Module

Protocols

1
1.1

ORALGLUCOSEPOWER/GEL
OralGlucosePowder/Gel

Classification:Carbohydrates Schedule:1
1.2 PharmaCOLOGY
(desirable) (undesirable/harmful) Studyofproperties&effectsofdrugs Pharmacologyeffects: TherapeuticEffects SideEffects

Administrationoforalglucosesolution/preparationprovidessoluble(simple)carbohydratetotissuesin ordertoraiseBloodGlucoseLevels.
1.3 AdverseEffects

Hyperglycaemia
1.4 Indication

AcutemanagementofHypoglycaemia HGT<3.5mmol/l(HGTHaemoglocotest)
1.5 ContraIndication

NoAbsolutecontraindications
1.6 Precaution

PatientMUSTbelateralifunconscious Avoidaspiration
1.7 Packaging

Powder:25gand50g(persachet) Gel:25gand50g
1.8 DosageandAdministration

Gel:25ggelappliedtooralmucosaofpt.withglovedfinger Powder:dilutepowderinglassofwater(ONLYifpt.isconscious) Repeatafter5minshouldbloodglucoseremain<3.5mmol/l

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2
2.1

ACTIVATEDCHARCOAL
ActivatedCharcoal

Classification:Carbon Schedule:1
2.2 PharmaCOLOGY
(desirable) (undesirable/harmful) Studyofproperties&effectsofdrugs Pharmacologyeffects: TherapeuticEffects SideEffects

ActivatedCharcoalabsorbsmanypoisonouscompoundstoitssurfacethisreducestheabsorptionbythe GIT(GastroIntestinalTract)
2.3 AdverseEffects

Thepatientmayexperiencemildconstipation
2.4 Indication

Toassistintreatmentofcertaincasesifoverdosesandpoisoningswhereagents/shavebeenorallyingested (ONLYwithinanhoursofingestion)
2.5 ContraIndication

ShouldNOTbeusedwithpoisoningwith: BoricAcid Cyanide Ethanol EthyleneGlycol Lithium Methanol Organophosphates PetroleumProducts Iron StrongacidsandAlkalis Whenapt.hasdecreasedlevelsofconsciousnessorisunconscious Unprotectedairway DONOTUSEifhecontainerwasnotsealedproperly Deactivationduetomoistureexposure)
2.6 Packaging

Powder:Fineblackpowderinbottlesof25gand50g
2.7 DosageandAdministration

Adult: Paediatric:

1g/kgmixedwithwater,givenorally 0.5g/kgmixedwithwater,givenorally

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3
3.1

ENTONOXNITROUSOXIDEANDOXYGEN
EntonoxNitrousOxideandOxygen

Classification: Schedule:
3.2 PharmaCOLOGY

AnalgesicGas 4

Studyofproperties&effectsofdrugs Pharmacologyeffects: TherapeuticEffects SideEffects

(desirable) (undesirable/harmful)

3.3

Colourless,sweetsmelling,nonirritantgas Heavierthanroomair/oxygen Mildanalgesicandanaestheticeffectdependingonthedoseinhaled WheninhaleditsupressedtheCNS(CentralNervousSystem)causinganaesthesia HighconcentrationsofoxygendeliveredalongwithnitrousoxideINCREASESoxygentensioninthe bloodtherebyREDUCINGhypoxia(Hypoxialackofoxygen) Providesrapid,easilyreversiblereliefofmildtomoderatepainrelief

PharmacoKINETIC

HOWthebodyHANDLESthedrugoverperiodoftime: Absorption o Absorptionbeginsatsiteofadministration o RATEandEXTENTofabsorptiondependson: Routeofadministration Dosage Dosageform Distribution o distributionistransportofthedrugthroughbloodstreamtovarioustissuesatitsactionsite o Barrierstodrugdistribution:bloodbarriers/placentalbarrier Biotransformation o Process:drugischemicallyconvertedtoametabolite(inorderforbodytometabolizedrug) Excretion o Iseliminationoftoxic/inactivemetabolites o Kidneysprimaryorganforexcretion o Otherorgans:intestine/lungs/glands/skin Aboveeffectspt.responsetodrugtherapy

3.4

EXTREMELYbloodsinsoluble NOTmetabolisedbythebody Eliminatedbythelungs(smallamountseliminatedthroughskin) Onsetaction:3060sec (MAX34min) o Canlastforupto10min

AdverseEffects

Lightheadedness Drowsiness NauseaandVomiting

3.5 Indication

Relieffrompainfrom: o AcuteMyocardialInfarction o Musculoskeletaltrauma o BurnsNOTburntorespiratorytract o Activelabour AnyotherconditionrequiringpainreliefPROVIDEDTHEREARENOCONTRAINDICATIONS

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3.6 ContraIndication

Protocols

GCS(GlasgowComaScale)<15/15(below15/15) Neurologicalimpairment: o ANYalteredlevelofconsciousness o Inabilitytocomplywithinstructions o Headinjuries AirEntrapment: o COPD(ChronicObstructivePulmonaryDisease) o Asthmapatientduringanacuteepisode o AcutePulmonaryoedema(AcuteSudden/OedemaSwelling) o ChestInjuries o Abdominaltrauma o DivingAccidentSPECIFICALLY:AcuteDecompressionIllness o Burnstotherespiratorytract Otherlimitations: o SPO2<90%mmHG(Oxygensaturation readwithfingerpulseoximetry) o MajorFacialTrauma
Precaution

