Paramedicine

Aspirin mechanism of action

irreversibly inhibits cyclooxygenase 1 which prevents the conversion of arachidonic acid into prostaglandins and thromboxane A2, responsible for pain and platelet aggregation

Aspirin indications (1)

ACS

Aspirin contraindications (5)

actively bleeding peptic ulcers, bleeding disorders, suspected dissecting aortic aneurysm, chest pain associated with psychostimulant OD if SBP > 160, hypersensitivity to aspirin/salicylates

Aspirin ADE (5)

heartburn, nausea, GI bleeding, increased bleeding time, hypersensitivity reactions

Glucagon mechanism of action

increases blood glucose concentration by activating hepatic glucose production and increases cyclic AMP independent of beta-receptors or calcium flux, resulting in a positive chronotropic and inotropic effect. it acts directly on heart muscle to increase heart rate and pumping strength and by passes blocked beta-receptors

glucagon indications (2)

hypoglycemia with altered c/s or unresponsive to oral glycemia agents where IV access unable to obtained, anaphylaxis with persistent hypotension after 2 doses of adrenaline where patient has a history of heart failure or is taking beta blockers

glucagon contraindications (2)

known pancreatic tumours, known adrenal gland tumour

glucagon ADE (2)

nausea and vomiting

ceftriaxone mechanism of action

cephalosporin antibiotic which interferes with bacterial wall cell peptidoglycan synthesis by binding to penicillin-binding proteins, leading to cell lysis and death

cef indications (2)

meningococcal septicaemia, sepsis when adult transport time is over 60 mins

cef contras (2)

cephalosporin allergy, preterm neonates under 41 weeks

cef ADE (5)

nausea, vomiting and diarrhoea, irritation at injection site, rash

morphine mechanism of action

an opioid analgesic which acts on mu-opioid receptors in the cns and pns to inhibit pain transmission from spinal cord to brain

morphine indications (3)

pain relief, sedation to maintain intubation, sedation facilitating intubation where fent is not appropriate

morphine contras (3)

renal impairment, late second stage of labour, history of hypersensitivity

morphine ADE (9)

respiratory depression, pinpoint pupils, bradycardia, nausea, vomiting, euphoria, drowsiness, addiction, hypotension

paracetamol mechanism of action

analgesic and antipyretic which inhibits COX enzymes to block prostaglandin production

paracetamol indication (2)

mild pain or pain relief in combination with other analgesics, headache

paracetamol contras (1)

children under 1m of age

paracetamol ADE

hypersensitivity incuding rashes, haematological reactions, hypotension with IV infusion in critically unwell patients

ondansetron mechanism of action

5HT-3 antagonist which blocks serotonin receptors to prevent the trigger of a vomiting reflex in the pns and cns

ondansetron indications (2)

undifferentiated nausea and vomiting, prophylaxis where vomiting could be clinically detrimental

ondansetron contras (1)

apomorphine

ondansetron ADE (5)

headache, dizziness, QT prolongation, constipation, visual disturbance including transient loss of vision

prochlorperazine mechanism of action

dopamine antagonist with antiemetic effects due to D2 receptor blockade. also acts on other neurotransmitter systems including histaminc, cholinergic and a-adrenergic receptors

prochlorperazine indications (2)

nausea and vomiting in patients over 21 years specifically for known allergy or c/i to ondansetron and vestibular nausea, headache irrespective of nausea and vomiting

prochlorperazine contras (2)

cns depression, patients under 21 years of age

prochlorperazine ADE (5)

sedation, blurred vision, postural hypotension, QT prolongation, extrapyrimidial reactions

ketamine

anasethetic agent with analgesic properties at lower doses, primarily works as an antagonist at N-methyl-D-aspartate receptors and may interact with opioid, muscarinic and other receptors.

ketamine indications (3)

intubation, analgesia, sedation for agitation and patient movement during CPR

ketamine contras

none

ketamine ADE (10)

hypertension and tachycardia, emergency reactions like vivid dreams, increased skeletal muscle tone, transient respiratory depression and apnoea, nausea and vomiting, injection site pain, laxcrimation, hypersalivation, diplopia and nystagmus

glucagon mechanism of action

increased blood glucose concentration by activating hepatic glucose production, also increases cyclic AMP indepedent of beta-receptors or calcium flux, resulting in a positive chronotropic and inotropic effect. it acts directly on heart muscle to increase heart rate and pumping strength and by passes b receptors

glucagon indications (2)

hypoglycemia with altered c/s or unresponsive to oral glycemia agents where IV access is unable to be obtained, anaphylaxis with persistent hypotension after 2 doses of adrenaline where patient has a history of heart failure or is taking beta blockers

glucagon contraindications (2)

known pancreatic tumors, known adrenal gland tumors

glucagon ADE

nausea and vomiting

GTN

gtn is an organic nitrate which releases NO in the body in order to relax vascular smooth muscle and vasodilate

