South Western Ambulance NHS Foundation Trust PGD Formulary May 2013

Transcription

1 South Western Ambulance NHS Foundation Trust PGD Formulary May 2013 NB Where a PGD is written for registered nurses it will automatically cover s or CCPs who are also registered nurses. Similarly, where a PGD is written for registered paramedics it will automatically cover s or CCPs who are also registered paramedics. DRUG PRESENTATION PGD PGD INDICATIONS ADSORBENT Activated charcoal Cetirizine Chlorphenamine Lidocaine Suspension of 50g of activated charcoal in 250ml of distilled water N & P Restricted ALLERGY AND ANPHYLAXIS 10mg tablets (7s) Oral solution 5mg in 5ml (200ml) 4mg tablets (28s) Oral solution 2mg in 5ml (150ml) ANAESTHETIC AGENTS Injection 1% (10mg in 1ml) The emergency treatment of acute oral poisoning and oral drug overdose Symptomatic relief of allergy such as seasonal allergic rhinitis (hayfever), perennial rhinitis (year round allergies to pets, dust, etc), urticaria, pruritis, including reactions to insect bites and stings when a non-sedating antihistamine is preferred. Symptomatic relief of allergy such as seasonal allergic rhinitis (hayfever), perennial rhinitis (year round allergies to pets, dust, etc), urticaria, pruritis, including reactions to insect bites and stings. Itch associated with chickenpox Provide local analgesia to enable wound closure, cleaning, examination or treatment. ANALGESICS Codeine 15mg tablets (28s) The treatment of mild to moderate pain (over 12 years)

2 Diclofenac Injection 75mg in 3ml or suppositories 50mg (10s) Ketamine See Critical Care Morphine sulphate Injection 10mg in 1ml N Severe pain Naproxen 250mg EC tablets (28s) Oral morphine sulphate Paracetamol Solution 10mg in 5ml UDV 10mg/ml Injection, 100ml (Plastic bottles only) P & N N Management of renal (ureteric) colic Management of acute back pain Adjuvant treatment for pain in palliative care (suppositories only) Management of acute musculoskeletal disorders and dysmenorrhoea. Management of pain and inflammation in acute gout. The treatment of moderate to severe pain Relief of high temperature in sepsis patients being transported to hospital. Relief of severe pain as part of a balanced analgesic regimen to reduce the need for an opiate while improving analgesic efficacy. Relief of severe pain where opiates are contraindicated. Relief of severe pain when an opioid-sparing effect is desirable, e.g. to to reduce the respiratory depressant effect of morphine. ANTICOAGULANTS, ANTIPLATELETS & FIBRINOLYTICS Aspirin 300mg tablets (7s) N & P Immediate management of Transient Ischaemic Attack (TIA) to reduce the risk of a subsequent stroke in patients over 16 years who have been assessed using the ABCD2 scoring tool as part of the Trust s TIA pathway (Clinical Guideline CG20 - Stroke and Transient Ischaemic Attacks)

3 Heparin Tranexamic acid Diazepam Diazepam Injection 5000 iu in 1ml (1ml) Injection 100mg in 1ml (5ml) Rectal tubes 2.5 and 5mg N & P N & P ANTICONVULSANTS Rectal tubes 2.5 and 5mg Emulsion for injection 5mg in 1ml P & (P) As an adjunctive treatment to the use of the fibrinolytic agent tenecteplase, to restore the patency of an occluded artery and prevent re-infarction following an acute myocardial infarction Treatment of traumatic haemorrhage within 3 hours of injury. Seizures including those of epileptiform or eclamptic origin Symptomatic cocaine toxicity N Seizures longer than 5 minutes and STILL FITTING; Post ROSC seizure which lasts more than 2-3 minutes or is recurrent and is unlikely to be due to hypoxia; Repeated seizures not secondary to an uncorrected hypoxia or hypoglycaemic episode; Status epilepticus Eclamptic fits (initiate treatment if fit lasts >2-3 minutes or if it is recurrent);. Symptomatic cocaine toxicity (severe hypertension, chest pain or fitting. ANTI-DIARRHOEALS Loperamide 2mg capsules (6s) The symptomatic treatment of acute diarrhoea ANTI-EMETICS Cyclizine Injection 50mg in 1ml Prevention and treatment of nausea and vomiting including: Motion sickness Nausea and vomiting

