Indications for use:

• Anaphylaxis

Contra-indications for use:

• Non in the emergency setting

Dosage & Administration

Route: Intramuscular

Initial Dose: 500 micrograms

Interval: 5 Minutes

Repeat Dose: 500 micrograms

Volume: 0.5ml

Maximum Dose: No limit

Indications for use:

• Cardiac Arrest

Contra-indications for use:

• Do NOT administer adrenaline when the patient’s core temperature is less than 30˚C. When the patient’s temperature is between 30˚C and 35˚C, double the time between doses.

Dosage & Administration

Route: Intravenous / Intraosseous

Cardiac Arrest

Initial Dose: 1 milligram

Interval: 3-5 Minutes

Repeat Dose: 1 milligram

Volume: 10ml

Maximum Dose: No limit

Indications for use:

• Cardiac Arrest

  • Shockable rhythms: if unresponsive to defibrillation administer amiodarone after the 3rd shock and an additional bolus depending on age to unresponsive VF or pulseless VT following the 5th shock.

Contra-indications for use:

• Do NOT administer amiodarone when the patient’s core temperature is less than 30˚C

Dosage & Administration

Route: Intravenous / Intraosseous

Initial Dose: 300 milligrams (After 3rd shock)

Interval: After 5th shock

Repeat Dose: 150 milligrams

Volume: 10ml (300mg) / 5ml (150mg)

Maximum Dose: 450 milligrams

Indications for use:

• Clinical or ECG evidence is suggestive of myocardial infarction or ischaemia.

Contra-indications for use:

• Known aspirin allergy or sensitivity.

• Children under 16 years (see additional information).

• Active gastrointestinal bleeding.

• Haemophilia or other known clotting disorders.

• Severe hepatic failure with jaundice.

Dosage & Administration

Route: Intravenous / Intraosseous

Initial Dose: 300 milligrams

Interval: N/A

Repeat Dose: NONE

Volume: 1 tablet

Maximum Dose: 300milligrams

Indications for use:

Symptomatic bradycardia in the presence of ANY of these adverse signs:

• Absolute bradycardia (pulse <40 beats per minute).

• Inadequate perfusion causing confusion, etc.

• Bradycardia following return of spontaneous circulation (ROSC).

Contra-indications for use:

• Should NOT be given to treat bradycardia in suspected hypothermia.

• Do NOT give atropine sulfate to patients with cardiac transplants; their hearts will not respond to vagal blocking by atropine and paradoxical high degree AV block or sinus arrest may result.

Dosage & Administration

Route: Intravenous / Intraosseous

Initial Dose: 600 micrograms

Interval: 3-5 minutes

Repeat Dose: 600 micrograms

Volume: 1 ml

Maximum Dose: 3 milligrams

Indications for use:

Suspected meningococcal disease in the presence of:

• a non-blanching rash (the classical, haemorrhagic, non-blanching rash (may be petechial or purpuric)

and/or

• signs/symptoms suggestive of meningococcal septicaemia

Contra-indications for use:

• Known penicillin allergy

Dosage & Administration

Route: Intravenous / Intraosseous

Initial Dose: 1.2 grams

Interval: N/A

Repeat Dose: NONE

Volume: 20 ml

Maximum Dose: 1.2 gram

Indications for use:

• Symptomatic allergic reactions falling short of anaphylaxis but causing patient distress (e.g. severe itching).

• Alleviating distressing cutaneous symptoms in anaphylaxis only after emergency treatment with adrenaline and the patient is stable and oral antihistamine administration is not possible.

Contra-indications for use:

• Known allergy

Dosage & Administration

oute: Intravenous / Intraosseous

Initial Dose: 10 milligrams

Interval: N/A

Repeat Dose: NONE

Volume: 1 ml

Maximum Dose: 10 milligrams

Indications for use:

• Pulmonary oedema and/or respiratory distress due to acute heart failure

Contra-indications for use:

• Reduced GCS with liver disease

• Cardiogenic shock.

