Round 1: Warm UpQ1. What is the best drug for anaphylaxis?
Anaphylaxis is treated with adrenaline, 10 mcg / kg IM in children.
Round 1: Warm UpQ2. What is methoxyflurane used for?
A methoxyflurane inhaler (Penthrox) can be used for acute pain in children ≥ 5. Pain relief starts after around 6 breaths.
Round 1: Warm UpQ3. What is benztropine used for?
Benztropine can be used to treat acute dystonic reactions, e.g. from Maxolon or Stemetil.
Round 1: Warm UpQ4. Which of these is better known as Buscopan?
Buscopan can be used for colicky abdominal pain or for respiratory secretions in palliative care. Safety and effectiveness in children younger than 6 years have not been established.
Round 1: Warm UpQ5. Which of these is better known as Stemetil?
Stemetil has a risk of extra-pyramidal side-effects in children and especially should not be used if <10kg.
Bonus: History of the Doctor’s BagName this bag:
‘In use for more than a century, this mid-nineteenth century bag was created by J. G. Beard, a London leather dealer, who named it after William Gladstone, the British Prime Minister, whom he greatly admired. This bag opened widely from the top and enabled the doctor to take out whatever was needed with relative ease.’ (Dammery, D AFP 45(9):September 2016, pp636-638)
Round 2: The PBS Doctor’s BagQ6. The PBS provides a limited number of medications for free in the Doctor’s Bag. Which of the following are available in the Doctor’s Bag?
Salbutamol inhalers and nebules are included in the Doctor’s Bag, but not aspirin, prednisolone, Epipens or NSAIDs. Adrenaline is only given in a 1:1000 vial.
Round 2: The PBS Doctor’s BagQ7. There are two forms of penicillin available for the Doctor’s Bag. In comparison to benzylpenicillin, procaine penicillin is:
Old and outdated
New and expensive
‘There is no emergency indication to justify the continued use of this outdated formulation.’ (Holmes, J. Aust Prescr 2012;35:7-9)
Round 2: The PBS Doctor’s BagQ8. Why is lignocaine included in the Doctor’s Bag?
Lignocaine 50mg in 5 mL was included to treat sustained VT, but IV lignocaine can worsen arrhythmias and should only be used in hospital. Outside of hospital, the priority is Basic Life Support.
Round 2: The PBS Doctor’s BagQ9. For hypoglycaemia in children <5 years, what is available in the PBS Doctor's Bag medications?
Glucagon is included in the Doctor’s Bag. For children <25kg, the dose is 0.5mg (SC, IM or IV).
Round 2: The PBS Doctor’s BagQ10. If a child has ongoing generalised seizures at your GP practice, which of the following is the best initial treatment while you wait for the ambulance?
Midazolam was added to the PBS Doctor’s Bag medications relatively recently. It can be tricked in to the buccal mucosa without any additional requirements for IV access. IM diazepam is notoriously unreliable in absorption.
Bonus: History of the Doctor’s BagWhich of the following did GPs NOT routinely boil in the early 20th century?
‘Prior to the relatively recent advent of urine test strips, urine was boiled and acidified to test for protein, while glycosuria was found by boiling urine with Benedict’s reagent. ‘ (Dammery, D AFP 45(9):September 2016, pp636-638)
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