4 caused by opiate analgesics Vomiting associated with radiotherapy or chemotherapy Nausea and vomiting in palliative care due to mechanical bowel obstruction or raised intracranial pressure Relieving vomiting and attacks of vertigo associated with Meniere s disease and other forms of vestibular disturbance Cyclizine Injection 50mg in 1ml N&P Prevention and treatment of nausea and vomiting: Prevention and treatment of nausea and vomiting in adults and children aged 16 years and over. Prevention and treatment of nausea and vomiting in children aged 6 years and over where there is a significant potential that vomiting will lead to airway compromise. Prevention and treatment of nausea and vomiting in children aged 6 years and over to enable them to be transported safely in a helicopter or a boat. Metoclopramide Tablets 10mg (28s) Treatment of nausea and vomiting associated with: Gastrointestinal disorders Migraine Palliative care (cytotoxic drugs, gastric/intestinal stasis, radiotherapy Congestive heart failure Administration of opiate drugs Ondansetron Injection 2mg in 1ml N Prevention and treatment of opiate-induced nausea and vomiting, e.g. morphine sulphate in adults

5 Prochlorperazine Aciclovir Amoxicillin 3mg buccal tablets and Injection 12.5mg in 1ml 800mg tablets (35s) that can be dispersed in water or swallowed whole 250mg & 500mg capsules (21s), 125mg/5ml and 250mg/5ml suspension (may be SF) 100ml ANTIMICROBIALS and children (from 1 month). Treatment of nausea and vomiting in adults (16 yrs and over). Management of motionsickness in children being transported in the air ambulance (2 years and over) The treatment of nausea and vomiting from any cause except motion sickness (12 years and over) The treatment of herpes zoster infections (Shingles). Acute exacerbation of COPD Rhinosinusitis in patients who are likely to be at risk of developing complications (See below) Bacterial communityacquired pneumonia Acute cough or acute bronchitis in patients who are likely to be at risk of developing complications (See below) Acute otitis media in patients who are likely to be at risk of developing complications (See below) Dental abscess for people who are systemically unwell or if there are signs of severe infection (eg fever, lymphadenopathy, cellulites or diffuse swelling). Dental abscess for high risk individuals to reduce the risk of complications (eg people who are

6 immunocompromised, diabetic or who have valvular heart disease.) Patients with respiratory infections who are likely to be at risk of developing complications Those who are systemically very unwell Those with symptoms and signs suggesting serious illness and/or complications (particularly pneumonia, mastoiditis, intraorbital and intracranial complications). Those at high risk of serious complications because of pre-existing comorbidity (including patients with heart, lung, renal, liver, or neuromuscular disease, immunosuppression, or cystic fibrosis and young children who were born prematurely). Those who are older than 65 years with acute cough and two or more of the following criteria, and those who are older than 80 years with one or more of the following criteria: o Admission to hospital in the previous year o Type 1 or Type 2 diabetes o History of congestive heart failure o Current use of oral glucocorticoids Benzylpenicillin Sterile powder for injection in 600mg vials N Suspected meningococcal disease; Signs/symptoms suggestive of

7 Ceftriaxone Chloramphenicol Clarithromycin Sterile powder for injection in 1G vials Eye drops 10ml Eye ointment 4G 250 & 500mg tablets, 125mg/5ml and 250mg/5ml suspension meningococcal septicaemia. N&P The treatment of suspected life-threatening septicaemia and meningitis Treatment of acute bacterial conjunctivitis Prophylactic use in cases of diagnosed corneal abrasion Second-line agent in the treatment of Acute exacerbation of COPD cellulitis, impetigo, sore throat, bacterial community acquired pneumonia (if CRB65=0 or if CRB 65=1 give with amoxicillin) leg ulcers (active infection cellulitis, increased pain, pyrexia, purulent exudate, odour) human bites (with metronidazole) when doxycycline is contraindicated Co-amoxiclav 250/125 and 500/125 tablets, 125/31 and 250/62 suspension The treatment of human or animal bites which are clinically infected Antibiotic prophylaxis for bite wounds that are primarily closed; for bite wounds that have been debrided; for puncture wounds; for superficial hand, foot or facial bite wounds; or if the person is diabetic, cirrhotic, asplenic or immunosuppressed. Antibiotic prophylaxis for human bites under 72 hours old, even if there is no sign of infection. Acute pyelonephritis in

