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Advanced Life Support > Peri-arrest and Second Line Drugs > Flashcards

Peri-arrest and Second Line Drugs Flashcards

1
Q

Action of atropine

A

Anticholinergic muscarinic receptor blocker
Blocks action of vagal nerve on the heart
Reduces refractory period of SA and AV node, increasing rate of discharge and enhancing conduction

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2
Q

Indications of atropine

A

Severe bradycardia with haemodynamic compromise
NO LONGER RECOMMENDED ASYSTOLE

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3
Q

Dosage of atropine

A

Symtomatic bradycardia 0.5-1mg

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4
Q

Dosage of atropine (paediatric)

A

20mcg/kg
40mch/kg ETT

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5
Q

Administration atropine

A

IV or IO bolus
can repeat every 3-5 minutes
Max 3mg

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6
Q

Administration atropine (paediatric)

A

IV or IO bolus
can repeat evert 5 minutes
Max 600mcg

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7
Q

Contraindications of atropine

A

Glaucoma

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8
Q

Adverse effects of atropine

A

Anticholinergic effects
Dries secretions
Urinary retention
Dilated pupils
Hyperthermic (large doses)
Delirium
Excitement
Tachycardia

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9
Q

Atropine considerations

A

Doses given too slowly or <0.5mg in adults can cause transient paradoxical slowing of heart rate and may cause arrythmias

Avoid large doses in coronary patients as excessive tachycardia can occur, aggravating myocardial ischemia and/or precipitating ventricular arrythmias

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10
Q

Action of lignocaine

A

1b antiarrhythmic
Sodium channel blocker, reducing action potential, slowing cardiac conduction
also LA effect

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11
Q

Indications of lignocaine

A

Failure of defibrillation and adrenaline to revery pulseless VT/VF
Can be used as prophylaxis in setting of recurrent VT/VT
Conscious VT

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12
Q

Dosages of lignocaine

A

1mg/kg
0.5mg/kg may be considered as additional bolus
2mg/kg ETT

administered between 3rd and 4th shock

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13
Q

Dosages of lignocaine (paediatric)

A

1mg/kg
2mg/kg ETT

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14
Q

Administration of lignocaine

A

IV/IO bolus 25-50mg/min
Max 300mg

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15
Q

Adverse effects of lignocaine

A

Hypotension
Bradycardia
Heart block
Seizures
Asystole
Slurred speech
Altered consciousness
Muscle twitching

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16
Q

Action of magnesium

A

Smooth muscle relaxation and cell membrane stabilisation through inhibition of calcium channels resulting in reduced intracellular calcium

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17
Q

Indications of magnesium

A

Torsades de Pointes
Hypomagnesaemia (particularly when associated with hypokalemia)
Documented hypokalemia
Cardiac arrest due to digoxin toxicity

May be requested in event of defib and adrenaline failure to revert VF and pVT

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18
Q

Dose of magnesium

A

5mmol - can repeat once

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19
Q

Dose of magnesium (paediatrics)

A

0.1-0.2mmol/kg

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20
Q

Administration of magnesium

A

IV/IO bolous

consider 10-20mmol infusion over 1-2hr per electrolytes

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21
Q

Administration of magnesium (paediatrics)

A

IV/IO bolus
followed by 0.3mmol/kg infusion

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22
Q

Contraindications of magnesium

A

AV blocks
Magnesium toxicity

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23
Q

Adverse effects of magnesium

A

Muscle weakness
Respiratory depression/fatigue
Hypotension

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24
Q

Magnesium considerations

A

1g calcium gluconate to reverse hypermagnesemia

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25
Q

Action of potassium

A

Essential for stability of cell membranes

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26
Q

Indications of potassium

A

Persistent VF/VT due to documented hypokalemia
Hypomagnesemia

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27
Q

Dosage of potassium

A

5mmol

28
Q

Dosage of potassium (paediatric)

A

0.05mmol/kg

29
Q

Administration of potassium

A

Slow IV or IO bolus

30
Q

Contraindications of potassium

A

N/A

31
Q

Adverse effects of potassium

A

Hyperkalemia
Bradycardia
Hypotension
Tissue necrosis with extravasation

32
Q

Action of sodium bicarbonate 8.4%

A

Alkalizing solution, combines hydrogen ions to form carbonic acid to reverse acidosis

33
Q

Indications of sodium bicarbonate 8.4%

A

Hyperkalemia
Documented metabolic acidosis (pH<7/0 or BE>-10,,ol/L)
Overdose of tricyclic antidepressants or phenobarbitone
Protracted cardiac arrest lasting >15minutes

