Resuscitation Drugs
Adrenaline: (Epinephrine)
1: 10,000 (1mg in 10mls) via peripheral IV
1: 1,000 (1mg in 1ml) via CVC
T ½ = 3 minutes
During Arrest administer 1mg 1 in 10,000 every 3 minutes
Actions of Adrenaline in non-perfusing rhythms:
 Vasoconstriction redistributes blood to vital organs: heart & brain
Actions of Adrenaline in perfusing rhythms:
 Increase heart rate & BP
 2 – bronchodilation
Adverse effects of Adrenaline:
 Tachycardia/tachyarrhythmias
 HT – CVA
  Glucose – may lead to  K
 tissue necrosis if extravasates
 peripheral vasoconstriction – can cause ischaemia
 tremor/anxiety/dilated pupils
Always flush with 10-20ml of N.Saline or D5W
Lignocaine Hydrochloride
Indications in cardiac arrest:
 To be administered in VF/VT arrest only
 After 2 rounds of shocks & 1 dose Adrenaline given
 NB Less effective if K low
Doses:
1mg/kg IV over 60 secs
May repeat at 0.5mg/kg after 5mins and again 5mins later to a total of 2mg/kg
T ½ is 4-5mins
If successful in reverting VF:
Infusion: 2g lignocaine in 500ml D5W
4mg/min for 1st hr (60ml/hr)
3mg/min for 2nd hr (45ml/hr)
2mg/min for 3rd hr (30 ml/hr)
Adverse effects of lignocaine
CNS: seizure, drowsiness, dizziness, confusion
CVS: BP, AV-block, bradycardia, asystole, Torsades (prolongs Q-T)
GIT: N&V
CONTRAINDICATED IN TORSADES
Other Second Line Anti-Arrhythmics
Potassium:
5mmol IV stat, 1g (13.4mmol) IV/hr
Aim to get K > 4.5
Magnesium
5mmol bolus, can repeat
Follow with infusion: 20mmol in 4 hrs
Sodium Bicarbonate
0.5-1mmol/kg VIA DEDICATED LINE, followed by flush
Indications:
 Prolonged arrest (>15-20 mins)
 Acidosis pH < 7.2 or documented metabolic acidosis pre-arrest (eg renal,
cardiac or hepatic failure, DKA, septic, hypoxic) – guided by ABG’s
 Hyperkalaemia
 TCA OD with arrhythmias (VE’s, VT, Torsades) alkalinizing serum  toxicity
of TCA
NB Last in protocol because CAN MAKE OUTCOME WORSE:
Theory – HCO3 will mop up H+ ions & make CO2/H20
HCO3- + H+  H2Co3  H20 + CO2
BUT most Pts don’t have acidosis until late in arrest
Adverse effects of HCO3
 Intracellular acidosis
HCO3 causes CO2 load
CO2 19 times more diffusible than O2 – so it enters cell & reverses equation
(causing shift to  H+)
 Respiratory acidosis
 Metabolic alkalosis
- Shifts O2/Hb dissociation curve left -  tissue oxygenation)
-  ionized Ca (as pH  Ca binds to Alb – makes less available to
myocardium)
-  effect of Adr (pH of Adr is 3.5 ie it’s an acid)
- NEVER GIVE HCO3 & Adr IN SAME LINE
- Hypokalaemia – H+ leaves cell, K enters, makes lignocaine less
effective
 Hypernatraemia – ie Na given with HCO3 (NaHCO3)
 Hyperosmolarity (from  Na) – can cause cerebral oedema
 Precipitates in line with MANY other drugs – must flush thoroughly
Atropine
Indications/Dose
Asystole: 1mg IV bolus
Symptomatic bradycardia or VE’s in presence of  heart rate: 0.5-0.6mg IV
Maximum dose = 3mg
Action: opposes parasympathetic effect on myocardium – allows sympathetic to
predominate -  HR
Adverse effects
 Tachycardia/tachyarrhythmias
  myocardial O2 consumption/ischaemia
 Dilated pupils, dry mouth, urinary retention, hyperthermia ( doses)
Adenosine
Can convert SVT to SR
Will not convert AF, flutter or VT to SR, but will slow ventric rate (which may help
to see flutter waves by  block)
NB Conscious with WIDE complex tachycardia - ? VT or ? SVT with aberrancy
Dose: Start with 6mg
Then 12mg
Can  to 24 mg, but if 12 doesn’t work, may try something else
CI:
2nd or 3rd degree AV block without pacemaker
May  ventric rate in WPW
Sick Sinus Syndrome (tachy-brady syndrome)
May exacerbate asthma
SE:
Extreme ancxiety/impending doom
Facial flushing, dyspnoea, chest tightness, nausea
SEVERE BRADYCARDIA – not resolved with atropine, may require Adr +/pacing.
NB: ALWAYS HAVE
ATROPINE (for bradycardia)
ARAMINE (for hypotension)
ADRENALINE (for arrest)
AND IV FUID RUNNING
WHILE GIVING ADENOSINE
2 IV’s ISN”T A BAD IDEA EITHER!
Can give Mg prior/as well
Before giving Adenosine for SVT try:
Carotid Sinus massage (if < 40yo)
Valsalva
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ON HAND
Ice-cold drink/Put face in ice water
Children: - cold facewasher, ripping off band-aid, rectal dilation
If Adenosine doesn’t work
Verapamil
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beware of contraindications for these
Sotalol
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Cardioversion
Amiodarone