Drugs used during treatment of cardiac arrest

Question 1

Adrenaline - dose and timing of doses in shockable rhythm? (pVT/VF)

Answer 1

1mg (10ml of 1:10000) IV

Give after 3rd shock once compressions resumed

Repeat every 3-5 minutes (alternate loops)

Given without interruption chest compressions

Question 2

Adrenaline - dose and timing of doses in non-shockable rhythm? (PEA/Asystole)

Answer 2

1mg (10ml of 1:10000) IV

Give as soon as IV access established

Repeat every 3-5 minutes (alternate loops)

Given without interruption chest compressions

Question 3

Adrenaline - mechanism of action? Benefits?

Answer 3

Alpha-adrenergic - systemic vasoconstriction which increases coronary and cerebral perfusion

Beta-adrenergic - inotropic, chronotropic - increase coronary and cerebral blood flow but increase myocardial oxygen demand and ectopic ventricular arrhythmias

Increases ROSC outcomes and benefits early in non shockable rhythms

Question 4

Amiodarone - dose and indications in shockable rhythm? (pVT/VF)

Answer 4

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

After 3rd shock during chest compressions

Further dose 150mg if pVT/VF persists after 5 shocks

Question 5

Amiodarone
- dose and indications in non-shockable rhythm? (PEA/Asystole)

Answer 5

Not indicated

Question 6

Mechanism of amiodarone in ALS?

Answer 6

Increases duration of action potential and refractory period

AV conduction slowed

Negative inotropic effects, peripheral vasodilation

Should be flushed with 0.9% saline or 5% dextrose

Question 7

Calcium dose and indication in ALS?

Answer 7

Calcium chloride 10ml 10% or 30ml 10% calcium gluconate

Indication - PEA caused specifically by hyperkalaemia, hypocalcaemia or overdose of beta blocker

Question 8

Sodium bicarbonate dose and indication in ALS?

Answer 8

50mmol (50ml of 8.4% solution) IV

No routinely recommended

Consider if:
- Associated with hyperkalaemia
- Tricyclic overdose

Repeat dose as necessary but guided by acid-base analysis

Cannot give calcium and bicarbonate solutions simultaneously by same route

Question 9

Fluids - indication and dose?

Answer 9

Rapid IV infusion (0.9% NaCl or Hartmann’s) if hypovolaemic

Or blood for major haemorrhage

Avoid dextrose (redistributes rapidly, hyperglycaemia, worsens neurological outcome and survival)

Question 10

Fibrinolytics - indications and dose in ALS?

Answer 10

Alteplase 50mg IV bolus if known or suspected PE only

Consider further bolus dose of 50mg IV during prolonged CPR attempt (30 minutes after first dose)

Consider CPR for 60-90 minutes after fibrinolysis

Question 11

Management of SVT - dose and drug?

Answer 11

Adenosine 6mg IV bolus

Then 12mg bolus after 1-2 minutes

Then 18mg bolus after 1-2 minutes

Question 12

Indications of amiodarone in peri-arrest period?

Answer 12

Haemodynamically stable VT, polymorphic VT and wide complex tachycardia

AF with RVR for chemical cardioversion

Unsuccessful electrical DC cardio version

Question 13

Dose of amiodarone in peri-arrest period?

Answer 13

300mg IV over 10-60 minutes

Followed by 900mg IV infusion over 24 hours

Ideally central venous access but in emergency can be given via large peripheral vein

Question 14

Indication of atropine in peri-arrest period?

Answer 14

Sinus, atrial or nodal bradycardia or AV block when haemodynamic instability

Question 15

Dose of atropine in peri-arrest period?

Answer 15

500mcg IV bolus up to 3mg in repeated doses

Question 16

Indications of betablockers in peri-arrest period?

Answer 16

narrow complex tachycardias not controlled with vagal/adenosine

AF/AFlutter with RVR when ventricular function preserved

Question 17

Indications of verapamil in peri-arrest period?

Answer 17

Stable regular narrow complex tachycardias uncontrolled by vagal/adenosine

Control ventricular rate in AF/AFlutter and preserved ventricular functin

Question 18

Dose of verapamil in peri-arrest periods?

Answer 18

2.5mg-5mg IV given over 2 minutes

Can give repeated doses 5-10mg every 15-30 minutes up to 20mg

Question 19

Indications and dose of magnesium in peri-arrest period?

Answer 19

Indications:
- Polymorphic VT
- Digoxin toxicity

Dose
- 2g IV over 10 minutes
- May be repeated once if necessary