Increase cerebral and coronary perfusion pressures increase HR Increse myocardial contractility Improve Return of spontaneous Circulation (ROSC)

Code Blue Flashcards by Pharmacy I

When to Call a CODE BLUE?

Respiratory Arrest

Cardiac Arrest

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Assess Adult Patient: CAB

Compressions- Feel for a carotid pulse
Airway-Open the ariway, use a chin lift+/ or head tilt
Breathing- Look, listen and Feel

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CPR

No chest compressions n LVAD patients

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Drug Delivery

For peripheral iv route, follow 20ml flush

If IV access not readily available, consider IO access

Endrotracheal Drug Delivery
( Lidocaine, EPI, naloxone, vasopression, & Atropine)
—-less predictable pharmacologic effect
—-use 2 to 2.5 times rec IV dose in 5-10 H20 or NS

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Drug therapy in VF/Pulseless VT Vasopressors

(epinephrine/vaspressin)

can be given after at least 1 shock and 2 minute CPR period

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Drug therapy in VF/Pulseless VT

Amiodarone

Improves rate of ROSC (Return of spontaneous Circulation) and hospital admission

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Drug therapy in VF/Pulseless VT

Magnesium

Only for torsades de pointes with a long QT interval

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Drug therapy in Pulseless electrical activity(PEA)/ Asystole

Vasopressor
can be given as soon as feasible
goal: increase myocardial/cerebral blood flow during CPR
Atropine
Treating Potentailly reversible causes (H’s and T’s)

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Acute Termination of PSVT

Vagotonic physcial manuever
—valsalva, breath-holding, ice water submersion, unilateral carotid sinus massage

Narrow QRS
—adenosine, verapamil, diltiazem, metoprolol,

Wide QRS >120msec
–procainamide, ibutilide, amiodarone (if structural heart disease)

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CCB, BBB and Digoxin should not be use in

Patients with undiagnsed Wide Complex Tachycardias

due to severe hemodynamic deterioration if VT or antidromic AVRT present

Atrioventricular reentrant tachycardia (AVRT) is a type of supraventricular tachycardia (SVT). It accounts for about 30% of all SVTs.

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Drugs: Key Elements

Goal: facilitate restoration/maintenance of spontaneous rhythm

CPR should be continued to facilitate drug distribution to the heart to optimize response

administration of a 10-20ml bolus of normal saline after each drug to assist drug distribution

If IV access not available, then intraosseous admin should be considered for all drugs

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Epinephrine dose

1 mg IV/IO q 3-5 mins

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Epinephrine classification

Vasopressor receptors: alpha adrenergic

beta 1 and 2 adrenergic

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Epinephrine Indication

Pulseless VT/VF
Symptomatic bradycardia
PEA
Asystole
Anaphylaxis

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Epinephrine Actions

Increase cerebral and coronary perfusion pressures
increase HR
Increse myocardial contractility
Improve Return of spontaneous Circulation (ROSC)

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Vasopressin dose

40 units IV (replace 1st or 2nd dose of epinepherine)

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Vasopressin classification

Vassopressin 1 &2

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Vasopressin indication

• Pulseless VT/VF 
• PEA
• Asystole 
• 1 dose may replace 1st does of epi 
***insuf evidence in ped cardiac arrest

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Vasopressin indication

increase coronary perfusion

* increase vasoconstriction

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Amiodarone dose

VF/pulseless VT: 300 mg IVP, MR with 150mg in 3-5 mins

Stable VT; 150 mg IV over 10 minutes

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Amiodarone Class

Antiarrhythimic Class III

potassium-channel blockade. Delay repolarization (phase 3) and thereby increase action potential duration and effective refractory period.

Amiodarone Indications

Pulseless VT/VF
Hemodynamic stable monomorphic VT
Polymorphic VT with normal QT
Afib/Aflutter

Amiodarone Actions

Prolongs AP duration and refractory period

Slows AV conduction/ Increase PR and Qtc

Increase short term survival to hospita admission

Lidocaine dose

1-1.5 mg/kg
MR 0.5-0.75 mg/kg to max of 3mg/kg
Start gtt 1-4 mg/min

Lidocaine Classification

Antiarrhythmic Class IB | IB - weak Small reduction in phase 0 slope; reduce APD; decrease ERP.

