Resuscitation Drugs

Adrenaline: (Epinephrine) 1: 10,000 (1mg in 10mls) via peripheral IV 1: 1,000 (1mg in 1ml) via CVC

T ½ = 3 minutes During Arrest administer 1mg 1 in 10,000 every 3 minutes

Actions of Adrenaline in non-perfusing rhythms:  Vasoconstriction redistributes blood to vital organs: heart & brain

Actions of Adrenaline in perfusing rhythms:  Increase heart rate & BP

 2 – bronchodilation

Adverse effects of Adrenaline:  Tachycardia/tachyarrhythmias  HT – CVA   Glucose – may lead to  K  tissue necrosis if extravasates  peripheral vasoconstriction – can cause ischaemia  tremor/anxiety/dilated pupils

Always flush with 10-20ml of N.Saline or D5W

Lignocaine Hydrochloride Indications in cardiac arrest:  To be administered in VF/VT arrest only  After 2 rounds of shocks & 1 dose Adrenaline given  NB Less effective if K low

Doses: 1mg/kg IV over 60 secs May repeat at 0.5mg/kg after 5mins and again 5mins later to a total of 2mg/kg

T ½ is 4-5mins

If successful in reverting VF: Infusion: 2g lignocaine in 500ml D5W 4mg/min for 1st hr (60ml/hr) 3mg/min for 2nd hr (45ml/hr) 2mg/min for 3rd hr (30 ml/hr)

Adverse effects of lignocaine CNS: seizure, drowsiness, dizziness, confusion CVS: BP, AV-block, bradycardia, asystole, Torsades (prolongs Q-T) GIT: N&V CONTRAINDICATED IN TORSADES Other Second Line Anti-Arrhythmics Potassium: 5mmol IV stat, 1g (13.4mmol) IV/hr Aim to get K > 4.5

Magnesium 5mmol bolus, can repeat Follow with infusion: 20mmol in 4 hrs

Sodium Bicarbonate 0.5-1mmol/kg VIA DEDICATED LINE, followed by flush Indications:  Prolonged arrest (>15-20 mins)  Acidosis pH < 7.2 or documented metabolic acidosis pre-arrest (eg renal, cardiac or hepatic failure, DKA, septic, hypoxic) – guided by ABG’s  Hyperkalaemia  TCA OD with arrhythmias (VE’s, VT, Torsades) alkalinizing serum  toxicity of TCA

NB Last in protocol because CAN MAKE OUTCOME WORSE: Theory – HCO3 will mop up H+ ions & make CO2/H20

HCO3- + H+  H2Co3  H20 + CO2

BUT most Pts don’t have acidosis until late in arrest

Adverse effects of HCO3  Intracellular acidosis HCO3 causes CO2 load CO2 19 times more diffusible than O2 – so it enters cell & reverses equation (causing shift to  H+)  Respiratory acidosis  Metabolic alkalosis - Shifts O2/Hb dissociation curve left -  tissue oxygenation) -  ionized Ca (as pH  Ca binds to Alb – makes less available to myocardium) -  effect of Adr (pH of Adr is 3.5 ie it’s an acid) - NEVER GIVE HCO3 & Adr IN SAME LINE - Hypokalaemia – H+ leaves cell, K enters, makes lignocaine less effective  Hypernatraemia – ie Na given with HCO3 (NaHCO3)  Hyperosmolarity (from  Na) – can cause cerebral oedema  Precipitates in line with MANY other drugs – must flush thoroughly Atropine Indications/Dose Asystole: 1mg IV bolus Symptomatic bradycardia or VE’s in presence of  heart rate: 0.5-0.6mg IV

Maximum dose = 3mg

Action: opposes parasympathetic effect on myocardium – allows sympathetic to predominate -  HR

Adverse effects  Tachycardia/tachyarrhythmias   myocardial O2 consumption/ischaemia  Dilated pupils, dry mouth, urinary retention, hyperthermia ( doses)

Adenosine Can convert SVT to SR Will not convert AF, flutter or VT to SR, but will slow ventric rate (which may help to see flutter waves by  block) NB Conscious with WIDE complex tachycardia - ? VT or ? SVT with aberrancy

Dose: Start with 6mg Then 12mg Can  to 24 mg, but if 12 doesn’t work, may try something else

CI: 2nd or 3rd degree AV block without pacemaker May  ventric rate in WPW Sick Sinus Syndrome (tachy-brady syndrome) May exacerbate asthma

SE: Extreme ancxiety/impending doom Facial flushing, dyspnoea, chest tightness, nausea SEVERE BRADYCARDIA – not resolved with atropine, may require Adr +/- pacing.

NB: ALWAYS HAVE ATROPINE (for bradycardia) } ARAMINE (for hypotension) } ON HAND ADRENALINE (for arrest) }

AND IV FUID RUNNING

WHILE GIVING ADENOSINE 2 IV’s ISN”T A BAD IDEA EITHER! Can give Mg prior/as well

Before giving Adenosine for SVT try: Carotid Sinus massage (if < 40yo) Valsalva Ice-cold drink/Put face in ice water Children: - cold facewasher, ripping off band-aid, rectal dilation

If Adenosine doesn’t work Verapamil } beware of contraindications for these Sotalol } Cardioversion

Amiodarone