Drugs inresus06122011


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Drugs inresus06122011

  2. 2. OBJECTIVESUpon completion of this session, you will be able to:• state the drugs commonly used in resuscitation• outline the major actions of these drugs• list 2 side effects related to the use of the drugs ALS Subcommittee 2010
  3. 3. DRUGS USED IN RESUSCITATION• Adrenaline• Vasopressin• Atropine• Amiodarone• Lignocaine• Adenosine• Dopamine ALS Subcommittee 2010
  4. 4. ACCESS TO DRUG ADMINISTRATION• Intravenous Peripheral or central• Intra-osseous• Intra-tracheal – Larger dose – Only if intravenous and intraosseous not available ALS Subcommittee 2010
  5. 5. TECHNIQUE FOR IV DRUG ADMINISTRATION• Use upper extremity veins• Keep the access site elevated• Each IV drug administration to be followed by 20-30mls bolus of normal saline• The cannula should be as large as possible• Use normal saline as the fluid of resuscitation ALS Subcommittee 2010
  6. 6. TECHNIQUE FOR ENDOTRACHEAL DRUG ADMINISTRATION• Dilute the drug in 10 ml saline• Thread a long catheter through the ETT• Stop chest compressions• Inject the drug through the catheter• Follow with 3-4 manual lung inflations• Dosage: 2-2.5x the recommended IV dose ALS Subcommittee 2010
  7. 7. INTRAOSSEOUS• Available for adult usage• Site: Iliac crest, sternum• As effective as intravenous line for resuscitation ALS Subcommittee 2010
  8. 8. ADRENALINE1st drug in cardiac arrest ALS Subcommittee 2010
  9. 9. ADRENALINE• Indications:- VF Pulseless VT Pulseless electrical activity (PEA) Asystole ALS Subcommittee 2010
  10. 10. ADRENALINE• Routes of administration:- › IV push OR Intraosseus 1 mg Infusion (3mg in 50 mls N/S at 1ml/hr =1ug/min), titrate accordingly › ETT (2-2.5X IV dose) ALS Subcommittee 2010
  11. 11. ADRENALINE ---- ACTIONS• increases contractile force of the heart thus increasing cardiac output• increases conduction of SA node, AV node and ventricle thus increasing heart rate• increases systemic vascular resistance through peripheral vasoconstriction thus increasing perfusion pressure ALS Subcommittee 2010
  12. 12. ADRENALINE ---- SIDE-EFFECTS• Ventricular irritability – tachyarrthymias• ↑ Myocardial Oxygen demand - risk of ischaemia and MI• Cerebrovascular event ALS Subcommittee 2010
  13. 13. VASOPRESSIN• A naturally occurring hormone• At high doses of 40 units (recommended dosage during resuscitation) – shunting of blood to heart and brain – intense vasoconstriction – may not increase myocardial oxygen demand -- unlike adrenaline ALS Subcommittee 2010
  14. 14. VASOPRESSIN• Indications for use – Considered as an alternative to adrenaline for shock due to refractory VF, asystole and PEA – Used as a single bolus 40 units IV to replace 1st or 2nd dose of adrenaline – As a hemodynamic support in septic shock ALS Subcommittee 2010
  15. 15. ATROPINE• Anticholinergic (parasympatholytic) – inhibits effect of acetylcholine on SA and AV node – increases SA node and AV node conduction velocity – decreases effective refractory period AV node• Increases heart rate and cardiac output ALS Subcommittee 2010
  16. 16. ATROPINEIndication:• Sinus, atrial or nodal bradycardia with hemodynamic instability ALS Subcommittee 2010
  17. 17. ATROPINERoutes of administration:-• IV: 0.5mg for Acute symptomatic bradycardia Max 3mg• ETT: 2-3 mg diluted in 10 mls saline ALS Subcommittee 2010
  18. 18. ATROPINE ---- SIDE-EFFECTS• Tachycardia• Palpitations• Paradoxical bradycardia (if dose < 0.5mg)• Seizure (rare)• Hypertension (rare) ALS Subcommittee 2010
