cardiac arrhythmia medications Flashcards
V-tach & -fib
- only 2 reasons to use defibrillator
- Vasopressors: epinephrine
- Antiarrhythmics: amiodarine, lidocaine
PEA/ Asystole
CPR
Epinephrine
Tachycardia
Stable: Vagal; adenosine
unstable(tachycardic and increased BP): cardiovert
regular: 50+100 joules
irregular: 120+200 joules
bradycardia
atropine
epinephrine drip
dopamine drip
medication access
peripheral access:route of choice; quicker, easier
Intraosseous access: goes into bone marrow, usually goes in to shin, never sternum
things to remember
Alpha + constrict
Beta + dilate
Beta: 1 heart, 2 lungs
Epinephrine
natural catecholamine
- alpha properties
- vasoconstriction
- Increased SVR= Increased BP
- increased contractility, CO, HR
- routing blood to brain and heart
- Beta properties: Bronchodilator
- No maximum dose
Amiodarone
- works on Na+ and K+ channels
- apha and beta properties
- ONLY 2 doses during arrest
- IV drip= complex dosing
- continuous EKG monitoring
- hypotension is common
- must take BP before giving it
- antiarhhythmic
lidocaine
alternative to amiodarone
- suppresses ventricular ectopy
- suppresses conduction of reentry pathways
- IV push
- IVgtt= maintenance
- MAX dose= 3mg/kg (3 boxes per code)
procainamide
-suppresses ventricular ectopy
-slows conduction through myocardium
-IV or PO
-initial loading dose- 20 mins
gtt thereafter
DC if QRS widens >50% of baseline- VTach getting worse
torsade de pointes
give 1-2 gms IV
-could be repeated
sequence
shock
drug
shock
drug
shock
meds: vasopressor, antiarrhythmic, vasopressor, antiarrhythmic
-After drug is given, circuate for 2 mins using CPR
-dont mix and match drugs- finish 1 drug before starting another- mixing makes them pro-arrhythmics
vagal maneuvars
only attempt if tachycardia is stable
- cough
- bear down
- gag
- do not do carotid massage
adenosine
- stable tachycardia
- slows conduction through SA and AV nodes
- depressed left ventricular function-dont give to someone with left ventricular issues unless necessary
- converts tachycardia rhythms into NSR
- given rapid Iv push over 1-3 secs
- brief asystole or bradycardia
- transient fushing +/or CP
- dosing 6-12mg
beta blockers
stable tachycardia
- controls rate & ventricular response
- decreased HR, force of contraction, BP, AV conduction, & myocardial O2 consumption
- end in “OLOL” [metoprolol, atenolol, propanolol, esmolol, labetolol]
- caution with CHF & pulmonary disease- if heart slows down too much can send pt into CHF or pulmonary edema
calcium channel bockers
- controls ventricuar rate in AFIB & Aflutter
- inhibits Ca+ion influx into myocardial cells
- slow AV& SA conduction
- may decrease contractility
- vasodilates smooth muscle to decrease afterload and BP
- antidote= CaCl 10% solution
verapomil
Calcium channel blocker
- given after adenosine use with normal/elevated BP
- not to be used with hypotension
- may repeat doses
diltiazem
- given after adenosine use
- IV loading the IV gtt
- caution with CHF
synchronized cardioversion
- unstable tachycardia
- slows rhythm down
- 50-100 joules
- step back- dont know which p waves it will shock on
amiodarone
preserved cardiac function
-avoid AV blocking agents
unstable tachycardia
atropine
-symptomatic bradycardia
-drug of choice
-increases HR
-blocks parasympathetic nervous system
enhances conduction at the AS and AV nodes
-IV push
-prepare for transcutaneous pacing
epinephrine (bradycardia)
given as gtt
- increases contractiity, HR, CO
- doesnt mess with BP
dopamine (bradycardia)
low dose= renal perfusion
moderate dose= cardiac doses, beta 1 receptors
increase contractility, CO, HR
high dose= vasopressor doses- alpha receptors
vasoconstriction, can cause tacycardia
what to do in asystole/PEA?
epinephrine
CPR- 5 cycles (30:2)
consider aborting resuscitation efforts
on top of the crash cart
- monitor/ defibrillator
- respiratory box
- sharps container
on the side of the crash cart
backboard
O2 tank
top drawer if crash cart
medications
the second drawer of crash cart
- airway
- respiratory equiment
third drawer of crash cart
- circulation
- IV supplies
fourth drawer of crash cart
- circulation
- IV fluids/ tubing
fifth drawer of crash cart
- cardiac
- chest procedures
sixth drawer of the crash cart
special procedures
- cutdown tray
- central line tray
- external pacemaker
treat chest pain with:
MONA
M-morphine-only if nitro doesnt work, decrease pain, anxiety, beta 2 (dilates)
O-Oxygen
N- Nitroglycerin- can give 3X SL, 5 mins apart
A- Aspirin: 160-325mg, chewable to get in system faster
search for and treat these contributing factors: (the H’s)
hypovolemia
hypoxia
hydrogen ions(Acidosis, dont give sodium bicarb w/o
confirmation)
hypo-/hyperkalemia
hypoglycemia
hypothermia (you cannot die cold)search for and treat these contributing factors: (the T’s)
toxins tamponade (cardiac) tension pneumothorax thrombosis (coronary/pulmonary) trauma (hypovolemia, increasing ICP)
