Acls medications
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    Acls medications Acls medications Presentation Transcript

    •  
    • Bradycardia
      • Atropine
      • Dopamine infusion
      • Epinephrine infusion
    • Atropine
      • Mechanism of Action
        • Inhibits the actions of acetycholine on structures innervated by postganglionic sites (smooth/cardiac muscle, SA/AV nodes)
    • Atropine
      • Indications
        • First drug for symptomatic sinus bradycardia
        • May be beneficial in AV block or asystole
        • Second drug in asystole or slow PEA
        • Organophosphate poisoning; large dose may be needed
      • Precautions
        • MI and hypoxia – atropine increases oxygen demand
        • Avoid in hypothermia
        • Not effective for 2 nd type II or new 3 rd degree block (may slow the rhythm)
        • Doses < 0.5 mg may cause a paradoxical slowing
    • Atropine
      • Asystole or slow (<60)PEA
        • 1 mg IV/IO push
        • Repeat every 3 to 5 minutes (if rhythm persists) to max. of 3 mg.
      • Bradycardia
        • 0.5 mg IV every 3-5 minutes as needed; max. of 3 mg.
        • Use shorter dosing interval and higher doses in severe clinical situations
      • Endotracheal Administration
        • 2-3 mg diluted in 10 mL water or NS
      • Organophosphate Poisoning
        • Large doses (2-4 mg or higher) may be necessary
      Don’t delay pacing for severely symptomatic (unstable) patients.
    • Dopamine
      • Mechanism of Action
        • Stimulates adrenergic receptors; dose dependent.
    • Dopamine
      • Indications
        • Second-line drug for symptomatic bradycardia
        • Hypotension with signs and symptoms of shock
      • Precautions
        • Correct hypovolemia with volume before initializing
        • Use caution with cardiogenic shock and associated CHF
        • May cause tachydysrhythmias; excessive vasoconstriction
        • Don’t mix with sodium bicarbonate
      • IV Administration
        • Infusion at 5-20 mcg/kg/min.
        • Titrate to patient response; taper slowly
    • Epinephrine
      • Mechanism of Action
        • Stimulates adrenergic receptors and is not dose dependent like dopamine.
    • Epinephrine
      • Indications
        • Cardiac arrest
          • VF; VT; asystole; PEA
        • Symptomatic bradycardia
          • After atropine; alternative to dopamine
        • Severe hypotension
          • When atropine and pacing fail; hypotension accompanying bradycardia; phosphodiesterase enzyme inhibitors
        • Anaphylaxis; severe allergic reactions
          • Combine with large fluid volume; corticosteroids; antihistamines
    • Epinephrine
      • Precautions
        • May increase myocardial ischemia, angina, and oxygen demand
        • High doses do not improve survival; may be detrimental
        • Higher doses may be needed for poison/drug induced shock
      • Dosing
        • Cardiac arrest 1 mg (1:10,000) IV/IO every 3-5 min.
        • High dose up to 0.2 mg/kg for specific drug OD’s
        • Infusion of 2-10 mcg/min.
        • Endotracheal of 2-2.5 times normal dose
        • SQ/IM 0.3-0.5 mg
    • Tachycardia
      • Adenosine
      • Diltiazem
      • Metoprolol
      • Amiodarone
      • Lidocaine
      • Magnesium Sulfate
    • Adenosine
      • Mechanism of Action
        • Slows impulse formation in the SA node; slows conduction time through AV node; depresses left ventricular function and restores NSR.
    • Adenosine
      • Indications
        • 1 st drug for stable, narrow complex, regular SVT
        • May consider for unstable SVT while preparing for cardioversion
        • Wide-complex tachycardia thought to be, or determined to be reentry SVT
        • Does not convert atrial fibrillation, atrial flutter, or VT
        • Diagnostic maneuver; stable narrow-complex SVT
    • Adenosine
      • Contraindications/Precautions
        • Poison/drug induced tachycardia is contraindicated
        • 2 nd and 3 rd degree block is contraindicated
        • Transient side effects; flushing, CP, asystole, brady, ectopy
        • Less effective with theophylline or caffeine
        • If used for VT may cause worsening of clinical condition
        • Transient periods of sinus brady or ventricular ectopy common after termination of SVT
        • Safe in pregnancy
    • Adenosine
      • Place supine or mild reverse Trendelenburg
      • 6 mg rapidly followed by 20 mL flush
      • May repeat at 12 mg every 1-2 minutes if unsuccessful
    • Diltiazem
      • Mechanism of Action
        • Inhibits calcium movement across cell membranes of cardiac and smooth muscle. Causes vasodilation, decreses heart rate and contractility, slows SA and AV conduction.
