DRUGS AND DEFIBRILLATION
Department of Anesthesiology & Reanimation General Hospital Tasikmalaya
(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
Survival rate of early defibrillation
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
Ventricular Tachycardia
Ventricular Fibrillation
Algorithm VF/VT :
Defibrillate 200J Defibrillate 200-300J Defibrillate 360J Hypothermic? Yes Hypothermia
Spontaneous circulation Vital Sign Support breathing Provide appropriate med.
VF/VT Intubate Continue CPR Obtain IV access
PEA
Asystole
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 Choose medication Procainamide 15 mg/kg at 30 mg/min BicNat 1 meq/kg Defibrillate 360J after 30-60 sec.
Defibrillation
Used
firstly 3 times in Ventricular Fibrillation Dose : 200 Joule 300 Joule 360 Joule Drug Shock Drug Shock Pediatric dose : 2 J/kg 4 J/kg
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
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.
Epinephrine ( Adrenaline )
Alfa adrenergic : promote peripheral vascular vasoconstriction increase of diastolic pressure
improve coronary circulation
preserve myocardial oxygenation greater possibilities of spontaneous heart contraction
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.
Lidocaine
Dose: 1- 2 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
Lidocaine
Potential complications: Dizziness, drowsiness, disorientation, seizures Hypotension - causes vasodilation; myocardial depression at higher concentrations Heart block - only rarely seen with high levels
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
Magnesium Sulfate
Dose
: 1 2 gr, if suspected hypomagnesemia or refractory VT
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
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
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.