Lidocaine Indication

• Pulseless VT/VF ---- if amio unvail • Hemodynamic stable monomorphic VT • RSI (Rapid sequence intubation)

Lidocaine Actions

Relative weak Sodium channel blocker

Magnesium dose

Pulseless VF/VT-Torsades | 1-2 grams IV in 10 ml of NS r 5-20 mins (if no pulse)

Magnesium Classification

Electrolyte/ antiarrhythmic

Magnesium Indication

* Torsades de pointes * Pulseless VT/VF with prolonged QT/ torsades * Asthma * Hypomagnesemia

Magnesium Actions

cofactor in variety of cell processes including control of Na and K transport

Atropine dose

symtomatic bradycardia; | 0.5 mg IV max dose 3 mg

Atropine Classification

Anticholinergic

Atropine indication

symtomatic bradycardia toxins/over dose RSI (Rapid sequence intubation) ** (consider in Peds before succin/ketamine)

Atropine Actions

``` Increase HR in PEA(pulseless electrical activity) asystole unlikely to have benefit NOT recommended ```

Na bicarbonate

Alkalinizing agent Indicated: Hyperkalemia, pre-existing metabolic acidosis, TCA OD Reverses metabolic acidosis, Increases CO2 and pH.

Drugs not recommended for routine use in cardiac arrest

Na bicarbonate Calcium chloiride 10% Flumazenil Naloxone

Calcium Chloride 10%

Electrolyte Indicaiton: hypocalcemia, hyperkalemia, hypermagnesemia, CCB overdose maintains cardiac contractility, platelet aggregation

Dextrose

Carbohydrate ``` Indication: Hypoglycemia -newborn 10% -infant/child 25% -Adults 50% Hyperkalemia (with insulin) ```

Flumazenil dose

0.2 mg, inc to 0.3 and 0.5 mg q 1 min. Max of 3 mg

Flumazenil

Acute W/D sx including chrnoic user Benzo OD Binds to GABAa receptor/ prevents attachement of benzodiazepines to their receptor

Adenosine dose

6 mg IV x1 | MR w/12 mg for 2nd dose

Adenosine Indication

Antiarrhythmic Indication: - stable narrow complex regular tach - unstable narrow complex regular tach - stable, regular, monomorphic wide complex tach as a therapeutic diagnostic tool

Adenosine actions

*Blocks AV node conduction depresses sinus node *Automaticity brief period of *systole/bradycardia

Naloxone dose

0.04 -0.4 mg IV | MR q 2-3 mins

Naloxone

Opioid reversal Indicaition: narcotic OD Action: potent opioid receptor antagonist acute W/D: pain, HTN, Tachycardia

Rapid Sequence Intubation | Etomidate -short acting hypnotic agent

Dose: 0.3 mg/kg IV push~20 mg in a 70 kg person Onset:10-20 secs Duration: 4-10 mins Adverse effects: Adrenal suppression

Rapid Sequence Intubation | Ketamine-general anesthetic

Dose: 1-2 mg/kg Onset: 30-40 secs Duration: 5-10 mins Adverse effects: hypertension, cardiac dysrhythmias, increased ICP, laryngeal spasm Avoid the use in cardiac, traumatic brain injury patients

RSI-Paralytics | Succinylcholine

Succinylcholine Dose: 1-1.5 mg/kg Onset: 30-60 secs Duration : 5-15 mins AE: Hyperkalemia (avoid ESRD) Inc ICP, Respiratory depression

RSI-Paralytics | Rocuronium

dose: 0.6-1.2 mg/kg (usually 1mg/kg Onset: 1-2 mins duration: 30-90 mins AE: Respiratory depression

RSI-Paralytics Vecuronium (in med tray)

dose:0.1-0.2 mg/kg Onset: 2-4 mins Duration: 30-45 mins AE: Respiratory depression