Cardiac Arrest Management Pharmacology Flashcards
Epinephrine dosage in cardiac arrest
- 1 mg IV/IO for cardiac arrest. Repeat q 3-5 minutes (current literature suggests maximum dose of 3-4 mg)
What is the preferred, second-line, and third-line route of drug administration in cardiac arrest
- Preferred: Intravenous
- 2nd: Intraosseous (humeral strongly preferred)
- 3rd: External Jugular IV
Sodium Bicarbonate dosage in cardiac arrest
- 1 mEq/kg slow IV push - repeat 0.5 mEq/kg q 10-15 min. prn
Lidocaine dosage in cardiac arrest
- 1.0 - 1.5 mg/kg IV bolus or 2.0 mg/kg via ETT if IV not available in the arrested patient
Followed by 0.5 - 1.0 mg/kg bolus repeat prn to max of 3 mg/kg
Describe ECG findings suggestive of a hyperkalemic cause of cardiac arrest and suggest pharmacological interventions
- PEA with bizarre, extremely wide complex rhythm (Sine-wave appearance)
- RRWCT (Regular REALLY Wide Complex Tachycardia)
- VF or asystole with Hx suggestive of hyperK
- Calcium Chloride
- 1 g over 3 minutes repeat x1 in 10 minutes if indications still present
- Sodium Bicarbonate
- 1 mEq/kg slow IV push - repeat 0.5 mEq/kg q 10-15 min. prn
Naloxone dosage in cardiac arrest with suspected opioid overdose etiology
- May consider 2 mg IM or IV (IV preferable) with the possibility that the patient is not in cardiac arrest
What is the most beneficial effect of epinephrine in cardiac arrest?
it increases systemic vascular resistance thus improving blood flow to vital organs with chest compressions
Calcium Chloride (CaCl2) dosage in cardiac arrest
- 1 g over 3 minutes repeat x1 in 10 minutes if indications still present
What is best practice for administration of epinephrine in cardiac arrest?
- use a 1:10,000 diluted dose of epinephrine (1 mg in 10 mLs)
- e.g. use a preload to reduce dosing errors
Which ACLS drugs have been definitively shown to improve patient-centred outcomes (neurologically-intact survival to hospital discharge) in adult cardiac arrest patients?
none of them!
Describe situations where Magnesium Sulfate may be of benefit in cardiac arrest
- Either refractory VF / pVT with the following
- Suspected hypo-magnesemic states such as alcoholism, anorexia and prescribed diuretic treatment
- Patients receiving prescribed anti arrhythmic medication, particularly sotalol hydrochloride
- The dysrhythmia is identified as Torsades de Pointes
Describe dosing differences for amiodarone between cardiac arrest vs. unstable refractory or recurrent VT
- Cardiac arrest
- Bolus!
- 300 mg IV bolus; may repeat 150 mg bolus in 10 min
- Refractory/recurrent VT
- Infusion!
- 150 mg IV over 10 min
List common TCAs and Salicylates and identify drugs used in TCA/Salicylate poisoning
- TCAs
- Amitriptyline (Elavil)
- Doxepin (Sinequan)
- Nortryptyline (Pamelor)
- Imipramine (Tofranil)
- Salicylates
- ASA (Aspirin)
- Treatment: Sodium Bicarbonate
- 1 mEq/kg slow IV push - repeat 0.5 mEq/kg q 10-15 min. prn
Describe situations where Sodium Bicarbonate may be beneficial in cardiac arrest
- Known or suspected hyperkalemia
- Suspected TCA or salicylate overdose
Is Amiodarone or Lidocaine preferred for treatment of refractory VF / pVT?
amiodarone
300mg IV bolus with 150mg IV bolus repeat after 10 minutes
Amiodarone dosage in cardiac arrest
- 300 mg IV bolus; may repeat 150 mg bolus in 10 min for ventricular fibrillation/pulseless VT.
A patient in cardiac arrest presents with the following rhythm strip. Discuss pharmacology to be considered in their management
- Pt is in VF
- Epinephrine
- 1mg q. 3-5minutes
- Amiodarone if refractory to defibrillation
- 300mg IV bolus after 3rd shock, 150mg IV bolus in 10 minutes
- Magnesium Sulfate if refractory to defibrillation
- 4g IV bolus if hypomagnesemia or antiarrhythmic cause suspected
- Further pharmacology targeted to specfic causes
Which drugs are given to correct hyperkalemia in cardiac arrest, and in what dosages?
- Calcium Chloride
- 1 g over 3 minutes repeat x1 in 10 minutes
- Sodium Bicarbonate
- 1 mEq/kg slow IV push - repeat 0.5 mEq/kg q 10-15 min. prn
- Note! Use extreme caution with co-administration of CaCl2 and bicarb to either use independent sites or fully flush the line between administrations. Ensure PIV patency as extravasation causes tissue necrosis.
Is amiodarone given as an infusion or bolus in cardiac arrest?
Bolus!
Magnesium sulfate dosage in cardiac arrest
- 4 g IV bolus in cardiac arrest with VF or pVT
- Note discrepancy from unstable or refractory TdP
When is the first dose of amiodarone given in cardiac arrest, and at what dose?
- after the 3rd attempt at defibrillation of a shockable rhythm (VF / pVT)
- The first dose is 300mg IV/IO push followed by 150mg IV/IO push in 10 minutes
