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40 Cards in this Set
- Front
- Back
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Magnesium Sulfate
pharmacology & actions |
A. affects impulse formation and conduction time in myocardium and thereby reduces incidence of dysrhythmias associated with hypomagnesemia or prolonged QT interval
B. Decreases acetylcholine in motor end terminals which produces anticonvulsant properties |
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Magnesium Sulfate
Indications |
Indications
A. VFIB / Pulseless VT 1. First Line antiarrhtymic for torsades de pointes pattern 2. Third line antiarrhythmic (after lido) in non torsades de pointes VFIB/pulseless VTACH cardiac arrest B treatment and prevention of seizures due to pregnancy (eclampsia) |
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Mag
Precautions and Side effects |
A. Monitor closely when used in patients with pulse
B. In non-arrest patient, magnesium toxicity may cause hypotension, bradycardia, and or respiratory arrest C. Early warning that magnesium toxicity is developing is decrease in reflexes measured at patella, antecubital area or heel D. S/E sweating, flushing, body warmth |
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Administration
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STANDING ORDER
Adult 1.0-2.0 Grams IV push over 1 minute DEFIB |
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Special Notes
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A. Main prehospital indication is shockable cardiac arrest or suspected torsades
B. Suspect torsades in a pt in VF/pulseless VT or in wide complex tach with classic torsades pattern C. Antidote for mag toxicity is calcium gluconate, or calcium chloride |
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Pts at risk for TdP
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1. toxic levels of antidsyrthmics include procainamide (pronestly) and quinidine
2. Toxic levels of certain psychotropic drugs including tricyclic 3. exposure to organophosphate insecticides 4. CVA / Strokes 5. Electrolyte IMBA, hypokalemia, hypomagnesemia, hypocalcemia 6. Hypothyroidism 7. CAD incluing AMI L ventricle failure 8. pacemaker malfunction antidepressents |
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Vasopressin
Pharmacology & Actions |
(Pitressin)
A. Posterior pituitary antidiuretic hormone B. Acting primarily at the renal tubular level increasing water permiability at the renal tubule and collecting duct, resulting in increased urine osmolality and decreased urinary flow, as well as vascular smooth muscle contraction C. Increases coronary artery flow |
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Vasopressin
indications |
(May replace either the first or second dose of epinephrine)
A. Pulseless VTACH/VFIB arrest states B. Asystole and PEA |
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Vasopressin
contraindications & side effects |
Contraindications
Hypersensitivity to vasopressin Side Effects Malignant Hyperthermia |
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Vasopressin
administration |
STANDING ORDER
Adult 40.0 units IV/IO (may repeat once after 20 min) Peds Not recommended |
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Vasopressin
Notes |
A. Vaso during CPR increases coronary perfusion pressure, vital organ blood flow, V-Fib median frequency & cerebral O2 delivery
B. for the arrest states of: Pulseless VTach/VFIB, Asystole, PEA, vasopressin may be used instead of epinephrine C. after a single dose of vaso, if no clinical response in 3-5 minutes, it is aceptable to return to 1 mg of eppie every 3-5 minutes |
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Calcium Chloride 10%
Pharmacology & actions |
Calcium is an electrolyte salt
A. Inotropic effects 1. increases force of myocardial contraction 2. increases excitability of muscle fibers B. may either increase or decrease system vascular resistance |
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Calcium Chloride
Indications |
A. To treat adverse effects in certain overdoses (calcium channel blockers and magnesium sulfate)
B. Some electrolyte disorders (hyperkalemia or hypocalcemia) |
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Calcium Chloride
precautions and side effects |
A. Do not add to IV in rapid sucession with sodium bicarb (will precipitate as carbonates)
B. In digitalized patients calcium may precipitate digitalis toxicity, additive effects may cause ventricular fibrillation or asystole C. local tissue irritation leading to necrosis if it infiltrates D. may produce vasospasm in coronary and cerebral arteries |
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Calcium Chloride
Administration Cardiac Arrest |
STANDING ORDER
Cardiac Arrest in DIALYSIS PT Adult 1.0 GRAM IVP a. VF/Pulseless VT - give after initial shock and first dose of eppie or vasopressin b. Asystole or PEA - give after first dose of epinephrine or vasopressin |
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Calcium Chloride
