Drugs for Resuscitation

Summary

This comprehensive script provides a clear, step-by-step overview of drug use during cardiopulmonary resuscitation and emergency cardiovascular care. It explains routes of drug administration, key medications used in cardiac arrest, shockable and non-shockable rhythms, and the pharmacology behind each agent. Through practical clinical scenarios, it covers adrenaline, amiodarone, lignocaine, magnesium sulfate, inotropes, vasopressors, adenosine, verapamil, atropine, and supportive treatments for acidosis and hyperkalemia. The script emphasizes correct dosages, indications, precautions, and rapid decision-making, guiding healthcare providers through high-stakes, real-time resuscitation management.

Takeaways

• 😀 High-quality cardiopulmonary resuscitation (CPR) is essential during emergencies and involves understanding drug administration routes and types of drugs used.
• 😀 The central venous route is effective for drug delivery, but it is time-consuming and interrupts chest compressions. Peripheral routes are often prioritized.
• 😀 Common drugs used in resuscitation include adrenaline, amiodarone, lidocaine, magnesium sulfate, adenosine, and dopamine.
• 😀 Adrenaline has both alpha and beta adrenergic effects, improving coronary blood flow and myocardial contractility, which can be crucial for ventricular fibrillation and other cardiac emergencies.
• 😀 After defibrillation, if ventricular fibrillation persists, amiodarone, lidocaine, or magnesium sulfate may be used to reduce automaticity and improve outcomes.
• 😀 Amiodarone is often used in refractory ventricular fibrillation and is administered intravenously, with specific dosages depending on the situation (e.g., 300mg for first dose).
• 😀 Lidocaine is an alternative to amiodarone and works by inhibiting sodium channels to prevent arrhythmias. It is often used when amiodarone is unavailable.
• 😀 Magnesium sulfate is primarily used in cases of tachycardia associated with hypomagnesemia or digoxin toxicity, with a recommended dose of 2 grams IV.
• 😀 In cases of bradycardia or heart block, atropine can be used to increase heart rate and improve conductivity, with dosages up to 3mg.
• 😀 For supraventricular tachycardia (SVT), adenosine is an effective treatment, with doses starting at 6mg IV push. If unsuccessful, doses can be increased up to 18mg.
• 😀 In cases of severe metabolic acidosis or hyperkalemia during cardiac arrest, sodium bicarbonate, calcium gluconate, and insulin may be administered to correct electrolyte imbalances and protect the heart.

Q & A

What is the primary goal of cardiopulmonary resuscitation (CPR)?

The primary goal of CPR is to restore circulation and oxygenation to the heart and brain during cardiac arrest, improving the chances of survival and return of spontaneous circulation (ROSC).

What are the preferred routes of drug administration during CPR?

The preferred routes for drug administration during CPR are intravenous (IV) access through the peripheral veins, particularly the antecubital fossa or larger veins in the forearm. Central venous access is another option, but it is more time-consuming and interrupts chest compressions.

Why is adrenaline commonly used during cardiac arrest?

Adrenaline is commonly used during cardiac arrest because it has both alpha and beta adrenergic effects, which help improve coronary blood flow (alpha effects) and increase myocardial contractility and heart rate (beta effects), thus enhancing the chances of restoring spontaneous circulation.

What is the recommended dose of adrenaline for a patient in cardiac arrest?

The recommended dose of adrenaline during cardiac arrest is 1 mg IV push, followed by a 20 mL normal saline flush and arm elevation. This dose can be repeated every 3 to 5 minutes, depending on the patient's response.

What is amiodarone used for in cardiac resuscitation?

Amiodarone is used to treat refractory ventricular fibrillation and pulseless ventricular tachycardia. It works by inhibiting sodium, potassium, and calcium channels, as well as having alpha and beta-blocking properties, which help stabilize the cardiac rhythm.

What are the adverse effects of amiodarone?

The acute adverse effects of amiodarone may include hypotension, bradycardia, and potential thyroid dysfunction. Care should be taken in patients with thyroid toxicosis or thyroid dysfunction.

How should amiodarone be administered for refractory ventricular fibrillation?

For refractory ventricular fibrillation, amiodarone should be administered as an IV push of 300 mg, followed by a second dose of 150 mg if needed. For stable tachycardias, a 300 mg infusion over 20 to 60 minutes can be given.

When is lignocaine (lidocaine) preferred over amiodarone?

Lignocaine is preferred over amiodarone when amiodarone is unavailable or for refractory ventricular fibrillation and ventricular tachycardia. Lignocaine works by inhibiting sodium channels and preventing re-entry arrhythmias.

What is the initial dose of lignocaine during cardiac arrest?

The initial dose of lignocaine during cardiac arrest is 1 to 1.5 mg/kg IV push. This can be repeated with 0.5 to 0.75 mg/kg every 5 to 10 minutes, up to a maximum of 3 mg/kg.

What are the indications for magnesium sulfate during cardiac arrest?

Magnesium sulfate is indicated for treating arrhythmias related to hypomagnesemia, digoxin toxicity, and certain types of complex tachycardia. It is administered slowly via IV (2 grams over 1-2 minutes), and it can be repeated every 10-15 minutes if necessary.

How is calcium used in the treatment of hyperkalemia during cardiac arrest?

In cases of hyperkalemia during cardiac arrest, IV calcium gluconate (30 mL) is administered to protect the heart. This may be followed by insulin (10 units) and dextrose (50 mL) to shift potassium into the cells and reduce the risk of further cardiac complications.

What is the role of adenosine in the treatment of supraventricular tachycardia (SVT)?

Adenosine is used in the treatment of supraventricular tachycardia (SVT) to restore normal sinus rhythm. It is a short-acting agent given as an IV push of 6 mg, followed by a saline flush. If the first dose is ineffective, additional doses of 12 mg and 18 mg may be given.

What should be done if a patient remains bradycardic despite atropine administration?

If a patient remains bradycardic despite atropine administration, an IV infusion of adrenaline (2 to 10 micrograms per minute) can be considered. If pacing is unavailable and the patient is still unstable, further support with inotropes may be needed.