Dosage & Administration

Route: Intravenous

Initial Dose: 400 milligrams

Interval: N/A

Repeat Dose: NONE

Volume: 4ml

Maximum Dose: 40 milligrams

Indications for use:

• Hypoglycaemia, clinically suspected hypoglycaemia or unconscious patients where hypoglycaemia is considered a likely cause (blood glucose >4.0 millimoles per litre)

NB Glucagon should only be administered when oral glucose administration is not possible or is ineffective, AND/OR when IV access to administer 10% glucose is not possible

Contra-indications for use:

• Glucagon should NOT be given by IV injection because of increased vomiting associated with IV use.

Dosage & Administration

Route: Intramuscular

Initial Dose: 1 milligram

Interval: N/A

Repeat Dose: NONE

Volume: 1 milligram per vial

Maximum Dose: 1 milligram

Indications for use:

• Hypoglycaemia (blood glucose <4.0 millimoles per litre) or suspected hypoglycaemia when oral administration is not possible and a rapid improvement in clinical state and blood glucose level is required.

• An unconscious patient, where hypoglycaemia is considered a likely cause.

• Management of hypoglycaemia in patients who have not responded to the administration of IM Glucagon after 10 minutes.

• Hypoglycaemia, clinically suspected hypoglycaemia or unconscious patients where hypoglycaemia is considered a likely cause (blood glucose >4.0 millimoles per litre)

Contra-indications for use:

• IM or subcutaneous injection

Dosage & Administration

Route: Intravenous / Intraosseous Infusion

Initial Dose: 10 grams glucose

Interval: 5 minutes

Repeat Dose: 10 grams glucose

Volume: 100 ml per 10 grams glucose

Maximum Dose: 300 ml (30 grams glucose)

Indications for use:

• Known or suspected hypoglycaemia in a conscious patient, without risk of choking

Contra-indications for use:

• None

Dosage & Administration

Route: Buccal - Oral

Initial Dose: 10-20 grams

Interval: 15 minutes

Repeat Dose: 10 grams

Volume: 1-2 tubes

Maximum Dose: No limit

Indications for use:

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

• In cardiac arrest, where opioid toxicity is considered to be the likely cause.

Contra-indications for use:

• None

Dosage & Administration

Route: Intravenous / Intraosseous / Intramuscular

IV/IO/IM - Respiratory arrest/depression

Initial Dose: 400 micrograms

Interval: 3 minutes

Repeat Dose: 400 micrograms

Volume: 1ml

Maximum Dose: 4,000 micrograms

IV/IO - Cardiac Arrest (where opioid toxicity is likely the cause)

Initial Dose: 400 micrograms

Interval: 1 minutes

Repeat Dose: 800 micrograms

Volume: 1ml

Maximum Dose: 10,000 micrograms

Indications for use:

• Severe or life-threatening asthma.

• Acute exacerbation of COPD.

• Adrenal crisis (including Addisonian crisis) which is a time-critical medical emergency with an associated mortality.

Contra-indications for use:

• Known allergy

Dosage & Administration

Route: Intramuscular / Intravenous / Intraosseous

Initial Dose: 100 milligrams

Interval: N/A

Repeat Dose: NONE

Volume: 2 ml

Maximum Dose: 100 milligrams

Indications for use:

• Relief of mild to moderate pain.

• Pyrexia with discomfort (may help to relieve the misery and often unpleasant symptoms that often accompany febrile illness, e.g. aches and pains).

• Soft tissue injuries.

• Best when used as part of a balanced analgesic regimen.

Contra-indications for use:

• Dehydrated.

• Hypovolaemic.

• A woman in the last trimester of pregnancy

• Patient with severe heart failure (NYHA Class IV), renal failure or hepatic failure.

Dosage & Administration

Route: Oral

Initial Dose: 400 milligrams

Interval: 8 hours

Repeat Dose: 400 milligrams

Volume: Varies

Maximum Dose: 1.2 grams per 24 hours

Indications for use:

• Acute, severe or life-threatening asthma.

• Acute asthma, unresponsive to salbutamol.

• Exacerbation of chronic obstructive pulmonary disease (COPD), unresponsive to salbutamol.

• Expiratory wheezing.

