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48 Cards in this Set

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Pharmacological Goals
Correct hypoxia
Establish spontaneous circulation
Promote optimal cardiac function
Pain relief
Correct acidosis
To treat congestive heart failure
Prevent/suppress arrhythmias
Pharmacology I
Drugs used for full arrest
Dysrythmics
Inotropic
affects the force of the contraction
Chronotropic
affects the heart rate
Drugs considered in ACLS only after
1)Correct identification of rhythm
2)Good airway management with 100% oxygen
3)CPR
4)Defibrillation, if indicated
Administration of Drugs:
1)IV anticubital vein (or existing c-line)
2)IV fluids should be flushed with NS 20-30ml after each injection
3)Raise extremity (helps with speed circulation-gravity
ETT DRUGS
A-Atropine
L-Lidocaine
O-Oxygen
N-Narcan
E-Epinephrine
ETT Drug Dose not including Oxygen
2.5 times IV dose diluted in 10cc NS and hyperventilate
Oxygen as a “drug” corrects:
-Hypoxia (cardiac dysrhythmia’s need 02)
Necessary for cellular metabolism
-Corrects acidosis
Cells do not respond to catecholamines
Dose of oxygen
-Spontaneous breathers
-Whatever device to meet oxygen demands of patient (100% O2)
-Never withhold oxygen to a COPD patient that is hypoxic
-Resuscitation 100%
-Bag valve mask
-ETT
Epinephrine
Action:
Increase everything (BP, O2 demand, blood flow, contractility)
Epinephrine
Indication:
Indicated in all forms of cardiac arrest-aystole, PEA, V-fib, Pulseless V-tach)
Epinephrine:
Dose & Max
Dose 1mg IV push q 3-5 min
Max dose : None
Epinephrine
Precautions:
1)cause of worsening myocardial ischemia
2)cause of ventricular ectopy
Vasopressin
Action:
Alpha
Vasoconstriction
Increase pressure in coronary arteries
Increase cerebral blood flow
Increase vital organ flow
No effect on myocardial oxygen consumption
Vasopressin
Indications:
pulseless v-tach/v-fib refractory to defib
Vasopressin
Dose & Max
40 units IV, single dose, 1 time only
½ life is 10-20 minutes
Vasopressin NOT used in ETT
Can be used as alternative to Epinephrine
Vasopressin
Pressure drug
Pressure drugs- increase circulation, increase BP, Constrict of vessels
Amiodarone(Cordorone)
Function/Indication
The choice drug for:
(1)Refractory VF/pulseless VT
(2)Tachicardias in patients with impaired heart function-only drug that works for SVT & VT
(3)Narrow complex tachycardias that fail to Adenosine
(4)Stable monomorphic v-tach
HISTORY OF SICK HEART
Amiodarone
Disadvantages
1)Cost
2)Delay in administration
A)Stored in glass ampules (scoring files & glass filters required)
B)Motion causes bubbles
C)Mixed with 20-30ml saline or dextrose before administration
Amiodarone
ECG Indications:
V fib/pulseless V Tach
Amiodarone
Dosing:
300mg/20-30 cc D5W or NS IV (NO ETT)
MR 150 IVP in 3-5 min (max 2.2 grams 24 hour)
Maintance: 1 mg/min in x 6 hours
½ mg/min till 2.2 gms/24hours
Lidocaine
Action
Ventricular anti-arrhythmic
V-fib, pulseless V-fib(specific for ventricular ectopy)
Lidocaine
Dosing: Look for Wide QRS
Dosage 1.0-1.5 mg/kg IV bolus
May be given down ETT
Max: 3 mg/kg
Hang maintenance IV drip 2-4 mg/min if Lidocaine is successful in correcting dysrhythmia
Lidocaine
Precautions:
Decrease by 50% in patients with:
1)hepatic disease (excreted by liver)
2)> 70 years old (reduce volume distribution)
Procainimide
Action
Anti-arrhythmic
2nd line drug for ventricular
Dysrhythmias- except in lethal rhythms (VT &VF)
Procainimide
Dosing:
Not given as a bolus only continuous infusion
Dosage: 20-30 mg/min until
1 ectopy is suppressed
2)until BP drops (hypotension occurs)
3)QRS widens by 50%
4)17 mg/kg has been given
Atrophine
Actions:
Increase HR
Atrophine
Actions:
1)systematic bradycardia
2)aystole
3)Slow PEA
Atrophine
Dosing Look for skinny QRS
Dosage: 0.5 mg-1.0 mg IV q 5 min
(<0.5 mg can cause bradycardia)
0.5-Bradycardia
1.0-Aystole
May be given ETT
Max 0.04 mg/kg (usually 2/3 kg)
Atrophine
Precautions:
1)use with caution on MI or Ischemia
2)Can cause ventricular tachydysrhythmias (PVCs, V-Tach, V-Vib)
Adenosine
Action:
1st line drug for SVT
Stable-(After vagal maneuvers)
Recommend for wide complex tach of unknown origin after Lidocaine
Adenosine
Dosing
Dosage: 6 mg IV push rapid
warn patient may be feel like they are having a heart attack
Adenosine
Precautions
Precautions: Flushing, dyspnea, chest pain
Side effect usually resolve within 1-2 min
Verapamil
Action
Calcium Channel Blockers
Make Sure it is a skinny QRS
Verapamil
Dosing
2.5-5mg IV over 1-2 min
Magnesium Sulfate
Indications:
1) Torsades de pointe
2)May reduce incidence of post-infarction dysrhythmias
Magnesium Sulfate
Dosing
Dosage: VT-1 or 2 gm in 10 ml D5W over 1-2 min
VF-give IV push
Diltiazem (cardizem)
Dose
15-20 mg IV Over 2 minutes
Diltiazem
Action
Slow HR, A-fib, A flutter
Sodium Bicarbonate
Action
Action: Corrects metabolic acidosis
(Code at least 10 minutes)
Sodium Bicarbonate
Dosing
Dosage: 1 meq/kg IV
MR with 0.5 meq/kg q 10 min
Sodium Bicarbonate
As interventional
Can be Class I of Class III interventional
In Class I (recommended) in
1)tricyclic antidepressant overdose
2)hyperkalemia
3)pre-existing metabolic acidosis
Morphine Sulfate
Action
1) Reduces vascular resistance
2)decrease myocardial oxygen requirements
Morphine Sulfate
Indications
1)Ischemia, chest pain 2) Pulmonary Edema 3)Relief of anxiety
Morphine Sulfate
Dosage:
1-3 mg IV over 15 min, titrated until pain is relieved
Morphine Sulfate
Precautions:
Severe respiratory depressant hypotension
(bottom out BP)
Calcium Chloride
Indications
1)hyperkalemia
2)hypocalemia
3)CA channel Blocker overdose