Indications for use:

• Rapid reversion to sinus rhythm of paroxysmal supraventricular tachycardia, including those associated with accessory conducting pathways (e.g. Wolff-Parkinson-White syndrome) 

Contra-indications for use:

• Asthma

• Chronic Obstructive Lung Disease

• Decompensated Heart Failure

• Long QT Syndrome

• Second or Third Degree AV Block and Sick Sinus Syndrome

• Severe Hypotension

Dosage & Administration

Route: Intravenous / Intraosseous

Initial Dose: 3 milligrams

Interval: 1-2 Minutes

Repeat Dose: 3 milligrams

Volume: 1ml

Maximum Dose: 12 milligrams

Indications for use:

• For the support of blood pressure in critically ill patients

  • Adrenaline is a vasopressor and inotrope

  • It has a role in patients who have reduced contractility, reduced heart rate or are vasodilated

  • It will have an impact in all the above areas to a different degree in each patient depending on their clinical pathology 

• Hypotensive patients that are unresponsive to fluid boluses and suspected to be due to vasiodilation

• Hypotensive patients that is suspected to be due to reduced myocardial contractility

• Hypotensive patients which has an unclear origin associated with bradycardia

Contra-indications for use:

• Hypertension

• Normal blood pressure (Normotensive)

Dosage & Administration

Route: Intravenous / Intraosseous 

Initial Dose: 10-50 micrograms

Interval: As requipred

Repeat Dose: 10-50 micrograms

Volume: 1-5ml

Maximum Dose: No limit

Indications for use:

• Cardiac Arrest, where pulmonary embolism is considered to be the likey cause of arrest

• Acute pulmonary embolism (PE)

Contra-indications for use:

• History of cerebral aneurysm

• Aortic dissection

Dosage & Administration

Route: Intravenous

Initial Dose: 50 micrograms over 1-2 minutes

Volume: 50ml

Maximum Dose: 50 micrograms

Indications for use:

• Acute severe hyperkalaemia, with ECG changes and associated with one or more of the following:

  • Chest pains

  • Palpitations

  • Arrhythmia’s

  • Vomiting

• Cardiac Arrest, where acute hyperkalemia is considered to be the likely cause of the cardiac arrest.

Contra-indications for use:

• Non in the emergency setting

Dosage & Administration

Route: Intravenous / Intraosseous

Initial Dose: 100 micrograms

Interval: N/A

Repeat Dose: NONE

Volume: 1 ml

Maximum Dose: 100 micrograms

Indications for use:

• Obvious open fracture

• Signs consistent with a fracture and a wound visible over the site of the fracture causing suspicion of an open fracture

• Major trauma to a limb where significant wounds and a high suspicion of a fracture is present

Contra-indications for use:

• Children aged under 12 months;

• Known hypersensitivity to penicillin or history of anaphylactic reaction to beta-lactam agents;

• Known history of co-amoxiclav or penicillin-associated jaundice or hepatic dysfunction;

• Severe renal impairment (may cause seizures);

• Current treatment with antibiotics or methotrexate. Penicillin may reduce the excretion of methotrexate causing a potential increase in toxicity;

• Patients without an open fracture or signs consistent or suggestive of an open fracture;

• Patients who have had their wounds surgically debrided.

Dosage & Administration

Route: Intravenous / Intraosseous

Initial Dose: 1.2 gram (given over 3-4 minutes)

Interval: N/A

Repeat Dose: NONE

Volume: 20 ml

Maximum Dose: 1.2 gram

Indications for use:

• Treatment of seizures in adults and children (all ages) who:

  • Have convulsions lasting 5 minutes or more and who are still convulsing.

  • Have had three or more convulsions in an hour and who are still convulsing.

  • Eclamptic convulsion - initiate treatment if the seizure lasts over 2-3 minutes or is recurrent.

• Symptomatic cocaine toxicity (severe hypertension, chest pain or convulsions).

Contra-indications for use:

• Known hypersensitivity to benzodiazepines or to any component of the product

Dosage & Administration

Route: Intravenous / Intraosseous

Initial Dose: 10 milligrams

Interval: 10 minutes

Repeat Dose: 10 milligrams

Volume: 2 ml

Maximum Dose: 20 milligrams

Indications for use:

• Management of patient’s requiring sedation for assisted ventilations

• Trauma involving a severe head injury for sedation as a protective measure

• Combative patient’s requiring sedation for medical treatment following an injury or illness

Contra-indications for use:

• Non for anaesthesia during assisted ventilations

Dosage & Administration

Route: Intravenous / Intraosseous

Slow Intravenous Injection

Initial Dose: 300-3500 milligrams

Interval: Titrate to Response

Repeat Dose: 100-200 milligrams as required

Volume: 100 milligrams per 1 ml

Maximum Dose: No limit

Intravenous Infusion

Initial Dose: 10 micrograms/kg over 10 minutes

Infused Dose: 6 micrograms/kg/hour

Volume: 50 ml

Maximum Dose: No limit

Indications for use:

