drugs used in cardiac arrest Flashcards
adrenaline usage ?
1mg IV (1ml in 1:10000)
for shockable after 3rd shock
for non shockable - given as soon as IV acess obtained
for both repeated every 3-5 mins
Although there is no evidence of long-term benefits from the use of adrenaline, the improved short-term survival documented in some studies warrants its continued use.
alpha-adrenergic effects = systemic vasoconstriction which improves coronary and cerebral perfusion
beta adrenergic effects = increase coronary and cerebral blood flow
amiodarone usage ?
only used for shockable rhythm
300mg Iv diluted in 5 percent dextrose
given after 3 defib
further dose of 150mg if Vtach or VFIB persists after 5 DEFIB ATTEMPT
membrane stabilising drug which increases AP duration and refectory period
calcium usage in shockable and non shockable ?
ONLY USED IN SHOCKABLE
10ml in 10 percent calcium chloride
or 30 ml in 10 percent calcium gluconate
indication PEA caused specifically by HYPERKALEMIA , HYPOCALCEMIA or overdose of CCB
usage of sodium bicarb
50nmol IV of 8.4 percent solution
consider in SHOCKABLE AND NON SHOCKABLE
TRICYCLIC OVERDOSE
CARDIAC ARREST ASSOCIATED WITH HYPERKALEMIA
ACIDOSIS
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Not routinely recommended. Has several adverse effects, including exacerbating intracellular acidosis - by generating CO2 which diffuses intracellular.
negative ionotropic effect on ischemic myocardium
produces shift to oxygen = further INHIBITNG RELEASE OF OXYGEN
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BEST TREATMNET FOR ACEDMIA IN CARDIAC ARREST IS CHEST COMPRESSIONS
WHY IS DEXTROSE not recommended ?
avoid dextrose - it is redistributed away from intravascular space
and cause hyperglycaemia
which may worsen neurological outcome and survival after cardiac arrest
fibrinolytic usage ?
TENECTEPLASE 500-600mcg/kg IV bolus
alteplase 50mg IV if cardiac arrest with known PE
consider further bolus of 50mg IV during a prolonged CPR
= only for proven pe
if FIBRINOLYTIC IS USED IN THESE CRCUMASTANCE FOR CPR ATEAST 60-90 MINS
ongoing CPR not contra for fibrinolytic
USUAGE OF ADENOSINE ?
PAROXYSMAL SVT
6mg IV bolus
if unsuccessful further bolus of 12mg after 1-2 min interval
give third dose of 12mg after further 1-2 min
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block transmission through AV node
side effects = flushing
adrenaline usage for bradycardia
ALTERNATIVE TO PACING
2-10mcg/min
adrenaline usage for anaphylaxis ?
0.5mg IM repeated every 5 min
amiodarone specific usage in arrythmia
control of hemodynamically stable : monomorphic VT , polymorphic VT
wide complex tachycardia (CAUTION IN LONG QT SYNDROME)
pre-excited atrial arrythmia - AF
300mg IV over 10-60 min
followed by 900 mg over 24hrs
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usage of atropine ?
repeated doses of 3mg max
sinus , atrial or nodal bradycardia or AV block
blocks effect of vagus nerve on SA and AV node / block parasympathetic system
usage of beta blocker?
narrow complex regular tachycardia by VAGAL MANOUVERS
or ADENOSINE IN PATIENTS WITH PRESERVED VENTRICULAR FUNCTION
control AF and atrial flutter when ventricular function is preserved
(atenolol , metoprolol)
usage of verapamil ?
stable regular narrow complex tachycardia uncontrolled orr unconverted by vagal manoeuvres or adenosine
control ventricular rate in patientest with AF or atrial flutter with preserved ventricular function when the duration of arrythmia is less than 48 hours
SVT
2.5-5mg Iv over 2 min
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increase refectory in AV node and slows conduction
may terminate re-entry arrhythmia
usage o digoxin ?
afib with fast ventricular response - 250-500mcg IV over 30 min
cardiac glycoside -slows ventricular rate by increasing vagal tone and decreasing sympathetic activity
usage of vasopressors and ionotropes ?
hypotension in the absence of hypovolemia
cariogenic shock
noradrenaline and dobutamine
noradrenaline - 0.05-1mcg/kg/min
dobutamine = 5-20mcg/kg/min
