is inappropriate Continued

NALBUPHINE.Continued
HYDROCHLORIDE (NUBAIN)
Contraindications
Known allergy to nubain.
Strong history of allergy to medication
Pregnancy and childbirth, where this is the primary presenting condition. If pain due to illness, trauma or ischaemic type chest pain seek medical advice via CAC.
Impaired levels of consciousness due to any cause. Evidence of chronically impaired respiratory function. Hypotension BP<90 systolic. Head injuries with GSC less than 14. Patients who have consumed significant amounts of alcohol. Patients already been administered strong analgesic. Patients taking Monoamine oxide inhibitors. MAOI’s.
Cautions
chest injuries when accompanied with dib.
Patients that are taking psychiatric medication other than MAOI’S as contraindicated above.
Side effects
Drowsiness, dizziness, dry mouth, Respiratory depression in large doses, nausea and vomiting.
Presentation
Ampoule 10mg in 1ml.
Administration and dosage
Ensure that 800mcg of naloxone is available in case of respiratory depression.
Patients aged 12 and over10mg IV slowly over 1-2 mins. using 1ml syringe. wait 5-10 mins and repeat if required. Maximum dose 20mg.

Patients 1-12: Administer 300mcg  per kilo of body weight IV slowly over 1-2 minutes max dose 600mcg/kilo.

Frusemide

Indications

Patients suffering Left Ventricular failure is often characterised by a history of cardiac problems, shortness of breath, often with accompanying dyspnoea, tachycardia, cyanosis, crackles and wheezes and often foamy blood tinged sputum. Due to impaired oxygenation the patient can also be very anxious and agitated. Oxygen must be considered before administration of drug therapy.

Contrainications

Pregnancy.

Side effects

Hypotension

Nausea and gastro-intestinal disturbances

Presentation

2ml ampoule containing 20mg frusemide

5ml ampoule containing 50mg frusemide

Administration and dosage

IV Injection slowly over 1minute (preferred route). When administering IV the frusemide is to be mixed with saline flush (total fluid including drug=10mls) in 10ml syringe.

A saline mixture is not required when administering IM

If IV access proves difficult  then IM route may be used.

Continued

Furosemide Continued

20mg furosemide for patients weighing up to 60kg (132lbs 9.5 stone)

50mg furosemide for patients weighing over 60kg

Maximum dosage

20mg or 50mg according to patients weight.

SALBUTAMOL
Indications
acute asthma attack or acute severe asthma attack.
Acute bronchospasm
Contraindications
acute myocardial ischaema.
Presentation
2.5mg nebul.
Administration and dosage
Patients over 5 years 5mg nebulised. second and subsequent dosages may be given on route to hospital if the patients condition does not improve.
Patients 0-5 years. 2.5 mg nebulised plus subsequent doses as above.
SYNTOMETRINE
Indications
Haemorrhage occurring within 24 hours of childbirth (post partum) where the bleeding is uncontrolled despite the application of uterine massage.
Contraindications
Never give syntometerine if the baby is still in the uterus. Be aware of the potential of the presence of a second or subsequent babies still to be delivered. The potential for an undiagnosed twin is higher in those women who have not sought ante-natal care/assessment.
Side effects
Nausea
Headaches
Abdominal pains
Palpitations
Bradycardia
Transient hypertension
Presentation
500mcg of ergometrine maleate plus 5
 units of oxytocin in a 1ml ampoule.
Administration and dosage
500mcg IM once only
500mcg IV once only. IV access should only be used if IV access was gained before the post partum haemorrhage occurred.

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