INDICATION

Snake bite

ANTIDOTE
Antivenom

STRENGTH ED STOCK
Black 2

LOCATION AT RPH*

PHARMACY
x

ADMINISTRATION

ADDITIONAL INFO FOR PHARMACIST

Dilute vial(s) in 500mL normal Dilute one vial 1:10 in Hartmann's saline. Give IV over 20 minutes [1] soln & give by slow IV inj [2] Dilute vial(s) in 500mL normal Dilute one vial 1:10 in Hartmann's saline. Give IV over 20 minutes [1] soln & give by slow IV inj [2] Dilute 1 vial in 500mL normal Dilute one vial 1:10 in Hartmann's saline. Give IV over 20 minutes [1] soln & give by slow IV inj [2] Dilute vial(s) in 500mL normal Dilute one vial 1:10 in Hartmann's saline. Give IV over 20 minutes [1] soln & give by slow IV inj [2] N/A Use polyvalent antivenom

Antivenom

Brown

Antivenom

Death Adder

Fridge in ED Critical Care

Antivenom Antivenom Antivenom

Polyvalent Taipan Tiger

2 x 4

x x 3

Dilute vial(s) in 500mL normal Dilute one vial 1:10 in Hartmann's saline. Give IV over 20 minutes [1] soln & give by slow IV inj [2]

Spider bite

Antivenom

Redback

10

Fridge in ED Critical Care

Give the contents of one vial by IM injection. In life-threatening Dilute one vial 1:10 in Hartmann's situations, it can be given IV - dilute soln & give by slow IV inj [2] vial(s) in 100mL normal saline and give over 20 minutes [1,2] Reconstitute each vial of the freezedried antivenom in 10mL WFI, dilute two ampoules in 100mL Only stocked in pharmacy store normal saline and give IV over 20 fridge. Stock owned by Perth Zoo. minutes. [1] Can be given IM.[2] Call on-call pharmacist if required after-hours. Administer one vial diluted in 500mL normal saline, IV over 20 minutes. [1] Contact on-call pharmacist to arrange supply. Administer one vial for every two spine puncture wounds, undiluted, by IM injection. Alternatively it may be diluted in 100mL normal saline and given IV over 20 minutes [1]
Prepared by N Dowling (Clinical Pharmacist, RPH) 30/06/2010 Reviewed by Dr J Soderstrom (Toxicologist) 30/06/2010

Antivenom

Funnel Web

Pharmacy

Marine bite

Antivenom

Sea Snake

SCGH

RPH will stock this when SCGH stock expires (07/11)

Antivenom

Stonefish

Fridge in ED Critical Care

* ED CC1 DD safe is in ED critical care pod near bed CC15

SAS drugs - complete Category A form.

INDICATION

ANTIDOTE

STRENGTH ED STOCK

LOCATION AT RPH*
ED CC2 imprest cupboard (bottom shelf)

PHARMACY

ADMINISTRATION Administer 1-2mg/kg (0.1-0.2mL/kg of 1% solution) IV slowly over 5 minutes. Flush with normal saline. Can repeat dose after 30-60 minutes if required.[1,2,3] Administer 12.5g (50mL of 25% solution) IV over 10 minutes (2.55mL/min). [1,4] Reconstitute each vial with 100mL sodium chloride 0.9% solution for injection, using the supplied sterile transfer device. Rock or invert the vial for at least 30 seconds to mix it must NOT BE SHAKEN as the contents may foam. Prime the infusion set provided with the solution. Repeat the procedure with the second vial. Administer as an intravenous infusion over 15 minutes. [5]

ADDITIONAL INFO FOR PHARMACIST G6PD deficiency - lack of NADPH causes methylene blue to be ineffective. Dose adjust in renal impairment.

Drug-induced methaemoglobinemia

Methylene blue

1%, 5mL

10

Cyanide poisoning

Sodium thiosulphate

2.5g/10mL (25%w/v)

10

ED CC2 imprest cupboard (bottom shelf)

Repeat after 30 minutes if necessary. [1]

Hydroxocobalamin

2.5g vial

ED CC1 DD safe (SAS)

A second dose may be required if severe poisoning. Rate of infusion for second dose ranges from 15 minutes to 2 hours based on patient condition. Max recommended dose is 10g. [5]

Isoniazid poisoning

Pyridoxine

100mg/mL

50

ED CC1 DD safe (SAS)

Can use 5g in 500mL glucose 5% as an infusion. Give 1g pyridoxine Give 5g IV over 30 minutes.[3] Give for every 1g isoniazid ingested. 0.5g/minute until seizures stop or Give 5g if ingested dose unknown. infusion is complete.[1] Repeat dose if seizures persist.[3] IV benzodiazepines are given concomitantly.[1,3]

* ED CC1 DD safe is in ED critical care pod near bed CC15

SAS drugs - complete Category A form. Prepared by N Dowling (Clinical Pharmacist, RPH) 30/06/2010 Reviewed by Dr J Soderstrom (Toxicologist) 30/06/2010

