ALS Medications Flashcards
Adrenaline - Dose and Route ( In cardiac arrests)
1mg (10mL 1 : 10,000) IV
Adrenaline - When to use ( In cardiac arrests)
Shockable - after 3rd Shock and then every other loop (3-5 mins)
Non-shockable - ASAP then every other loop (3-5 mins)
Adrenaline MOA (2 things)
Alpha-adrenergic effects cause systemic vasoconstriction which increases cerebral and coronary perfusion.
Beta-adrenergic effects are inotropic and chronotropic which may be beneficial but also increase oxygen demand of myocardial tissue.
Amiodarone - Dose, route ( In cardiac arrests)
300mg bolus IV followed by 150mg future dose.
Amiodarone - when to use in cardiac arrest
Only used in shockable rhythms.
Give after 3rd shock. Further reduced dose given if still shockable following a further 2 shocks (total five shocks)
Amiodarone MOA
Stabilises membrane of cardiac myocytes which increases duration of action potential and refractory period producing anti-arrhythmic effects.
Calcium - Dose and route
10mL 10% calcium chloride IV
Calcium - When to use
PEA caused by hyperkalaemia, hypocalcaemia or OD of calcium channel blocking drugs
Sodium Bicarbonate - Dose and Route
50mmol (50mL of 8.4%) IV
Sodium Bicarbonate - when to use
consider in shockable and non-shockable rhythms caused by hyperkalaemia or TCA OD
When to use IV fluids in Cardiac Arrest
When hypovolaemia may be a contributing factor
Which IV fluids to use in Cardiac Arrest ( and one to avoid)
Sodium chloride or Hartmanns, or Blood in major haemorrhage. Avoid dextrose as this is rapidly distributed away from the intravascular space and may cause hyperglycaemia which is detrimental to neurological recovery)
Fibrinolytics - when would you consider?
If PE is suspected. Consider use but none are licensed.
Adenosine - Dose and Route
6mg IV bolus. If unsuccessful give up to 2 further 12mg doses after 1-2 minute intervals.
Adenosine - Indication
Paroxysmal SVT with re-entrant circuits. (regular, narrow VT without response to vagal manoeuvres)
Adenosine - MOA and two things to remember
naturally occurring purine nucleotide which blocks conduction through the AV node
Preferable to other antiarrhythmics in heart failure
Remember to warn patients they will briefly feel nauseous, sweaty, chest discomfort and sense of doom.
Adrenaline - indications and relevant doses outside of cardiac arrest (3)
2nd line for cardiogenic shock - 0.05 to 1 mcg per kg IV
Bradycardia - alternative to pacing in patients with adverse features who do not respond to atropine - 2-10mcg per min IV.
Anaphylaxis 0.5mg IM every 5 mins.
Amiodarone - Indications outside of cardiac arrest (3).
control of haemodynamically stable monomorphic VT, polymorphic VT, broad complex tachycardia of uncertain origin.
Chemical cardioversion or control of pre-excited atrial arrhythmias such as AF.
To increase the likelihood of success of electrical cardioversion.
Amiodarone - Dose and Route
300mg IV over 10-60 mins bolus
followed by 900mg over 24 hours
Aspirin - indication, dose, route, MOA
ACS ASAP
300mg crushed or chewed orally
antiplatelet action prevents thrombus formation
Atropine - indication, dose
bradycardia, AV block causing haemodynamic instability
500mcg IV - repeated doses up to 3mg
Beta Blockers - indication
rate control in AF and atrial flutter
In narrow complex regular tachycardia which has not resolved with vagal manoeuvres and adenosine (probable flutter)
Verapamil - MOA, Indications,
Calcium channel blocker, rate control in AF and flutter. Helps preserve ventricular function if given within 48 hours of onset. Stable, regular, narrow tachycardias which have not responded to adenosine and vagal manoeuvers.
Digoxin - MOA, Indication, Dose
cardiac glycoside which slows ventricular rate. AF with fast ventricular response, 500mcg IV over 30 mins.
Inotropic drugs - indications, examples
Hypotension in absence of hypovolaemia, cardiogenic shock. Dobutamine, noradrenaline.
Magnesium dose and route
2g IV over 10 mins
Magnesium Indications (2)
Polymorphic VT, Digoxin toxicity
Nitrates, indication, dose
ACS without hypotension (<90 systolic) GTN spray 1 o2 sublingual