Dysrhythmias in Dialysis PT |
STANDING ORDER
Adult 1.0 GRAM slowly IVP (2 minutes) [consult with MD first if possible] a. bradydysrhythmias - use brady algo, consider calcium when clinically suspect the patient has hyperkalemia b. wide complex - use tachy algo, consider calcium when suspected hyperkalemia (muscle weakness in dialysis pt) |
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Calcium Chloride
OD on calcium channel blockers |
STANDING ORDER
Adult up to 1.0 GRAM slowly IVP (over 2 minutes) a. hypotension < 80 systo - treat for shock but consider calcium if confirmed OD on calcium channel blockers b. bradycardia < 50 min - brady algo, consider if confirmed OD on calcium channel blockers |
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Calcium Chloride
Mag sulfate toxicity |
BY MD ORDER
Adult 1.0 Gram slowly IVP (over at least 2 min) a. suspect mag sulfate toxicity in preggers recieving mag sulfate and deveoping decreased respiratoions or hypotension and diminishing reflexes |
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Calcium Chloride
pediatric dose & special notes |
MD order
Child 20 mg/kg slow IV push over 5 minutes Special notes A. SLOWLY PUSH (can cause bradycardia or arrest) B. May increase cardiac irritability, PVC's especially with digitalis C. Local infiltration will cause necrosis |
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Lidocaine
Pharmacology/Actions |
XYLOCAINE
A. Depresses automaticity of the Perkinje fibers, ventricles less likely to fibrillate B. Little Antiarrhythmic effect at subtoxic levels on atrial muscle C. CNS stimulation, tremor, restlesness, clonic convulsions followed by respiratory depression & respiratory failure at higher doses D. Cardiovascular effect: decreased conduction rate and force of contraction, mainly at toxic levels E. The effect of a single bolus on the heart dissapears in 10-20 min due to redistribution in the body. Halflife is 2 hours, toxicity with repeated doses |
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Lidocaine
Indications |
A. VFIB / Pulseless VTach
B. VTach with pulse C. Following successful defibrillation or cardioversion from V Tach D. Significant PVCs in suspected myocardial infarction when though to be clinically significant 1. coupled 2. multifocal PVC 3. R on T 4. Burst or sustained V Tach E. Premedication during RSI for pt with ICP dose 1.5mg/kg |
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Lidocaine
Precautions and side effects |
A. Extreme caution in presence of advanced AV block, unless artificial pacemaker is in place, Consult MD
B. In A flutter/A Fib quinidine like effect may cause alarming ventricular acceleration C. Lidocaine Toxicity = drowsines, disorientation, decreased hearing, paresthesia, muscle twitching, agitation. serious = focal or grand mal seizure, blcok, decreasd contractility CV collapse D. versed for grand mal seizures E. Not for idioventricular rhythm with a slow rate |
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Lidocaine
Administration Pulseless arrest, VFIB, Vtach |
Pulseless Arrest / VFib / Vtach
STANDING ORDER Adult 1.0-1.5mg/kg IV push first dose then 0.5-0.75mg/kg to max 3 dose or 3mg/kg Peds (standing order) 1.0 mg/kg IVP or ET 2.0mg/kg |
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Lidocaine
Admin Wide Complex Tach with pulse (including tachycardia) & Ventricular ectopy in setting of suspected AMI |
STANDING ORDER
Adult 1.0-1.5 mg/kg IVP MR 0.5-0.75 mg/kg to max dose 3mg/kg EVERY 5-10 MINUTES if rhythm converts run a drip at 2-4mg/min (1g to 250ml to may 4mg/ml) Run at 30/45/60 gtt/min |
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Lidocaine
Situations requiring MD ORDER & rsi dose |
1. BP less then 90 systo
2. Heart rate is less then 50/min 3. Periods of sinus arrest or an A-V block are present RSI 1.5mg/kg before intubation |
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LIdocaine Notes
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1.still used to treat ventricular ectopy when present in the setting of suspected AMI
2. Drug is metabolized more slowly in pt's with hepatic disease, shock, CHF, older then 70 yrs, reduce maintainance dose 3. toxicity is more likely in older pt's 4. 50% of pts who develop VFIB in Acute MI have no warning arrhythmias 5. not effective in SV arrhthmias, indicated in wide complex tach that could be V Tach 6. Peds use is uncommon since their rhythms are raraely due to cardiac pathology |
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Amiodarone
Pharmacology & actions |
CORDARONE
A. Amio is generally considered a Vaughn Class 3 antiarrhythmic med that possesses electro-physiological characteristics of all 4 classes 1. Blocks sodium calcium and potassium channels of cardiac muscle 2. By blocking sodium channels amio slows intraventricular conduction of the electrical impulse of the heart 3. Blockade of potassium channels prolongs atrial and ventricular repolarization of the cardiac actions potential 4. blockade of the beta adrenergic receptors and calcium channels slows heart rate and delays conduction through the AV node |