INDICATION

ANTIDOTE

STRENGTH ED STOCK

LOCATION AT RPH*

PHARMACY

ADMINISTRATION 1. Reconstitute each vial of Digibind with 4mL WFI 2. GENTLY mix the vials 3. Draw up all vial contents 4. Attach 0.22 micron membrane filter to the syringe then attach the needle 5. Push contents into a 100mL sodium chloride 0.9% bag 6. Infuse over 30 minutes [1,2] * can be given as an IV bolus if cardiac arrest is imminent [4]

ADDITIONAL INFO FOR PHARMACIST

Digoxin toxicity

Digoxin immune fab (Digibind)

38mg

20

Fridge in ED Critical Care

10

Heavy metal poisoning

Dimercaprol (BAL)

100mg/2mL

20

ED CC1 DD safe (SAS)

Calcium disodium versenate (EDTA-Ca) (sodium calcium edetate)

1000mg/5mL

ED CC2 imprest cupboard (bottom shelf)

For lead encephalopathy: commence dimercaprol 4 hours before commencing EDTA. Give 4mg/kg by IM injection every 4 hours for 5 days. [1,3] **Contraindicated in peanut allergy Dilute dose in 500mL normal saline or glucose 5% and infuse over 24 hours (starting 4 hours after first dose of dimercaprol).[1] Dilute to 250-500mL with normal saline or glucose 5% and infuse over 8-12 hours.[3,4] Oral capsule. Start at 10mg/kg tds for 5/7 then 10mg/kg bd for 14/7. [1]

Formulated in peanut oil contraindicated in peanut allergy

Dose for lead encephalopathy: 5075mg/kg d. Dose for symptomatic lead poisoning without encephalopathy: 25-50mg/kg d.

Succimer (DMSA)

100mg

Main Pharmacy (SAS)

1 x 100

Iron overload/ poisoning Desferrioxamine

500mg

10

ED CC1

Reduce infusion rate if hypotension Reconstitute 500mg powder with occurs. Rate may be increased up 5mL WFI, dilute to 100mL with to 40mg/kg/hr if life-threatening normal saline or 5% glucose. Infuse toxicity. Avoid prolonged infusion at up to 15mg/kg/hour [1,3,4] >24hours

* ED CC1 DD safe is in ED critical care pod near bed CC15

SAS drugs - complete Category A form. Prepared by N Dowling (Clinical Pharmacist, RPH) 30/06/2010 Reviewed by Dr J Soderstrom (Toxicologist) 30/06/2010

INDICATION
Organophosphate poisoning

ANTIDOTE

STRENGTH ED STOCK

LOCATION AT RPH*
ED CC2 imprest cupboard (bottom shelf)

PHARMACY

Pralidoxime

500mg/20mL

20

ADDITIONAL INFO FOR PHARMACIST 0.2% sodium chloride solution is Initial dose 2g diluted in glucose 5% another alternative as a diluent. or saline 100mL and given over 15 There are no stability data to support minutes [1,3] use of normal saline. ADMINISTRATION Give IV, no faster than 1mg/minute.[3] Give 0.5-1mg IV Product info photocopied onto back over 5 minutes. [1] Compatible with of blue SAS form. normal saline and 5% glucose. [3] Topical. Can also be prepared by mixing 10mL 10% calcium gluconate solution with 30g/30mL KY gel. [1]

Anticholinergic delirium Physostigmine

2mg/2mL

ED CC1 DD safe (SAS)

Hydrofluoric acid burns Calcium gluconate gel

2.5%, 50g

20

ED CC2 imprest cupboard (bottom shelf) ED assessment drug room

Calcium gluconate

1g/10mL

Fat emulsion (Intralipid)

Lipid soluble drug overdose

20%, 500mL

ED CC2 imprest cupboard (bottom shelf)

Start with 1.5mL/kg over 1 minute, then give as a continuous infusion of 0.25mL/kg/min for 30-60 minutes. [6] Toxicologists will generally give a 0.5-1mL/kg bolus then run the rest of the 500mL over 1 hour in rescue situations.

References: 1. Murray L, Daly F, Little M, Cadogan M. Toxicology Handbook. Marrickville (NSW): Elsevier Australia; 2007. 2. UBM Medica. MIMSOnline. UBM Medica; Sydney: 2010. Acessed 24/05/2010. 3. Micromedex 1.0 (Healthcare Series) 4. Burridge N, editor. Australian Injectable Drugs Handbook. Collingwood: The Society of Hospital Pharmacists of Australia; 2009. 5. Product Information: CYANOKIT(R) IV injection, hydroxocobalamin IV injection. Dey LP, Napa CA. 2006. 6. Felice KL & Shumann HM. Intravenous lipid emulsion for local anesthetic toxicity; a review of the literature. Journal of Medical Toxicology. 2008; 4(3):184-191.

* ED CC1 DD safe is in ED critical care pod near bed CC15

SAS drugs - complete Category A form. Prepared by N Dowling (Clinical Pharmacist, RPH) 30/06/2010 Reviewed by Dr J Soderstrom (Toxicologist) 30/06/2010