Contra-indications for use:

• None

Dosage & Administration

Route: Nebuliser

Initial Dose: 500 micrograms

Interval: N/A

Repeat Dose: NONE

Volume: 2ml

Maximum Dose: 500 micrograms

Indications for use:

• Treatment of nausea or vomiting

• Prevention and treatment of nausea and vomiting following administration of morphine sulfate

Contra-indications for use:

• Renal failure.

• Gastrointestinal obstruction.

• Cases of drug overdose.

Dosage & Administration

Route: Intravenous / Intramuscular

Initial Dose: 10 milligrams

Interval: N/A

Repeat Dose: NONE

Volume: 2ml

Maximum Dose: 10 milligrams

Indications for use:

• 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

• Convulsion continuing 10 minutes after the first dose of anticonvulsant medication.

Contra-indications for use:

• Known allergy

• Severe respiratory insufficiency.

• Prior administration of two doses of a benzodiazepine during the current episode of care (including those given by carer from an individual’s own medication).

Dosage & Administration

Route: Buccal

Initial Dose: 10 milligrams

Interval: 10 minutes

Repeat Dose: 10 milligrams

Volume: 1ml

Maximum Dose: 20 milligrams

Indications for use:

• Pain associated with suspected myocardial infarction (analgesic of first choice).

• Severe pain as a component of a balanced analgesia regimen.

• Oral morphine can be used as a component of managing moderate pain.

Contra-indications for use:

• Respiratory depression (adult <10 breaths per minute, child <20 breaths per minute).

• Hypotension (actual, not estimated, systolic blood pressure <90 mmHg in adults, <80 mmHg in school children, <70 mmHg in pre-school children).

• Head injury with a significantly impaired level of consciousness (e.g. below P on the AVPU scale or below 9 on the GCS).

• Known allergy to morphine.

Dosage & Administration

Route: Intravenous / Intraosseous / Subcutaneous / Intramuscular / Oral

Intravenous / Intraosseous

Initial Dose: 10 milligrams

Interval: 5 minutes

Repeat Dose: 10 milligrams

Volume: 10ml

Maximum Dose: 20 milligrams

Subcutaneous / Intramuscular

Initial Dose: 10 milligrams

Interval: 15 minutes

Repeat Dose: 10 milligrams

Volume: 1ml

Maximum Dose: 20 milligrams

Oral

Initial Dose: 10-20 milligrams

Interval: 30 minutes

Repeat Dose: 20 milligrams in 5ml

Volume: 10ml

Maximum Dose: 40 milligrams

Indications for use:

• Pain associated with suspected myocardial infarction (analgesic of first choice).

• Severe pain as a component of a balanced analgesia regimen.

• Oral morphine can be used as a component of managing moderate pain.

Contra-indications for use:

• Respiratory depression (adult <10 breaths per minute, child <20 breaths per minute).

• Hypotension (actual, not estimated, systolic blood pressure <90 mmHg in adults, <80 mmHg in school children, <70 mmHg in pre-school children).

• Head injury with a significantly impaired level of consciousness (e.g. below P on the AVPU scale or below 9 on the GCS).

• Known allergy to morphine.

Dosage & Administration

Route: Intravenous / Intraosseous / Subcutaneous / Intramuscular / Oral

Intravenous / Intraosseous

Initial Dose: 10 milligrams

Interval: 5 minutes

Repeat Dose: 10 milligrams

Volume: 10ml

Maximum Dose: 20 milligrams

Subcutaneous / Intramuscular

Initial Dose: 10 milligrams

Interval: 15 minutes

Repeat Dose: 10 milligrams

Volume: 1ml

Maximum Dose: 20 milligrams

Oral

Initial Dose: 10-20 milligrams

Interval: 30 minutes

Repeat Dose: 20 milligrams in 5ml

Volume: 10ml

Maximum Dose: 40 milligrams

Indications for use:

• Moderate to severe pain.

• Labour pains

Contra-indications for use:

• Chest injury and a clinically suspected pneumothorax.

• Severe head injuries with impaired consciousness due to possible presence of intracranial air.

• Violently disturbed psychiatric patients.

