Drug and defibrillator

1. DRUGS AND
DEFIBRILLATION
Tinni T Maskoen
Department of Anesthesiology & Reanimation
School of Medicine Padjadjaran University/
Dr.Hasan Sadikin Hospital

2. (D) Defibrilate VF and VT (if identified)
 The initial “call for help” should result
defibrillator
 Hunt for VF/VT
 90% who survives sudden non traumatic
cardiac arrest was resuscitated from VF
 The success of defibrillation is remarkably
time dependent

3. Survival rate of early defibrillation

4. VF/VT Pulseless Algorithm
• The most important algorithm in all of ACLS
• The reason : VF/VT occur often, are lethal and
correctable more often than asystole and PEA
• The first rule is shock early and often, continuing to
alternate defibrillation attempts with attempts at drug
therapy until you succeed or until the patient goes to
another algorithm

5. Ventricular Tachycardia

6. Ventricular Fibrillation

7. Algorithm VF/VT :
Defibrillate 200J
Defibrillate 200-300J
Defibrillate 360J
Hypothermic?
VF/VT Intubate
Continue CPR Obtain IV
access
Epinephrine 1mg every 3-5 min
Lidocaine 1.5-2 mg/kg repeat in 3-5 min
Bretylium 5 mg/kg repeat in 5 min at 10 mg/kg
MgSO4 1-2 gr in susp HypoMg or refractory VF
Procainamide 15 mg/kg at 30 mg/min
BicNat 1 meq/kg
Hypothermia
Yes
Spontaneous circulation
Vital Sign
Support breathing
Provide appropriate med.
PEA Asystole
Defibrillate 360J
after 30-60 sec.
Choose medication

8. Defibrillation
 Used firstly 3 times in Ventricular Fibrillation
or VT without pulse
 Dose : 200 Joule – 300 Joule – 360 Joule
 Drug – Shock – CPR - Drug – Shock - CPR
 Pediatric dose : 2 J/kg – 4 J/kg

9. Defibrillation
 Used firstly 3 times in Ventricular Fibrilatin
 Dose : 200 Joule – 300 Joule – 360 Joule
 Drug – Shock – Drug – Shock
 Pediatric dose : 2 mg/kg – 4 mg/kg

10. Epinephrine ( Adrenaline )
may help restore spontaneous
circulation in cardiac arrest of 1 – 2
minute duration
Alpha and beta receptor activity
Alpha receptor activity is the most important in
cardiac arrest
Dose : 1 mg IV, can be repeated every 3-5 min.

11. Alfa adrenergic :
promote peripheral vascular
vasoconstriction
increase of diastolic pressure
improve coronary circulation
preserve myocardial oxygenation
greater possibilities of spontaneous heart
contraction
Epinephrine ( Adrenaline )

12. Lidocaine
Pharmacologic action:
1. Decreases automaticity
2. Depresses conduction in reentrant pathways
3. May raise fibrillation threshold, especially
in combination with bretylium
Uses:
 The drug of first choice for ventricular
arrhythmias
 ventricular ectopy, and
 wide complex tachycardias of unknown
origin.

13. Lidocaine
Dose:
 1-1.5 mg/kg IV bolus, followed by additional
0.5-1.5 mg/kg every 5-10 min to a total of 3 mg/kg
 Can be administered via the endotracheal tube.
Use 2 to 2.5 times the intravenous dose.
 Upon return of circulation, use continuous
infusion at 2 - 4 mg/min.
 Reduce the maintenance dose if decreased cardiac output
or hepatic failure or more than 70 years of age.
 Pediatric infusion: 20-50 mcg/kg per min

14. Lidocaine
Potential complications:
 Dizziness, drowsiness, disorientation,
seizures
 Hypotension - causes vasodilation;
myocardial depression at higher
concentrations
 Heart block - only rarely seen with high
levels

15. Bretylium
 Antiarrhythmic, as second line drug after
lidocaine
 Dose : 5 mg/kg or as initial dose 500 mg
 Repeat in 5 min at 10 mg/kg
 Total dose : 35 mg/kg (or 2 more doses of 10
mg/kg at 5-30 min)
 At persistent VT, loading 500 mg/8 – 10
min,followed by continous infusion at 2 mg/min
 Initial : sympathomimetic , after steady state :
sympatholytic
 Side Efect : Hypertension →Hypotension

16. Magnesium Sulfate
 Dose : 1 – 2 gr, if suspected
hypomagnesemia or refractory VT

17. Procainamide
 Antiarrhythmic
 Dose 15 mg/kg at 30 mg/min
 Indication : VF, VT, Atrial tachyarrhythmia
 Second line drug during arrest
 Third line antiarrhythmic used after
lidocaine and bretylium
 Second line drug in VT after lidocaine
failed

18. Sodium Bicarbonate
Pharmacologic action:
Acid neutralization
Uses:
1. Preexisting metabolic acidosis (pH < 7)
2. Hyperkalemia
3. Tricyclic or phenobarbital overdose
Dose:
Initial: 1 mEq/kg IV bolus
Subsequent doses: 0.5 mEq/kg IV every 10 min

19. Sodium Bicarbonate
Potential complications:
1. Metabolic alkalosis
2. Hypercarbia
3. Hyperosmolar state
Note:
Since HCO3
- does not cross cell membranes
and CO2 does, the administration of
bicarbonate may actually make tissues more
acidotic.