34
Q

Dosage of sodium bicarbonate 8.4%

A

1mmol/kg

35
Q

Dosage of sodium bicarbonate 8.4%

A

1mmol/kg

36
Q

Administration of sodium bicarbonate

A

IV/IO bolus over 2-3min
Then as guided by ABG usually pH<7.1

37
Q

Administration of sodium bicarbonate (paediatrics)

A

IV/IO bolus over 2-3min
Then as guided by ABG usually pH<7.1

38
Q

Contraindications of sodium bicarbonate

A

Nil

39
Q

Adverse effects of sodium bicarbonate

A

Hypernatremia and hyperosmolality
Hypokalemia
Paradoxical cerebral acidosis
Depressed cardiac contractility
Metabolic alkalosis shifts O2/hb curve to left

40
Q

Sodium bicarbonate considerations

A

INCOMPATIBLE WITH ALL OTHER DRUGS - requires dedicated IV line in the prolonged arrest >15min

May be indicated after confirmation of severe acidosis (ABG)

41
Q

Action of calcium

A

Electrolyte essential for normal muscle and nerve activity
Increases myocardial excitability, contractility and peripheral resistance

42
Q

Indication of calcium

A

Hyperkalemia
Hypocalcaemia
Overdose of calcium-channel blockers
Hypermagnesiumaemia

43
Q

Dosage of calcium

A

5-10ml of 10% calcium chloride or calcium gluconate

44
Q

Dosage of calcium (paediatric)

A

0.2ml/kg of 10% calcium chloride OR
0.7ML/KG OF CALCIUM GLUCONATE

45
Q

Administration of calcium

A

IV/IO bolus (adults and paediatrics)

46
Q

Contraindications of calcium

A

N/A

47
Q

Adverse effects of calcium

A

Possible increased myocardial and cerebral injury by mediating cell death
Tissue necrosis by extravasation

48
Q

Calcium considerations

A

Incompatible with range of drugs - may precipitate in IV lines

49
Q

Action of isoprenaline

A

Acts exclusively on beta-adrenergic receptors
B1 effects include increased cardiac contracility and heart rate
B2 effects include bronchodilation and vasodilation

50
Q

Indications of isoprenaline

A

Symptomatic bradycardia - particularly when originating below AV node
AV blocks unresponsive to atropine
Pharmacological pacing in Torsades de points

51
Q

Dosage of isoprenaline

A

Bolus 20mcg - 60mcg
Infusion 0.5-10mcg/min

52
Q

Dosage of isoprenaline (paediatric)

A

Bolus not recommended
Infusion 0.05-2mcg/kg/min

53
Q

Isoprenaline infusion

A

3mg in 50ml 5% dextrose
OR
6mg made up to 100ml 5% dextrose = 60mcg/ml

54
Q

Administration routes of isoprenaline

A

IV/IO adults and paeds

55
Q

Contraindications of isoprenaline

A

N/A

56
Q

Adverse effects of isoprenaline

A

Tachyarrhythmia
Hypotension - diastolic BP may fall due to reduction in peripheral vascular resistance
Myocardial iscaemia

57
Q

Considerations of isoprenaline

A

Sometimes referred to as “pharmacological pacing”
Use continuous cardiac monitoring when administering

58
Q

Action of adenosine

A

Depresses node activity, slowing conduction AV nod, causing transient AV block, interrupting re-entry circuit - allows restoration normal sinus rhythm

59
Q

Indications of adenosine

A

SVT - acute treatment
Diagnostic aid for broad and narrow complex tachycardia
Wolfe Parkinson White Syndrome

60
Q

Dosage of adenosine

A

Initial: 3mg rapid IV bolus
If unsuccessful after 1-2min: rapid 6mg bolus
If unsuccessful after 1-2min: rapid 12mg bolus

61
Q

Dosage of adenosine (paediatric)

A

All ages
1st dose 0.1mg/kg (max 6mg)
2nd 0.2mg/kg (max 12mg)
3rd 0.3mg/kg (max 12mg)

62
Q

Administration of adenosine

A

IV/IO bolus (adults and paeds)
Administer into large IV cannula rapid IV bolus
followed by rapid N/S flush

63
Q

Contraindications of adenosine

A

N/A

64
Q

Adverse effects of adenosine

A

Bradycardia
Chest pain
Dizziness
Nausea
“Impending doom”
Facial flushing
Headache

65
Q

Considerations of adenosine

A

ECG during drug administration is required due to transient AV block determining atrial activity

Advanced Life Support (7 decks)

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