1 / 31

ACLS Medications

ACLS Medications. Bradycardia. Atropine Dopamine infusion Epinephrine infusion. Atropine. Mechanism of Action Inhibits the actions of acetycholine on structures innervated by postganglionic sites (smooth/cardiac muscle, SA/AV nodes). Atropine. Indications

Gabriel
Télécharger la présentation

ACLS Medications

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. ACLS Medications

  2. Bradycardia • Atropine • Dopamine infusion • Epinephrine infusion

  3. Atropine • Mechanism of Action Inhibits the actions of acetycholine on structures innervated by postganglionic sites (smooth/cardiac muscle, SA/AV nodes)

  4. Atropine • Indications • First drug for symptomatic sinus bradycardia • May be beneficial in AV block or asystole • Second drug in asystole or slow PEA • Organophosphate poisoning; large dose may be needed • Precautions • MI and hypoxia – atropine increases oxygen demand • Avoid in hypothermia • Not effective for 2nd type II or new 3rd degree block (may slow the rhythm) • Doses < 0.5 mg may cause a paradoxical slowing

  5. Atropine Don’t delay pacing for severely symptomatic (unstable) patients. • Asystole or slow (<60)PEA • 1 mg IV/IO push • Repeat every 3 to 5 minutes (if rhythm persists) to max. of 3 mg. • Bradycardia • 0.5 mg IV every 3-5 minutes as needed; max. of 3 mg. • Use shorter dosing interval and higher doses in severe clinical situations • Endotracheal Administration • 2-3 mg diluted in 10 mL water or NS • Organophosphate Poisoning • Large doses (2-4 mg or higher) may be necessary

  6. Dopamine • Mechanism of Action Stimulates adrenergic receptors; dose dependent.

  7. Dopamine • Indications • Second-line drug for symptomatic bradycardia • Hypotension with signs and symptoms of shock • Precautions • Correct hypovolemia with volume before initializing • Use caution with cardiogenic shock and associated CHF • May cause tachydysrhythmias; excessive vasoconstriction • Don’t mix with sodium bicarbonate • IV Administration • Infusion at 5-20 mcg/kg/min. • Titrate to patient response; taper slowly

  8. Epinephrine • Mechanism of Action Stimulates adrenergic receptors and is not dose dependent like dopamine.

  9. Epinephrine • Indications • Cardiac arrest • VF; VT; asystole; PEA • Symptomatic bradycardia • After atropine; alternative to dopamine • Severe hypotension • When atropine and pacing fail; hypotension accompanying bradycardia; phosphodiesterase enzyme inhibitors • Anaphylaxis; severe allergic reactions • Combine with large fluid volume; corticosteroids; antihistamines

  10. Epinephrine • Precautions • May increase myocardial ischemia, angina, and oxygen demand • High doses do not improve survival; may be detrimental • Higher doses may be needed for poison/drug induced shock • Dosing • Cardiac arrest 1 mg (1:10,000) IV/IO every 3-5 min. • High dose up to 0.2 mg/kg for specific drug OD’s • Infusion of 2-10 mcg/min. • Endotracheal of 2-2.5 times normal dose • SQ/IM 0.3-0.5 mg

  11. Tachycardia • Adenosine • Diltiazem • Metoprolol • Amiodarone • Lidocaine • Magnesium Sulfate

  12. Adenosine • Mechanism of Action Slows impulse formation in the SA node; slows conduction time through AV node; depresses left ventricular function and restores NSR.

  13. Adenosine • Indications • 1st drug for stable, narrow complex, regular SVT • May consider for unstable SVT while preparing for cardioversion • Wide-complex tachycardia thought to be, or determined to be reentry SVT • Does not convert atrial fibrillation, atrial flutter, or VT • Diagnostic maneuver; stable narrow-complex SVT

  14. Adenosine • Contraindications/Precautions • Poison/drug induced tachycardia is contraindicated • 2nd and 3rd degree block is contraindicated • Transient side effects; flushing, CP, asystole, brady, ectopy • Less effective with theophylline or caffeine • If used for VT may cause worsening of clinical condition • Transient periods of sinus brady or ventricular ectopy common after termination of SVT • Safe in pregnancy

  15. Adenosine • Place supine or mild reverse Trendelenburg • 6 mg rapidly followed by 20 mL flush • May repeat at 12 mg every 1-2 minutes if unsuccessful

  16. Diltiazem • Mechanism of Action Inhibits calcium movement across cell membranes of cardiac and smooth muscle. Causes vasodilation, decreses heart rate and contractility, slows SA and AV conduction.