8 adults aged 18 yrs and over Adult facial cellulitis Doxycycline 100mg capsules (14s) The treatment of human or animal bites (in combination with metronidazole) when coamoxiclav is contraindicated and the bite is clinically infected Antibiotic prophylaxis, when co-amoxiclav is contraindicated, for bite wounds that are: o primarily closed; o debrided; o puncture wounds; o superficial hand, foot or facial bite wounds; o sustained by patients who are diabetic, cirrhotic, asplenic or immunosuppressed. Antibiotic prophylaxis for human bites under 72 hours old, even if there is no sign of infection. N.B. Doxycline must be used together with metronidazole 400mg in the management of human and animal bites. Coamoxiclav is the drug of first choice but doxycycline plus metronidazole is an alternative for adults and children 12 years and over for whom co-amoxiclav is contraindicated. Acute rhinosinusitis in patients who are likely to be at risk of developing complications Acute cough or acute bronchitis in patients who are likely to be at risk of

9 developing complications Bacterial communityacquired pneumonia Flucloxacillin Influenza vaccine Locorten-vioform (cloquinolflumetasone) Metronidazole 250mg and 500mg capsules (28s), 125mg/5ml & 250mg/5ml oral suspension (may be SF) 100ml Split virion, inactivated vaccine Ear drops (7.5ml & 10ml) Metronidazole tablets 200mg & 400mg (21s) N & P Treatment of skin infections Prophylaxis of influenza, based on official recommendations Inflammatory conditions of the external ear where a secondary infection is suspected Treatment of acute oral infections second-line to amoxicillin where the patient is allergic to penicillin or the infection has failed to respond to amoxicillin within 48 hours. The treatment of human or animal bites which are clinically infected if the patient is allergic to penicillin Antibiotic prophylaxis for wounds that are sutured; for wounds that have been debrided; for puncture wounds; for superficial hand, foot or facial wounds; or if the person is diabetic, cirrhotic, asplenic or immunosuppressed. Antibiotic prophylaxis for human bites under 72 hours old, even if there is no sign of infection. N.B. Metronidazole must be used together with doxycycline or clarithromycin in the management of human and

10 animal bites. Co-amoxiclav is the drug of first choice but metronidazole plus doxycycline or clarithromycin are alternatives when a patient is allergic to penicillin. Nitrofurantoin 50mg capsules (30) Acute lower urinary tract infection Treatment of suspected catheter-related acute Penicillin V Tablets 250mg (28s), 125mg/5ml & 250mg/5ml oral solution (may be SF) 100ml lower urinary tract infection Acute sore throat NB. Most sore throats are viral and self-limiting. Antibiotics only shorten the duration of symptoms by 8hrs. Reassure and offer non-prescription form. The National Institute for Health and Clinical Excellence recommends antibiotics in the following situations: o Features of marked systemic upset secondary to the acute sore throat o Unilateral peritonsillitis o A history of rheumatic fever o An increased risk of infection (such as a child with diabetes or immunodeficiency). Trimethoprim 200mg tablets (6 &14) Furosemide 50mg in 5ml suspension 100ml Ampoules 50mg in 5ml or Ampoules 40mg in 2ml or CARDIAC N Acute lower urinary tract infection. Acute prostatitis Pulmonary oedema, secondary to left ventricular failure.

11 Calcium Chloride Pre-filled syringes 80mg CRITICAL CARE (Require Additional Trust Training) 10ml Pre-filled Syringe Calcium Chloride 10% solution N&P Cardiac arrest related to hyperkalaemia, hypocalcaemia or overdose of calcium channel blocking drugs Diazepam Flumazenil Ketamine Emulsion for injection 5mg in 1ml, 2ml ampoules Injection 100mcg in 1ml Injection 200mg in 20ml (10mg in 1ml) PFS N & P N&P N&P Conscious sedation to produce a state of depression of the central nervous system that enables treatment to be carried out, but during which verbal contact with the patient is maintained throughout. The level of consciousness that must be maintained is further defined as V or greater on the AVPU scale; the patient may feel sleepy and or close their eyes when not disturbed, but will respond appropriately to verbal stimulus. The patient will require no interventions to maintain a patent airway, spontaneous ventilation will be adequate and cardiovascular function will be maintained. The complete or partial reversal of the central sedative effects of midazolam The management of severe traumatic pain, following the administration of morphine where clinically indicated, associated with: o Fracture reduction and splinting; o Multiple or significant fractures requiring facilitated extrication; o Burns.