3.7

3.8

Oxygenandnitrousoxidedisassociateat<4C IMPERITIVEthatcylinderisinvertedafewtimesandthenplacedhorizontallywhenusedincold conditionspt.willotherwiseinhalepurenitrousoxide NitrogenhasDECREASEDsolubilityinblood o OnceingascontainingspacethegasdissociatesandNITROGENdiffusesOUTSLOWER thanNITROUSOXIDEdiffusesIN o CausesaNETINCREASEinGASVOLUME Whenmaskedisremovedafterprolongeduse o gaswillcomeoutofsolutioninlungsanddisplacetheoxygeninthealveolicausing hypoxia o Prevention:MaskmustNOTbestrappedtopt.face.Pt.mustreceiveoxygenfor510min NitrousoxideisaNONexplosivegas
Packaging

Pressurisedcylinders:mixture52%nitrousoxide+48%oxygen (N2O+O252%:48%)
3.9 DosageandAdministration

Entonoxispredominantlyaselfadministeredgas Administrationistobeexplainedcarefullytopt.beforehandpreventunnecessarycomplications Oncept.hasinhaledenoughEntonoxtocontrolthepain,theymustremovethemaskpreventingchances ofoverdosing Ifpt.becomesdrowsyREMOVEEntonoxandreplaceimmediatelywithoxygen ONLYregisteredALSmayadministerEntonoxtopt. Asitrequirecarefulmonitoringofpt.inordertopreventcomplicationsarising.

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4
4.1

MEDICALOXYGEN
MedicalOxygen

Classification:
4.2 PharmaCOLOGY

NaturalOccurringAtmosphericGas

Studyofproperties&effectsofdrugs Pharmacologyeffects: TherapeuticEffects SideEffects

(desirable) (undesirable/harmful)

Colourless,tasteless,odourlessgas Presentinatmosphereapprox.21%localatmosphericpressure Reversesdeleteriouseffectsofhypoxeamiaonthebrain,heartandothervitalorgans o (decreaseamountofoxygenintissue) Expiredaircontains16%17%oxygen DuringoptimalactiveCPRonly25%30%ofnormalcardiacoutputismaintainedandforthese reasonsupplementaloxygenshouldbeadministered o GoodCPRwithsupplementO2youcanmaintainnormalcardiacoutputof2530%

Indication

4.3

4.4

GCS(GlasgowComaScale)<15/15(below) Anyrespiratoryinsufficiencyorarrest AcutedecompensationofCOPD/Asthma Chestpain(medical/traumaorigin) Cardiacarrest/cardiacfailure Toxicinhalations SPO2<90%(Oxygensaturation readwithfingerpulseoximetry) ANYpt.withabnormalvitalsigns Confirmed/suspectedhypoxia(lackofO2inblood) Severeanaemia Multiple/severetrauma Scubadivingaccident(Nitrogenbubblescreatedingaseousspacesinourbodies) Prophylacticallyduringaretransport
ContraIndication

NOabsolutecontraindicationforuseofoxygeninemergencysetting
4.5 Precaution

Productionofsuperoxideradicalsinpresenceofparaquat(herbicideusedtokillsmarijuanaplantsin Mexico)paraquatandoxygenenhanceeachotherstoxicitycausingseverepulmonaryinjury HighconcentrationsofoxygenmayREDUCErespiratorydriveofCOPDpt.carefulmonitoringofpt. requiredDONOTwithoutoxygenfromthesepatientsifconditionissuchtheoxygenisrequired Neonateswithpatentductusarteriosus(PDA): o shouldcyanosisandsignsofhypoxiadevelopafteroxygenadministrationremoveoxygen o SomeinfantswithPDSandcongenitalheartdiseasethepresenceofPDAmaybelifesaving becauseofductaldependentsystemic/pulmonarybloodflow Increasedoxygenconcentrationtendstoconstrictfoetalductusarteriosus Longexposuretohighconcentrationsofoxygenmayresultinretrolentalfibroplasiainneonatesand pulmonaryfibrosis OxygensupportcombustionDONOTuseinpresenceoffire/smoke/cigarettesmoking HighpressuredoxygenshouldNOTbeusedwithoil/greasebasedsubstancescausesexothermic reactionriskofexplosion REMOVEoxygensourcetoonemetreawayfromdefibrillationpads/paddles
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4.6 Packaging

Protocols

Pressurisedcylindercontaining100%medicaloxygen
4.7 DosageandAdministration

Administeredvia: Oxygenmasks SimpleMask VenturiMask PartialReBreatherMask NonReBreatherMask Nasalcannulae Nebulizerdevice(5mlofsaline) Jetinsufflation BagValveMask/Tube(BVM) BagValveMask/TubeReservoirDevice CorrectFlowrates(FiO2): NasalCannulae 2140% @16L/min VenturiMask 2450% @412L/min SimpleMask 3560% @610L/min PartialReBreatherMask 3570% @610L/min NonReBreatherMask 60100% @615L/min BagValveMask/tube 50% @615L/min BagValveMask/tubereservoirdevice 95100% @15L/min (Adequateflowrate=Reservoirbaginflated>1/3atalltime)Justunder1/3.

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