  19. 19. AMIODARONE• Has characteristics of all 4 antiarrhythmic drug classes – affect sodium, potassium and calcium channel – alpha and beta blocking properties• Used in BOTH supraventricular and ventricular tachyarrthymias – Refractory VT/VF – Stable monomorphic or polymorphic VT – PSVTs, atrial tachycardia, atrial fibrillation – Wide complex tachycardia of uncertain origin – Pre-excited atrial arrhythmia ALS Subcommittee 2010
  20. 20. AMIODARONE• VF, pulseless VT and refractory VT/VF – Drug of Choice • IV bolus dose 300 mg • repeat IV bolus 150 mg in 3-5 mins followed by IV Infusion 900 mg over 24h• Other arrhythmias › IV Infusion 150 mg over 10 min followed by IV infusion 900 mg over 24h ALS Subcommittee 2010
  21. 21. LIGNOCAINEIndication:• Refractory VT/ VF (when amiodarone is not available) ALS Subcommittee 2010
  22. 22. LIGNOCAINE ---- ACTIONS• Raises fibrillatory threshold • enhances the effect of DC shock• Suppresses automaticity and shortens effective refractory period and action potential duration • slows down heart rate• Inhibits reentry mechanism – halts arrhythmias ALS Subcommittee 2010
  23. 23. LIGNOCAINE• Routes of administration:- – IV push (1.0 to 1.5 mg/kg) Additional 0.5-0.75 mg/kg Max: 3 mg/kg Infusion 1 gm Lignocaine in 500 ml N/S 30 to 120 ml/hr (1 – 4 mg/min) – ETT (2-2.5X IV dose) ALS Subcommittee 2010
  24. 24. LIGNOCAINE - SIDE-EFFECTS• Seizures• Respiratory depression / arrest• Widening of QRS complexes• Bradycardia - cardiac arrest ALS Subcommittee 2010
  25. 25. ADENOSINE• A short acting agent that depresses SA node and AV node function• Used in narrow complex supraventricular tachycardia• Half life : 5 seconds• Initial dose of 6 mg rapid IV push (may be repeated at 12 mg ) ALS Subcommittee 2010
  26. 26. ADENOSINE - SIDE-EFFECTS• Transient bradycardia or even ASYSTOLE• Hypotension• Chest pain• Dyspnoea• Bronchospasm (caution in asthma )• Transient flushing ALS Subcommittee 2010
  27. 27. DOPAMINEIndications:• cardiogenic shock• septicaemic shock• neurogenic shock• anaphylactic shock• hypovolaemic shock only after fluid resuscitation has failed to raise BP ALS Subcommittee 2010
  28. 28. DOPAMINERoute of administration:• Infusion via central vein ALS Subcommittee 2010
  29. 29. DOPAMINE - ACTIONS Dose dependant effects Usual dose: 5– 20ug/kg/min• Increases myocardial contractility – Increases cardiac output• Causes peripheral vasoconstriction – Increases blood pressure ALS Subcommittee 2010
  30. 30. DOPAMINE - SIDE-EFFECTS• Tachycardia• Tachyarrhythmias• Excessive peripheral vasoconstriction ALS Subcommittee 2010
  31. 31. SODIUM BICARBONATE• A significant sodium load• 8.4% solution is hypertonic => arterial vasodilatation and hypotension• Extravasation => tissue necrosis• Not to be injected via same IV line as catecholamines and calcium ALS Subcommittee 2010
  32. 32. SODIUM BICARBONATE• only beneficial in hyperkalaemia• probably beneficial in - bicarbonate responsive acidosis• possibly beneficial in - protracted cardiac arrest with effective ventilation - postresuscitation acidosis with effective ventilation ALS Subcommittee 2010
  33. 33. REVIEW OBJECTIVES Are you be able to?• State the drugs commonly used in resuscitation• outline the major actions of these drugs• list 2 side effects related to the use of the drugs ALS Subcommittee 2010
  34. 34. THANK YOUNATIONAL COMMITTEE ON RESUSCITATION TRAINING SUBCOMMITEE FOR ADVANCED LIFE SUPPORT  Dr Tan Cheng Cheng  Dr Luah Lean Wah  Dr Ismail Tan  Dr Wan Nasrudin  Dr Chong Yoon Sin  Dr Priya Gill  Dr Ridzuan bin Dato’Mohd Isa  Dr Thohiroh Abdul Razak  Dr Adi Osman ALS Subcommittee 2010