• Abdominal pain where intestinal obstruction is suspected.

Dosage & Administration

Route: Inhalation

• Nitrous oxide should be self-administered via a facemask or mouthpiece, after suitable instruction. It takes about 3–5 minutes to be effective, but it may be 5–10 minutes before maximum effect is achieved

Indications for use:

• Prevention and treatment of opiate-induced nausea and vomiting (e.g. morphine sulphate).

• Treatment of nausea or vomiting.

Contra-indications for use:

• Known allergy

Dosage & Administration

Route: Intravenous / Intramuscular

Initial Dose: 4 milligrams

Interval: 20 minutes

Repeat Dose: 4 milligrams

Volume: 2ml

Maximum Dose: 8 milligrams

Indications for use:

Oral

• Relief of mild to moderate pain or high temperature with discomfort (not for high temperature alone).

Intravenous

• As part of a balanced analgesic regimen for moderate and severe pain paracetamol is effective in reducing opioid requirements while improving analgesic efficacy and is an alternative analgesic when morphine is contraindicated.

Contra-indications for use:

• Known allergy

Dosage & Administration

Route: Intravenous / Oral

Oral - Tablet

Initial Dose: 500 milligrams - 1 gram

Interval: 4-6 hours

Repeat Dose: 500 milligrams - 1 gram

Volume: 1-2 tablets

Maximum Dose: 2-4 tablets in 24 hours 

Intravenous Infusion (Paramedic)

Initial Dose: 1 gram

Interval: 4-6 hours

Repeat Dose: 500 milligrams - 1 gram

Volume: 100ml

Maximum Dose: 4 grams is 24 hours 

Indications for use:

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

• Expiratory wheezing associated with allergy, anaphylaxis, beta-blocker overdose, smoke inhalation or other lower airway cause

• Exacerbation of chronic obstructive pulmonary disease (COPD)

Contra-indications for use:

• None

Dosage & Administration

Route: Inhalation

Initial Dose: 5 milligrams

Interval: 5 minutes

Repeat Dose: 5 milligrams

Volume: 5ml

Maximum Dose: No limit

Indications for use:

Fluid Therapy

• Medical conditions without haemorrhage

• Medical conditions with haemorrhage

• Trauma-related haemorrhage

• Burns

• Limb Crush injury

Flush

• As a flush to confirm the patency of an IV or IO cannula

• As a flush following drug administration

Contra-indications for use:

• None

Dosage & Administration

Route: Intravenous / Intraosseous

Flush

Initial Dose: 5-10ml

Interval: As required

Repeat Dose: 5-10ml

Volume: 5-10ml

Maximum Dose: N/A

Medical Emergencies - Without haemorrhage

Initial Dose: 250-500ml

Interval: As required

Repeat Dose: 250ml

Volume: 250-500ml

Maximum Dose: N/A

Medical Emergencies - With haemorrhage

Initial Dose: 500ml

Interval: As required

Repeat Dose: 500ml

Volume: 500ml

Maximum Dose: N/A

Trauma

Initial Dose: 250-500ml

Interval: As required

Repeat Dose: 250ml

Volume: 250-500ml

Maximum Dose: 2 litres

Burns

Initial Dose: 1 litre

Interval: N/A

Repeat Dose: NONE

Volume: 1 litre

Maximum Dose: 1 litre

Crush syndrome

Initial Dose: 2 litre

Interval: N/A

Repeat Dose: NONE

Volume: 2 litre

Maximum Dose: 2 litre

Indications for use:

Patients with signs of actual or suspected severe haemorrhage in the following clinical scenarios:

• Patients with time critical injury where significant internal or external haemorrhage is known or suspected

• Injuries patient from birth onwards, fulfilling Step 1 or Step 2 of the trauma triage tool

• Patients with a known or suspected head injury, with a GCS of 12 or less

Contra-indications for use:

• Known or suspected gastrointestinal haemorrhage

Dosage & Administration

Route: Intravenous / Intraosseous

Initial Dose: 1 gram

Interval: N/A

Repeat Dose: NONE

Volume: 10ml

Maximum Dose: 1 gram