12 Magnesium Sulphate Magnesium Sulphate Magnesium Sulphate 50% solution for injection 50% solution for injection 50% solution for injection N&P N&P N&P To facilitate the management of severely agitated patients Acute severe asthma (FEV1<25% predicted) where the patient has not had a good response to inhaled bronchodilator therapy; Life threatening or near fatal asthma. The immediate control of life-threatening seizures in eclampsia of pregnancy. Refractory VF only where there is any suspicion of hypomagnesaemia (e.g. patients on potassiumlosing diuretics: bendroflumethiazide, chlorthalidone, indapamide, bumetanide, furosemide). NB The benefits of giving magnesium in known hypomagnesaemic states are recognised but the benefit of giving magnesium routinely during cardiac arrest is unproven. Studies in adults in and out of hospital have failed to demonstrate any increase in the rate of ROSC when magnesium is given routinely during CPR. Midazolam Injection 1mg in 1ml N&P Management of ketamine disinhibition when reassurance and calming words to the patient and attempts to reduce external stimulation have failed. Management of significant ketamine emergence symptoms not attenuated by reassurance. Sodium Bicarbonate 8.4%, 50ml PFS N&P To correct acidosis in cardiac arrest associated with hyperkalaemia or

13 tricyclic antidepressant overdose; To reduce metabolic acidosis following prolonged cardiopulmonary resuscitation (CPR) after 15 minutes of ambulance personnel CPR. FLUID REPLACEMENT Sodium Chloride 0.9% injection N Intravenous infusion for blood and fluid loss to correct hypovolaemia and improve tissue perfusion; To reconstitute, dilute or make up certain drugs; IV flush following drug administration; Following cannulation to keep the cannula and vein open for fluid or drug therapy. Compound macrogol Diazepam Oxytocin PhEur and 0.5mg Ergometrine maleate PhEur LAXATIVES Sachets (8s) The treatment of faecal impaction MUSCLE RELAXANT OR SEDATIVE 2mg tablets (6s) Rectal tubes 2.5 and 5mg Emulsion for injection 5mg in 1ml 1ml ampoule Syntometrine OBSTETRIC N The treatment of severe muscle spasm causing lower back pain or torticollis Acute restlessness in patients receiving end of life care Postpartum haemorrhage within 24 hours of delivery of the infant where bleeding from the uterus is uncontrollable by uterine massage. Miscarriage with lifethreatening bleeding and a confirmed diagnosis e.g. where a patient has gone home with medical management and starts to

14 Prednisolone 5mg tablets (28s or 42s) RESPIRATORY bleed.. Mild to moderate, and severe exacerbations of asthma Mild to moderate exacerbations of COPD 5mg tablets, soluble (30s) Prednisolone 5mg tablets (42s) N & P Mild, moderate and severe exacerbations of asthma Salbutamol Metered dose inhaler, CFC The immediate relief of acute asthma symptoms (with prednisolone) Adrenaline 1 in 10,000 Amiodarone Amiodarone Inactivated influenza vaccine Revaxis (Diphtheria, tetanus and poliomyelitis (inactivated) vaccine (adsorbed, 1 milligram in 10ml (1:10,000) injection 300 milligrams in 10ml injection (Prefilled syringe) Injection 300mg administered in 250ml of 5% glucose Pre-filled syringes containing 0.5 ml of suspension Suspension for injection in a 0.5ml pre-filled syringe (Not stocked) RESUSITATION N N N & P VACCINES P, N & Treatment of VF/pulseless VT cardiac arrest in adults and children; Treatment of nonshockable (PEA/Asystole) cardiac arrest in adults and children; Management of patients after the return of spontaneous circulation (ROSC) to prevent the frequent post-rosc decrease in blood pressure. Treatment of VF/pulseless VT cardiac arrest in adults and children refractory to defibrillating Management of symptomatic broad complex tachycardia in adults Prophylaxis of influenza, based on official recommendations Revaxis is indicated for active immunisation against tetanus as a result of an infected wound in adults and children aged 10 years of age and over.

15 reduced antigen(s) content)