Drugs during the treatment of cardiac arrest Flashcards

1
Q

When is adrenaline used in VF/pVT?

A

After third shock once compressions have been resumed
Repeat every 3-5 minutes

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2
Q

What is the dose of adrenaline in VF/pVT?

A

1mg (10ml 1:10000 or 1ml 1:1000) IV

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2
Q

When is adrenaline given in PEA/asystole?

A

As soon as circulatory access is obtained
Repeated every 3-5 minutes

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3
Q

Why is adrenaline used in cardiac arrest?

A

Alpha-adrenergic effects cause systemic vasoconstriction, which increases coronary and cerebral perfusion pressure

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4
Q

What are the negative effects of adrenaline?

A

Beta-adrenergic effects (inotropic and chronotropic) may increase coronary and cerebral blood flow but;

  • concomitant increases in myocardial oxygen consumption and ectopic ventricular arrhythmias
  • transient hypoxaemia because of pulmonary AV shunting
  • impaired microcirculation
  • increased post-cardiac arrest myocardial dysfunction
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5
Q

What does adrenaline do in cardiac arrest?

A

Increases ROSC and the number of survivors with either a favourable/non-favourable outcome

The benefit may be greater when adrenline is given for a non-shockable rhythm

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6
Q

When is amiodarone used in cardiac arrest?

A

Only in pVT/VF

Given after three defibrillation attempts
Further dose can be given if VF/pVT persists after five defibrillation attempts

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7
Q

What does amiodarone do?

A

Membrane stabilising anti-arrhythmic that increases the duration of the action potential and refractory period in the atrial and ventricular myocardium

AV conduction is slowed, similar effect in accessory pathways

Mild negative inotropic action and causes peripheral vasodilatation through non-competitive alpha-blocking effects

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8
Q

How should amiodarone be administered?

A

300mg bolus IV diluted in 5% dextrose to a volume of 20mL

Further dose of 150mg if persists

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9
Q

What is the indication for calcium?

A

PEA caused by hyperkalaemia, hypocalcaemia or overdose of calcium channel blockers

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10
Q

How should calcium be administered?

A

10mL 10% calcium chloride (contains 6.8 mmol Ca)
or
30mL 10% calcium gluconate IV

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11
Q

What are the negative effects of calcium?

A

High plasma concentrations after injection may be harmful to ischaemic myocardium and may impair cerebral recovery

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12
Q

What can calcium not be given at the same time as?

A

Sodium bicarbonate solutions via the same route

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13
Q

What is the dose of sodium bicarbonate?

A

50 mmol (50mL of an 8.4% solution) IV

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14
Q

What is the indication for sodium bicarbonate?

A

Shockable and non shockable rhythms for
- cardiac arrest associated with hyperkalaemia
- TCA overdose

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15
Q

How should sodium bicarbonate use be monitored?

A

By acid-base analysis

16
Q

What is the best treatment for acidaemia in cardiac arrest?

A

Chest compression

17
Q

What does cardiac arrest do to the acid-base balance?

A

combined respiratory and metabolic acidosis as pulmonary gas exchange ceases and cellular metabolism becomes anaerobic

18
Q

What does sodium bicarbonate do in cardiac arrest?

A

Causes generation of CO2, which diffuses rapidly into cells;
- exacerbates intracellular acidosis
- produces negative inotropic effect on ischaemic myocardium
- presents a large, osmotically active sodium load to an already compromised circulation and brain
- produces a shift to the left in the oxygen dissociation curve, further inhibiting release of 02 in the system

19
Q

When should fluids be used in cardiac arrest?

A

If hypovolaemia is suspected

20
Q

What fluid should be used in cardiac arrest?

A

Use 0.9% NaCl or Hartmann’s solution, or blood for major haemorrhage

21
Q

Why is dextrose avoided in cardiac arrest?

A

Redistributed away from the intravascular space rapidly and causes hyperglycaemia which may worsen neurological outcome and survival

22
Q

What are the options for fibrinolytics in cardiac arrest?

A

Tenecteplase 500-600mcg kg-1 IV
Alteplase 50mg iv bolus if cardiac arrest with known or suspected PE
Consider giving a further 50mg if prolonged CPR attempt (30 minutes after first dose)