acls 4 - pharma

8/6/2019 Acls 4 - Pharma

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ADVANCED CARDIAC

LIFE SUPPORT

EMERGENCY DRUGS


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DRUG ADMINISTRATION

During CPR: priority high quality CPR &

early defibrillation

Insertion of advance airway & drug

administration are of secondary importance

Drugs in ACLS are administered via

IV

IO ET


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DRUG ADMINISTRATION

ENDOTRACHEAL ROUTE

optimal drug dose is not known

dose is 2 -2.5 x the IV route

can only administer the ff drugs: Naloxone

Atropine

Vasopressin

Epinephrine Lidocaine

Dilute dose in 5-10 ml of NSS, inject directly to thetrachea


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DRUG ADMINISTRATION

Peripheral IV route takes about 1-2 min

before reaching central circulation

Give drug by bolus injection unless otherwisespecified

Followwith a 20ml bolusof IVF

Elevateextremity abovethelevelofthe

heartforabout 10-20stofacilitate deliveryofthe drugtothe central circulation


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FIRST LINE

ACLS DRUGS


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OXYGEN

I: hypoxemia, any suspected CP ER

Raises blood oxygen saturation, reduce anxiety

& further damage

Provide better tissue oxygenation Decrease workload on the myocardium

1st line in ALL ACLS cases

stable patient : nasal prongs: 2-4lpm, increaseor change PRN

Unstable patient: simple mask 6-8LPM

Dead: BVM w/ reservoir at 12-15lPM


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EPINEPHRINE

1st DOC: all ACLS px who arepulseless

Improve coronary & cerebral perfusion

Increase automaticity & make VF more

susceptible to shock

Increase: HR, force of contraction,conduction velocity

Peripheral vasoconstriction

Bronchial dilation


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EPINEPHRINE

Initial dose: 1mg IV push every 3-5min, no maximum dose

May be given via ET tube (mix w/10cc NSS)

May cause worsening of myocardial ischemia

(increase BP, HR,O2 demand)

V tach Undesired tachycardia


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VASOPRESSIN

Antidiuretic hormone

Used in shock, V fib

Clamp down on vessels: Improves perfusion

of heart, lungs, & brain

No direct effect on the heart

One time dose of 40 units IV only

Not repeated at any time

Can worsen MI, V tach, hypertension,

Pressor effects can last 30-60 mins


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DOPAMINE

Hypotension NOT 2 to hypovolemia Dose:

>10mcg/kg/min: alpha properties to treat

hypotension If BP < 70mmHg = NE

3-10mcg/kg/min: beta 1 properties increase

cardiac rate = CO

1-3mcg/kg/min: dopaminergic properties vasodilation of renal, mesenteric & cerebral

arteries


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DOPAMINE

Mix 800mg of dopamine in 250cc NSS. Titrateas ff

Renal perfusion/dose: 1-3 mcg/kg/min

Beta range/ cardiac dose: 3-10mcg/kg/min

Alpha range/ vasopressor dose: 10-20mcg/kg/min

>20mcg/kg/min: switch to NE

Higher doses may cause myocardial BF to decrease

Always treat underlying hypovolemia before

using dopamine

Use w/ volumetric infusion device

AR: profound tachycardia in the presence of

hypovolemia


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ATROPINE

Dose: 0.5-1 mg IV push every3-5 min w/ a max dose of 3 mg


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ADENOSINE

DOC: narrow complex paroxysmal SVT plays an important role in biochemical

processes, such as energy transfer - asadenosine triphosphate (ATP) & adenosine

diphosphate (ADP) an inhibitory neurotransmitter, believed to

play a role in promoting sleep & suppressingarousal

Slows tachycardia associated w/the AV node (modulate ANS)


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ADENOSINE

Dose: 6 mg push IV push rapidlyover 1-3 seconds ff by NSS bolusof 20 ml

2nd dose may be repeated at 12mg (max 30 mg) after 1-2mins

AR: facial flushing, light

headedness, paresthesia, chestpain, headache, palpitation, SOB,diaphoresis, nausea, metallic taste


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VERAPAMIL

Antidysrhythmic & anti anginal drug Decreases atrial automaticity, reduces AV

conduction velocity

Decrease myocardial contractility, reducevascular smooth muscle tone & dilates

coronary arteries in normal & ischemic

tissues

Primarily used in PSVT, atrial fibrillation, &

atrial flutter


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VERAPAMIL

Dose: 2.5-5 mg IV bolus over2

min, repeat doses of 5-10 mg may

be given every 15-30 minAR: hypotension, dizziness, HA,

nausea, vomiting, bradycardia,

complete AV block, peripheraledema

Toxicity: give calcium chloride


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FIRST LINE ACLS DRUGS

ANTI ARRHYTHMIC


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LIDOCAINE

Suppression of V tach & V fib 1st line antiarrhythmic DOC

Depress automaticity, excitability, raises Vfib threshold &decrease ventricular irritability

Dose: 1-1.5mg/kg IV every 3-5 min with a maximumdose of 3 mg/kg

Maintenance infusion: 2-4 mg/min

1000mg/250 ml D5W = 4mg/ml

15 ml/hr: 1mg/min

30 ml/hr: 2mg/min

45 ml/hr: 3mg/min

60 ml/hr: 4mg/min

d/c infusion if signs of toxicity develops


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LIDOCAINE

Toxicity: CNS depression,convulsions, coma,hypotension, death

In px w/ impaired liver fxn or>70 y/o, give normal bolus

but dec infusion rate by50%


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MAGNESIUM SULFATE

Indications primarily for Torsades de pointes

hypomagnesemia

dysrhythmias 2 to TCA overdoseor digitalis toxicity

Refractory VF Dose: 1-2 g IV diluted in 100 cc of

NSS


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MAGNESIUM SULFATE

AR: diaphoresis, facial flushing,hypotension, depressedreflexes, hypothermia, reduced

HR, respiratory depression,circulatory collapse

CNS depressant effects may beenhanced if patient is takingother CNS depressants


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AMIODARONE

Most effective antiarrhythmic drug

Very expensive

Dose: 300 mg IV bolus diluted in 20-30ml D5W after 1st epinephrine dose

Repeat dose: 150 mg IV

AR: halo vision, photosensitivity,pulmonary toxicity, may cause (-)inotropic effect, vasodilation & shock

acls 4 - pharma

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