  17. Diltiazem • Indications • Controlling ventricular rate in a-fib or flutter • After adenosine to treat refractory reentry SVT if adequate blood pressure • Contraindications/Precautions • Do not use with wide-complex rhythms • Do not use with poison/drug induced tachycardia • Avoid in WPW • Avoid in AV nodal blocks • Blood pressure may drop from peripheral vasodilation

  18. Diltiazem • Rate control • 15-20 mg (0.25 mg/kg) IV over 2 minutes • After 15 min. another 20-25 mg (0.35 mg/kg) IV over 2 minutes, if needed • Maintenance Infusion • 5-15 mg/hour; titrated to physiologically appropriate heart rate

  19. Metoprolol • Mechanism of Action Selectively blocks beta-1 receptors, slowing sinus heart rate, decreasing cardiac output, and decreasing BP.

  20. Metoprolol • Indications • Administer to all patients with suspected MI or unstable angina, absent contraindications • Second-line agent for SVT refractory to adenosine • To reduce myocardial ischemia in MI patients with elevated heart rate and/or blood pressure • Emergency antihypertensive therapy for acute hemorrhagic or ischemic stroke

  21. Metoprolol • Contraindications/Precautions • Hemodynamically unstable patients should not receive • Signs of heart failure • Low cardiac output • Increased risk for cardiogenic shock • Relative contraindications: 1st, 2nd, 3rd degree blocks; active asthma; reactive airway disease; severe bradycardia; hypotension < 100 mmHg • Concurrent administration of calcium channel blockers can cause serious hypotension • Monitor cardiac and pulmonary status throughout

  22. Amiodarone • Mechanism of Action Prolongs myocardial cell action potential duration and refractory period by direct action on all cardiac tissue; decreases AV and SA conduction rates.

  23. Amiodarone • Indications • Life threatening dysrhythmias • VF/pulseless VT unresponsive to shock, CPR, and vasopressor • Recurrent hemodynamically unstable VT • Seek expert opinion for other uses • Contraindications/Precautions • Bradycardia • 2nd and 3rd degree block • Do not administer with meds that prolong QT interval (procainamide)

  24. Amiodarone • VF/VT – 300 mg IV/IO in 20-30 mL NS. Can follow with ONE dose of 150 mg in 3-5 minutes, if needed. • Life threatening dysrhythmias • 150 mg over 10 minutes. May repeat every 10 minutes as needed.

  25. Lidocaine • Mechanism of Action Decreases depolarization, automaticity, and excitability of ventricle during diastole by direct action, reversing ventricular dysrhythmias.

  26. Lidocaine • Indications • Alternative to amiodarone in VF/VT arrest • Stable monomorphic VT • Malignant PVC’s • Can be used if Torsades is suspected • Contraindications/Precautions • Prophylactic use in AMI is contraindicated • Reduce maintenance dose in liver impaired patients • Discontinue infusion if toxicity develops

  27. Lidocaine • Cardiac Arrest • Initial dose is 1-1.5 mg/kg • Refractory VF 0.5-0.75 mg/kg in 5-10 min. Max 3 mg/kg • Endotracheal dose 2-4 mg/kg • Perfusing Dysrhythmia • 0.5-0.75 mg/kg up 1-1.5 mg/kg dosing range. Repeat if necessary at lower range to total dose of 3 mg/kg • Maintenance Infusion • 1-4 mg/min

  28. Magnesium Sulfate • Mechanism of Action Increases magnesium levels in cases where prolonged QT interval is thought to be secondary to hypomagnesemia.

  29. Magnesium Sulfate • Indications • Torsades is suspected in cardiac arrest • Lfe-threatening ventricular dysrhythmias in digitalis OD • Precautions • Fall in BP with rapid administration • Use caution in renal failure • Dosing • Arrest 1-2 g over 5-20 min. • Torsades w/ pulse 1-2 g over 5-60 min.

  30. Vasopressin • Mechanism of Action Causes vasoconstriction with reduced blood flow, increasing core perfusion during cardiac arrest.

  31. Vasopressin • Indications • Alternative to epinephrine in adult refractory VF/VT • Alternative to epinephrine in asystole or PEA • Contraindications/Precautions • Potent peripheral vasoconstrictor (increased demand upon resuscitation) • Dosing • Single dose of 40 u that replaces either the 1st or 2nd dose of epinephrine. Epinephrine can be resumed 3-5 minutes after • Can be used endotracheally; no suggested dose

More Related