• Management of severe acute behavioural disturbance symptom management

Contra-indications for use:

• CNS depression; comatose states

• Congenital long QT syndrome

• Dementia with Lewy bodies

• History of torsade de pointesa

• History of ventricular arrhythmia

• Parkinson's disease

• Progressive supranuclear palsy

• QTc-interval prolongation

• Recent acute myocardial infarction

• Uncompensated heart failure

• Uncorrected hypokalaemia

Dosage & Administration

Route: Intramuscular

Initial Dose: 5 milligrams

Interval: 10-15 minutes

Repeat Dose: 5 milligrams

Volume: 5 ml

Maximum Dose: 20 milligrams

Indications for use:

• For the management of moderate to severe pain

• Procedural sedation for painful interventions

• For the procedural sedation of agitated patients to facilitate adequate oxygenation, monitoring and/or support safe transfer to hospital.

Contra-indications for use:

• Age younger than 6 months (higher risk of airway complications)

• Adults and children over 6 months who are physically trapped or who are in a position which prevents immediate management of their airway following administration for procedural sedation

• Known or suspected schizophrenia, even if currently stable or controlled with medications (can exacerbate condition)

• Those who may be hypersensitive to Ketamine

• Pre-eclampsia or eclampsia

• Severe coronary or myocardial disease, cerebrovascular accident or cerebral trauma.

Dosage & Administration

Route: Intravenous / Intraosseous 

Sub-dissociative analgesia

Initial Dose: 0.2 milligram/kg (10-20 milligram)

Interval: N/A

Repeat Dose: 10 milligram

Volume: 1 ml per milligram

Maximum Dose: No limit

Dissociative analgesia

Initial Dose: 0.5 milligram/kg (10-20 milligram)

Interval: N/A

Repeat Dose: 10-20 milligram

Volume: 1 ml per milligram

Maximum Dose: No limit

Pre-Hospital Emergency Anaesthesia

Initial Dose: 1.5 milligram/kg (10-20 milligram)

Interval: N/A

Repeat Dose: 10-20 milligram

Volume: 1 ml per milligram

Maximum Dose: No limit

Indications for use:

• For the support of blood pressure in critically ill patients

  • Metaraminol is a vasopressor and best used in patients who are vasodilated such as in severe sepsis

Contra-indications for use:

• Following a recent myocardial infarction (MI)

Dosage & Administration

Route: Intravenous / Intraosseous bolus

10mg in 1ml ampoule of metaraminol should be diluted up to 20ml with sodium chloride 0.9%

Initial Dose: 2.5mg in 5mls

Interval: As required

Repeat Dose: 2.5mg in 5mls (1-20/hr via infusion)

Volume: 5 mls

Maximum Dose: No limit

Indications for use:

• Conscious sedation for the management of restlessness and agitation to allow safe assessment and treatment

• Maintenance sedation for patients who have received muscle relaxants 

Contra-indications for use:

• Known hypersensitivity to benzodiazepines

Dosage & Administration

Route: Intravenous / Intraosseous 

Initial Dose: 1-2 milligrams

Interval: 2-5 minutes

Repeat Dose: 1-2 milligrams

Volume: 1-2 ml

Maximum Dose: 7.5 milligrams

Indications for use:

• For the respiratory paralysis of patients post-Return of Spontaneous Circulation (ROSC) who require artificial ventilatory support.

Contra-indications for use:

• Lack of a well-fitting endotracheal tube or supraglottic airway

• Lack of easy access to the patient's airway at all times

• Lack of suitable airway management equipment and monitoring

• Known or suspected hyper-sensitivity to rocuronium or other paralysing agent.

Dosage & Administration

Route: Intravenous / Intraosseous 

Rapid Sequence Induction

Initial Dose: 600 microgram/kg

Interval: As required

Repeat Dose: 150 microgram/kg

Volume: 10 ml

Maximum Dose: No limit

Indications for use:

• Acute ST-segment elevation MI (STEMI) within 6 hours of symptom onset where the patient has more than 1mm elevation in 2 or more leads.

Contra-indications for use:

• Has a known bleeding discord

• Suspected aortic dissection

• The patient has had recent trauma, surgery or head injury within the last 3 weeks

• Has suffered a haemorrhage stroke or transient ischaemic attack within past 3 months

Dosage & Administration

Route: Intravenous

Rapid Sequence Induction

Initial Dose: 6000 units

Interval: N/A

Repeat Dose: NONE

Volume: 6ml

Maximum Dose: 6000 units