    • Diltiazem
      • Indications
        • Controlling ventricular rate in a-fib or flutter
        • After adenosine to treat refractory reentry SVT if adequate blood pressure
      • Contraindications/Precautions
        • Do not use with wide-complex rhythms
        • Do not use with poison/drug induced tachycardia
        • Avoid in WPW
        • Avoid in AV nodal blocks
        • Blood pressure may drop from peripheral vasodilation
    • Diltiazem
      • Rate control
        • 15-20 mg (0.25 mg/kg) IV over 2 minutes
        • After 15 min. another 20-25 mg (0.35 mg/kg) IV over 2 minutes, if needed
      • Maintenance Infusion
        • 5-15 mg/hour; titrated to physiologically appropriate heart rate
    • Metoprolol
      • Mechanism of Action
        • Selectively blocks beta-1 receptors, slowing sinus heart rate, decreasing cardiac output, and decreasing BP.
    • Metoprolol
      • Indications
        • Administer to all patients with suspected MI or unstable angina, absent contraindications
        • Second-line agent for SVT refractory to adenosine
        • To reduce myocardial ischemia in MI patients with elevated heart rate and/or blood pressure
        • Emergency antihypertensive therapy for acute hemorrhagic or ischemic stroke
    • Metoprolol
      • Contraindications/Precautions
        • Hemodynamically unstable patients should not receive
          • Signs of heart failure
          • Low cardiac output
          • Increased risk for cardiogenic shock
        • Relative contraindications: 1 st , 2 nd , 3 rd degree blocks; active asthma; reactive airway disease; severe bradycardia; hypotension < 100 mmHg
        • Concurrent administration of calcium channel blockers can cause serious hypotension
        • Monitor cardiac and pulmonary status throughout
    • Amiodarone
      • Mechanism of Action
        • Prolongs myocardial cell action potential duration and refractory period by direct action on all cardiac tissue; decreases AV and SA conduction rates.
    • Amiodarone
      • Indications
        • Life threatening dysrhythmias
          • VF/pulseless VT unresponsive to shock, CPR, and vasopressor
          • Recurrent hemodynamically unstable VT
          • Seek expert opinion for other uses
      • Contraindications/Precautions
        • Bradycardia
        • 2 nd and 3 rd degree block
        • Do not administer with meds that prolong QT interval (procainamide)
    • Amiodarone
      • VF/VT – 300 mg IV/IO in 20-30 mL NS. Can follow with ONE dose of 150 mg in 3-5 minutes, if needed.
      • Life threatening dysrhythmias
        • 150 mg over 10 minutes. May repeat every 10 minutes as needed.
    • Lidocaine
      • Mechanism of Action
        • Decreases depolarization, automaticity, and excitability of ventricle during diastole by direct action, reversing ventricular dysrhythmias.
    • Lidocaine
      • Indications
        • Alternative to amiodarone in VF/VT arrest
        • Stable monomorphic VT
        • Malignant PVC’s
        • Can be used if Torsades is suspected
      • Contraindications/Precautions
        • Prophylactic use in AMI is contraindicated
        • Reduce maintenance dose in liver impaired patients
        • Discontinue infusion if toxicity develops
    • Lidocaine
      • Cardiac Arrest
        • Initial dose is 1-1.5 mg/kg
        • Refractory VF 0.5-0.75 mg/kg in 5-10 min. Max 3 mg/kg
        • Endotracheal dose 2-4 mg/kg
      • Perfusing Dysrhythmia
        • 0.5-0.75 mg/kg up 1-1.5 mg/kg dosing range. Repeat if necessary at lower range to total dose of 3 mg/kg
      • Maintenance Infusion
        • 1-4 mg/min
    • Magnesium Sulfate
      • Mechanism of Action
        • Increases magnesium levels in cases where prolonged QT interval is thought to be secondary to hypomagnesemia.
    • Magnesium Sulfate
      • Indications
        • Torsades is suspected in cardiac arrest
        • Lfe-threatening ventricular dysrhythmias in digitalis OD
      • Precautions
        • Fall in BP with rapid administration
        • Use caution in renal failure
      • Dosing
        • Arrest 1-2 g over 5-20 min.
        • Torsades w/ pulse 1-2 g over 5-60 min.
    • Vasopressin
      • Mechanism of Action
        • Causes vasoconstriction with reduced blood flow, increasing core perfusion during cardiac arrest.
    • Vasopressin
      • Indications
        • Alternative to epinephrine in adult refractory VF/VT
        • Alternative to epinephrine in asystole or PEA
      • Contraindications/Precautions
        • Potent peripheral vasoconstrictor (increased demand upon resuscitation)
      • Dosing
        • Single dose of 40 u that replaces either the 1 st or 2 nd dose of epinephrine. Epinephrine can be resumed 3-5 minutes after
        • Can be used endotracheally; no suggested dose