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Amio
Indications |
A. Treatment of shock-refractory VF and pulseless VT
B. Amio is first line over lido C. BC of diverse effects, amio may also be used for other arrhythmias D. Tx of wide complex tachycardias with a pulse including VTach, & preexcited A Fib (AF&WPW) |
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Amio
Precautions & side effects |
A. may produce vasodilation & hypotension
B. may have negative inotropic effects C. May prolong QT interval, use with caution if renal failure D. Administration is contraindicated in pt's with cardiogenic shock, sinus brady, and 2nd and 3rd degree AV block in the absense of a pacemaker |
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Amio
admin |
Pulseless Arrest; Ventricular Fibrillation or Ventricular Tachycardia
1. In cardiac arrest give 300 mg IVP/IO once by standing order 2. consider additional dose of 150MG IVP/IO once. May be administered by standing order in 3-5 minutes if arrhythmia persists and repeated defib is unsuccessful. MAX DOSE = 2.2g IV/24 hour 3. after conversion if arrhythmia returns with a pulse or if patient has increasing ectopy administer 150mg over 10 min (150mg in 100cc NS or D5W run at 15 mg/min) 4. if cardiac arrest recurs drop 150mg 5. if hypotesion or brady cardia develops, stop infusion, reassess and call MD 6. Peds not recommended |
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Amio
admin Wide Complex Tachy with pulse including VTach & AF+WPW |
1. consider 150 mg iv/io over 10 minutes by standing order (mix 150mg in 100cc NS or D5W run at 15 mg/min) repeat as needed to max dose of 2.2 grams/24 hours
2. Prepare for elective synchronized conversion |
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Amio special notes
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A. Cordarone is incompatible with sodium bicarb, heparin, and other meds
B. Use large bore filter needle or filter straw and draw gently from ampule to prevent foaming |
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Sodium Bicarbonate
Pharmacology and Actions |
A. Reacts with hydrogen ions to form water and carbon dioxide, buffers acidosis
B. alkalinizes blood and urine which may decrease amount of circulating drugs (causes protein binding of the drug or affected excretion) C. Alkalinaztion of the blood may lower the level of circulating potassium |
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Sodium Bicarb
Indications |
A. To treat cardiac arrest or dysrhthmias due to hyperkalemia
B. To treat arrhythmias in tryclcic antidepressant overdose C. To reverse documented or clinically suspected metabolic acidosis |
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Sodium Bicarb
Precautions & side effects |
A. addition of too much sodium bicarb may cause alkalosis (difficult to fix)
B. Pt must be adequately ventiled or acidosis will worsen C. may increase cerebral acidosis especially in ketacidosis D. Should not be given in mixture with calcium or cathecholamine (will inactivate catecholamines and cause precipitation with calcium E. When administered to pediatric patient under 1 year of age, should be diluted 1:1 with sterile water |
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Sodium Bicarb
Admin Cardiac Arrest in Dialysis PT |
Standing order
VF, Pulseless VT Adult 1 mEq/kg or 50 mEq (50ml) IVP give after inital shock and first dose of eppie or vaso Asystole & PEA give after first dose of eppie PEDs Standing order 1mEq/Kg IVP |
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Sodium Bicarb
Admin Cardiac Arrest in Tricyclic antidepressant OD |
Standing Order
VF/Pulseless VT Adult 1 mEq/kg or 50mEq (50ml) IVP give after initial shock and first dose of eppie or vaso Asystole or PEA -give after first dose of Eppie Peds Standing order 1 mEq/kg IVP |
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Sodium Bicarb
Dysrhythmias in Dialysis Pt |
Standing order
Adult Same Dose Brady Dysr. - use brady algorithm, but consider bicarb when clinical suspicion of hyperkalemia Wide Complex Dysr - may be brady or look like VT, use tach algorithm, but consider for hyperkalemia |
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Sodium Bicarb
Dysrhth in tricyclic antidepressant OD |
includes sinus tach with widening QRS
MD ORDER Adult 1 mEq/kg or 50mEq IVP MD ORDER Peds 1 mEq/kg IVP May repeat 1/2 original dose in 10 minute intervals if directed by MD |
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Sodium Bicarb
Side effects & special notes |
A. Each am contains 44 or 50 mEq may increase intravascular volume and hyper osmolarity conditions which may result in further cardiac stress or cerebral impairment
B. No longer routinely given in CA, if given do other interventions first C. respiratory arrest without cardiac arrest... ventilate, only bicarb if cardiac arrest and 10 minutes of resusitation D. Requires good ventilation |
