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ACLS

Advanced Cardiovascular Life Support Medications

QuestionAnswer
Medication administration during a code should not interrupt what? Chest compressions
Administration closest to ______ is most effective. Central circulation
If administering drugs peripherally, how can you improve time for drug to reach central circulation? 1) Keep extremity raised 2) Push drug into a line with free running fluids OR follow every bolus with a 10-20 ml FLUSH
If giving drugs via endotracheal tube, what is the usual dose, and how should they be prepared? 2-2.5x usual dose. 1) Chest compressions stopped 2) Diluted in 10 mL NS or distilled water 3) Given via catheter passed beyond the tip of the trach tube followed by quick insufflations 4) Given quickly 4)
What 5 drugs can be given via endotracheal tube? NAVEL: Naloxone, Atropine, Vasopressin, Epinephrine, Lidocaine
Alpha 1 and 2 receptors cause what? Vascular smooth muscle vasoconstriction, alpha 1: +inotropic and -chronotropic activity
Beta 1 receptors cause what? Vascular smooth muscle vasoconstriction, +inotropic and +chronotropic activity
What is the most beneficial drug during cardiac arrest and why? Epinephrine - improves cerebral and myocardial blood flow due to vasoconstriction causing increased perfusion pressure
What is the epinephrine dose in cardiac arrest? 1mg (1 bristojet) q 3 -5 minutes IV or IO *If endotracheal, 2-2.5mg (2 bristojets) q 3-5 minutes Drip: 1 mg in 250 NS or D5W, start at 1 mcg/min, titrate to effect, typically 2-10 mcg/min
What is vasopressin? Antidiuretic hormon that causes peripheral vasoconstriction without increasing myocardial oxygen consumption
When would you use vasopressin? As alternative to epi for tx of adult, shock-refractory, VFib. Ex: If pt on pressors for a few days and concern for pressor-resistance. OR If pt initially responds to epinephrine, then after 2 min, BP falls again.
What is the vasopressin dose? 40 units x 1 IV or IO (drawn up from 2 vials). T1/2 = 10-20 minutes. May replace either 1st or 2nd dose of epi.
What are 2 negative side effects of antiarrhythmics? They can cause arrythmias and depress LV function, precipitating or worsening HF. Lidocaine and Amio have less negative inotropic effects than others.
What is the mechanism of action of Amiodarone? Decreases conduction velocity, prolongs repolarization and refractory period, and has alpha and beta anti-andrenergic activity.
What are the indications for Amiodarone? Ventricular tachycardia, ventricular fibrillation, supraventricular tachycardia.
What is the dose of Amiodarone in pulseless VT/VF? 300mg in 20-30 ml NS or D5W. May repeat 150mg in 3-5 minutes if needed x 1. No filter necessary for doses made at bedside.
After successful resuscitation of VT/VF by Amiodarone, what infusion dose should be administered (with filter)? I mg/min = 360 mg IV over 6 hours, then 540 mg IV over 18 hours (0.5mg/min). Max dose 2 g/24 hours. Convert to PO as soon as able.
What are acute adverse effects of Amiodarone? Bradycardia, hypotension, QT prolongation
What is the mechanism of action of Lidocaine? Inhibits ion flow through Na channels. (lower rates of ROSC and higher rates of asystole with lidocaine than with amio)
What are the indications for Lidocaine? VT/VF, PVCs, wide complex tachycardias
What is the dose of Lidocaine in VT/VF? 1 to 1.5mg/kg IV (one bristojet is usually an adequate dose) If VT/VF persists, an additional dose of 0.5 to 0.75mg/kg IV push can be given 5-10 minutes later (max 3mg/kg or 3 bristojets)
After successful resuscitation of VT/VF by Lidocaine, what is the maintenance dose? 1-4 mg/min, with the lowest dose 1mg/min best. Reduce dose in presence of impaired liver function or LV dysfunction
What is the 1/2 life of Amiodarone and Lidocaine? Amiodarone: 53 days Lidocaine: 1.5-3 hours (prolonged in HF, liver disease, shock or renal dysfunction)
What are signs of Lidocaine toxicity? CNS related: muscle twitching, slurred speech, altered consciousness, decreased hearing, parasthesias, seizures. D/C immediately if these signs seen.
Created by: csumme
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