This document outlines drugs commonly used in cardiopulmonary resuscitation and their properties. It discusses adrenaline, atropine, amiodarone, lignocaine, adenosine, and dopamine. For each drug it covers indications for use, routes of administration, mechanisms of action, and potential side effects. The objectives are to be able to state the major resuscitation drugs, outline their actions, and list side effects.

1. DRUGS IN
CARDIOPULMONARY
RESUSCITATION

2. OBJECTIVES
Upon 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

3. DRUGS USED IN RESUSCITATION
• Adrenaline
• Atropine
• Amiodarone
• Lignocaine
• Adenosine
• Dopamine

4. ACCESS TO DRUG ADMINISTRATION
• Intravenous
-Peripheral or central
• Intra-osseous (2nd preferred route after failed x2 attempts
on IV access)
• Intra-tracheal
– Only if intravenous and intraosseous not available
– “NAVEL”
(Naloxone,Atropine,Vasopressin,Epinephrine,Lidocaine)

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

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

7. INTRAOSSEOUS
• Available for adult usage
• Site: Iliac crest, sternum
• As effective as intravenous line for resuscitation

8. ADRENALINE
1st drug in cardiac arrest

9. ADRENALINE
• Indications:-
VF
Pulseless VT
Pulseless electrical activity (PEA)
Asystole

10. ADRENALINE
• Routes of administration:-
› IV push OR Intraosseus 1mg
Infusion (3mg in 50 mls N/S at 1ml/hr
=1ug/min), titrate accordingly
› ETT (2-2.5X IVdose)

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

12. ADRENALINE ---- SIDE-EFFECTS
• Ventricular irritability
– tachyarrthymias
• ↑ Myocardial Oxygen demand
- risk of ischaemia and MI
• Cerebrovascular event

13. 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

14. ATROPINE
Indication:
• Sinus, atrial or nodal bradycardia with
hemodynamic instability

15. ATROPINE
Routes of administration:-
• IV: 1mg for Acute symptomatic/unstable
bradycardia (Max 3mg)
• ETT: 2-3 mg diluted in 10 mls saline

16. ATROPINE ---- SIDE-EFFECTS
• Tachycardia
• Palpitations
• Paradoxical bradycardia (if dose < 0.5mg)
• Seizure (rare)
• Hypertension (rare)

17. 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

18. 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 10min
followed by IV infusion 900 mg over 24h

19. LIGNOCAINE
Indication:
• Refractory VT/ VF (when amiodarone is not
available)

20. 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

21. 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)

22. LIGNOCAINE - SIDE-EFFECTS
• Seizures
• Respiratory depression / arrest
• Widening of QRS complexes
• Bradycardia - cardiac arrest

23. 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 )

24. ADENOSINE - SIDE-EFFECTS
• Transient bradycardia or even ASYSTOLE
• Hypotension
• Chest pain
• Dyspnoea
• Bronchospasm (caution in asthma )
• Transient flushing

25. DOPAMINE
Indications:
• cardiogenic shock
• septicaemic shock
• neurogenic shock
• anaphylactic shock
• hypovolaemic shock only after fluid resuscitation
has failed to raise BP

26. DOPAMINE
Route of administration:
• Infusion via central vein

27. DOPAMINE - ACTIONS
Dose dependant effects
-Usual dose: 5– 20ug/kg/min
• Increases myocardial contractility
– Increases cardiac output
• Causes peripheral vasoconstriction
– Increases blood pressure

28. DOPAMINE - SIDE-EFFECTS
• Tachycardia
• Tachyarrhythmias
• Excessive peripheral vasoconstriction

29. SODIUM BICARBONATE
• A significant sodiumload
• 8.4% solution is hypertonic => arterial
vasodilatation and hypotension
• Extravasation => tissue necrosis
• Not to be injected via same IV line as
catecholamines and calcium

30. 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

31. 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

32. THANK YOU
NATIONAL 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