GTN indications (5)

chest pain in ACS, hypertension in ACS, acute cardiogenic pulmonary oedema, autonomic dysreflexia, preterm labour

gtn contraindications (7)

bp under 100, hr over 150, hr under 50 except in autonomic dysreflexia, VT, PDE5 inhibitors current or recent use, ricioguat current use and bleeding in pregnancy

gtn ade (7)

hypotension, tachycardia, bradycardia, headache, dizziness, syncope, skin flushing

fentanyl mechanism of action

synthetic opioid analgesic which mainly acts on mu-opioid receptors in the cns to reduce transmission of the pain impulse and by modulating the descending inhibitory pathway from the brain

fentanyl indications (2)

analgesia, sedation to facilitate intubation etc

fentanyl contraindications (3)

serotonin toxicity, MAOI’s within the previous 14 days, late second stage of labour

fentanyl ade (4)

bradycardia, respiratory depression, rigidity of diaphragm and intercostal muscles, nausea and vomiting, rash, erhythema

dexamethasone mechanism of action

synthetic corticosteroid which crosses cell membranes to bind with intracelular glucocorticoid receptors to decrease pro-inflammatory proteins and upregulate anti-inflammatory mediators.

dex indications (6)

anaphylaxis associated with bronchospasm, asthma, COPD, severe covid19, croup, non foreign body obstruction stridor in an adult

dex contras and ade

none

ipratropium bromide mechanism of action

anticholinergic bronchodilator so it blocks ach receptors to inhibit parasympathetic mediated bronchoconstriction which in turn promotes bronchodilation

ipra indications (3)

anaphylaxis associated with bronchospasm, severe or life threatening asthma, copd

ipra contras

none

ipra ade (3)

palpitations, tachycardia, nausea, dizziness and headache

adrenaline mechanism of action

naturally occurring adrenergic agonist which binds to a1, b1 and b2 receptors in the body causing vasoconstriction, positive inotropic and chronotropic effects such as increased HR and bronchodilation. assists in stabilising mast cells

adrenaline indications (7)

anaphylaxis, life threatening asthma, bradycardia with poor perfusion, cardiac arrest, severe croup, shock, orolingual oedema seocndary to tPA infusion with consult

adrenaline contras

nil

adrenaline ade (8)

arrythmia, palpitations, hypertension, angina, headache, anxiety, tremor, hyperglycemia

salbutamol mechanism of action

a beta adrenergic stimulant with primarily beta 2 effects in order to promote bronchodilation, activates sodium potassium pumps in the body to shift potassium into cells

salbutamol indications (6)

anaphylaxis with bronchospasm, asthma, copd, hyperkalemia, oleoresin capsicum spray exposure with bronchospasm, smoke inhalation with bronchospasm

salbutamol contras

nil

salbuatmol ade (4)

palpitations, tachycardia, headache, muscle tremors

acs treatment

aspirin 300mg, gtn 600mcg and 50mg patch, fentanyl 50mcg at 5 minute intervals, ondans 8mg

asthma treatment

salbutamol 5mg / continously nebulised, ipra 500mcg, dex 8mg, MICA, if unconscious ventilate 5-8 with prolonged expiratory phase, if bag becomes stiff stop and reasses for 15 seconds and commence chest compressions

anaphylaxis treatment

adrenaline 0.5 every 5 minutes, glucagon 1g if non responsive to 2 doses, adrenaline 5mg nebulised for stridor, salbutamol 5mg at 20 minute intervals for bronchospasm, ipratropium bromide 500mcg, dex 8, normal saline 40ml/kg if hypotension persists beyond first dosage

chest infection, pleural effusion, pleurisy, bronchitis, pneumonia and PE treatment

rest and reassurance, oxygen if needed, position upright, escalation, IV if really unwell, pain relief

APO

oxygen as per CPG, if adequate perfusion gtn, mica if not improving after 2 doses of gtn or inadequately perfused, if there is severe respiratory distress, full field crackles, persistent hypoxia or no improvement from initial management initiate cpap at 10cm water with 13l oxygen

bradycardia treatment

if symptomatic with less than adequate perfusion including STEMI or ischaemic pain, APO with HR under 40, VT runs, VT escape rhythym, HR under 20, request MICA who will use atropine

COPD treatment

salbutamol 4-12 puffs every 1 hour or salbutamol 5mg nebulised every 1 hour with ipratropium bromide 500mcg if severe respiratory distress with persistent or worsening hypoxia or signs of respiratory muscle fatigue, request MICA and cpap 7.5cm prior to extrication and consider av clinician or salbutamol puffs

cardiogenic shock

crackles - adrenaline MICA, no crackles NS 250mL IV MICA

igel indications

unconscious patient without gag reflex, anticipated need for prolonged assisted ventilation

igel contras

intact gag reflex or resistance to insertion, strong jaw tone or trismus, suspected epiglottitis or upper airway obstruction

valsalva indications

avrt, avnrt

valsalva contraindications

bp under 90, unstable or rapidly deteriorating patient, Afib or aflutter

CPAP indications

cardiogenic pulmonary oedema, COPD, undifferentiated dysponoea

CPAP contras

inability to manage own airway, upper airway obstruction, hypoventilation, untreated tpt, haemodynamic instability, injuries precluding mask appliction

meningococal septicaemia

cef 2g over 4 minutes, NS 500-1000, MICA

sepsis

news2 5-6 or 3 in any category high - ed transport and maybe treat, news 2 over 7 or 2 or more of hypotension, altered c/s, tachypneoa, oxygen as per critical illness, ns 500-1000, signal 1

largynoscopy indications

altered c/s, requiring inspection of airway

magills contras

unconscious patient with a FBAO