Wide complex tachycardia with pulse: 0. Seizures, heart block, bradycardia, dyspnea, respiratory depression, nausea, vomiting, headache, dizziness, tremor, drowsiness, tinnitus, blurred vision, hypotension, rash. Torsades with a pulse: gram IV over minutes followed by infusion at 0. Confusion, sedation, weakness, respiratory depression, hypotension, heart block, bradycardia, cardiac arrest, nausea, vomiting, muscle cramping, flushing, sweating. Fever; dizziness; arrhythmia; chest pain; hypertension; nausea; vomiting; abdominal cramping and pain; hives.
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How medications fit in Resuscitation drugs administered in response to cardiac arrest can be attributed to four lethal arrhythmias: ventricular fibrillation VF , pulseless ventricular tachycardia VT , asystole, and pulseless electrical activity PEA. Medications are given to increase coronary and cerebral perfusion.
Because directly measuring perfusion in response to CPR and medication administration isn't easy, the updated ACLS guidelines recommend fewer pulse checks during resuscitation efforts. The rationale is that palpable pulses don't tell you if coronary or cerebral flow is adequate. Interrupt compressions only for defibrillation and rhythm checks. Medications should be administered during CPR as soon as possible after a rhythm check.
Now let's look at specific medications and when to give them. Epinephrine's alpha-adrenergic properties can increase coronary and cerebral blood flow during CPR. The drug's beta-adrenergic effects, however, can increase myocardial work and reduce subendocardial perfusion. Give 1 mg of epinephrine I. The drug also may be administered via ET tube if I. High-dose and escalating epinephrine aren't routinely recommended under the guidelines. However, higher doses may be administered for specific problems, such as beta-blocker or calcium channel blocker overdose.
The ACLS guidelines let a health care professional administer epinephrine, the conventional treatment choice, or a onetime dose of vasopressin. Some emergency care providers question the widespread use of epinephrine over vasopressin, saying it's being used out of habit.
According to the AHA, no studies have shown that either epinephrine or vasopressin improves rates of patient survival to discharge. Because vasopressin's effects haven't been shown to differ from those of epinephrine in cardiac arrest, one dose of vasopressin 40 units I.
Vasopressin can be administered via ET tube, but evidence is insufficient to recommend a specific dose. Amiodarone has alpha- and beta-adrenergic blocking properties and affects sodium, potassium, and calcium channels.
Its principal effect on cardiac tissue is to delay repolarization by prolonging the action potential duration and effective refractory period. Administer an initial dose of mg dilute in 20 to 30 mL D5W I. This can be followed, after 3 to 5 minutes, by one dose of mg I.
The AHA guidelines state that although lidocaine has no proven short-term or long-term efficacy in cardiac arrest, it's an alternative to amiodarone that has been used for many years, is familiar to clinicians, and causes fewer immediate adverse reactions than other antiarrhythmics. For VF and pulseless VT, administer an initial dose of 1 to 1. Lidocaine also can be administered via ET tube. A prolonged QT interval can induce torsades de pointes, an irregular polymorphic VT associated with a prolonged QT interval.
Avoid rapid administration, which can precipitate asystole. Pulseless electrical activity refers to any semiorganized electrical activity seen on the cardiac monitor, although the patient lacks a palpable pulse. This definition excludes VF, VT, and asystole. In: Reichman EF. Reichman E. Eric F. Emergency Medicine Procedures, 2e. McGraw Hill; Accessed November 14, APA Citation Chapter 9. Reichman EF. McGraw Hill. MLA Citation "Chapter 9. Download citation file: RIS Zotero.
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