RESUSCITATION

PHARMACOLOGY

RESUSCITATION PHARMACOLOGY

Correct hypoxia

Establish spontaneous circulation at an

adequate blood pressure

Promote optimal cardiac function

Prevent or suppress arrhythmias

Relieve pain

Correct acidosis

Treat congestive heart failure

IMPORTANT DRUGS FOR ACLS

Oxygen
BP

Epinephrine/adrenaline

asopressin

Dopamine
!R

"tropine
entricular arrhythmia

"miodarone

#idocaine / lignocaine

Procainamide

$agnesium sulphate
%upraventricular arrhythmia

"denosine

&iltia'em

"miodarone
"$(

$orphine

)itroglycerine

"spirin

*ibrinolytics

$isc

%odium bicarbonate

Calcium chloride

SCHEME FOR STUDY

$echanism of action +,hy -.

(ndication +,hen -.

&osage +ho, -.

correct dose for the

correct indication through the

correct route

Precautions +,atch out /.

OXYGEN

$echanism of action
O
0
tension

hemoglobin saturation

tissue oxygenation

(ndication

"ll patients in "C#%

OXYGEN

&osage

%pontaneous breathing

1 2 3 #/min via nasal cannula

4 #/min for "$(

3 2 15 #/min via non6breathing face mas7

Cardiac arrest

18 #/min using bag mas7

Precaution

-- CO"&

Epinephrine / Adrenaline

$echanism of "ction

9 adrenergic stimulation

%R: %BP: &BP

coronary and cerebral blood flo,

electrical 9 strength of myocardium

myocardial O
2
requirement

automaticity

Epinephrine / Adrenaline

(ndication

"ll patient in cardiac arrest

Severe hypotension

Symptomatic bradycardia

Anaphylaxis

&osage

Cardiac arrest

1 mg +15ml 1;15555. ( push <=68 min

*lush ,ith )% > arm elevation for 15605s

0 2 0?8x ( dose through ETT

)on6Cardiac arrest

0 6 05g/min

Precautions

Precipitate in al7aline solutions

Epinephrine / Adrenaline

Va!prein

$echanism of action

Potent vasoconstrictor

%R: %BP: &BP

coronary and cerebral blood flo,

(ndication

"lternative to 1
st
and 0
nd
dose of epinephrine for
*/ pulseless T

Va!prein

&osage

45 @ ( push 1x

Precautions

$ay provo7e cardiac ischemia

D!pa"ine

$echanism of action

%timulation of dopaminergic: 9
adrenergic receptor

(ndication

!ypotension +A5 2 155mm!g.

%econd drug for hypotensive bradycardia

D!pa"ine

&osage

8 6 05g/7g/min

Titrate to response

Precautions

Taper gradually

%tart after volume replacement

&o not mix ,ith sodium bicarbonate

$onitor ( site

A#r!pine

$echanism of action

Bloc7 parasympathetic receptor of heart

%" node automaticity

" node conduction

)ot to stimulate the heart

(ndication

%ymptomatic sinus bradycardia

Bhile ,aiting for pacing +donCt delay.

%econd drug in asystole / PE"

Organophosphate poisoning

A#r!pine

&osage

"rrest

1mg (/(O push <= 2 8min

0 2 =mg ETT

Bradycardia

5?8mg (/(O <= 2 8min

$ax? =mg

Extremely large dose may be need for

organophosphate poisoning

A#r!pine

Precautions

Paradoxical bradycardia ,ith D 5?8mg

Borsen myocardial ischaemia

"void in hypothermic bradycardia

)ot useful in " bloc7 of

0
nd
degree Type ((

=
rd
degree

An#i$arrh%#h"i&

Pro6arrhythmics

)egative inotrope + force.

+>. for Ca channel bloc7er: 6bloc7er:

procainamide: lignocaine

+>. for amiodarone

+6. for digoxin

An#i$arrh%#h"i&

%lo, the heart +6ve chronotrope.

" node vs? accessory path,ay

" node only

"denosine: digoxin

" node E accessory path,ay

Ca channel bloc7er: 6bloc7er

#idocaine

" node F accessory path,ay

"miodarone: procainamide

A"i!dar!ne

$echanism of action

Bloc7 )a: G and Ca channels

9 bloc7ing properties

(ndication

T/* cardiac arrest refractory to shoc7 >

epinephrine

Recurrent life6threatening T

Other arrhythmias +need expert.

A"i!dar!ne

&osage

Cardiac "rrest

=55mg ( push +in 056=5ml &8.

> 185mg ( push in =68 min 1x

entricular Tachyarrhythmias

185mg ( over 15min

$aintenance

1mg/min ( for 3 hours then

5?8mg/min ( for 1H hours

$ax dose 0?0g/day

A"i!dar!ne

Precautions

$ultiple drug interaction

#ong half6life +up to 45 days.

!ypotension ,ith rapid/repeated dose

Prolong <T interval

Lid!&aine / li'n!&aine

$echanism of "ction

Bloc7 )a channel

ventricular ectopy

excitability in ischemic tissue

(ndication

"lternative to amiodarone in cardiac

arrest from T/*

%table T ,ith good #

Lid!&aine / Li'n!&aine

&osage

#oading

161?8mg/7g ( push +arrest.

5?865?A8mg/7g ( push +stable T.

> 5?865?A8mg/7g ( <= 6 8min

@p to =mg/7g

ETT; 064mg/7g 1x

$aintenance

164mg/min (

Lid!&aine / Li'n!&aine

Precautions

)ot recommended as prophylaxis in $(

Reduce dose

(mpaired liver function

Poor #

%top infusion if signs of toxicity occurs

Pr!&aina"ide

$echanism of "ction

Bloc7 )a channel

ventricular ectopy

conduction

(ndication

%uppression of recurrent */T

Other tachy6arrhythmias

Pr!&aina"ide

&osage

Recurrent */T

05mg/min +up to 85mg/min. infusion until

o
"rrhythmias suppression
o
!ypotension
o
<R% ,iden by 85I
o
1Amg/7g given +35mins for A57g patient.

$aintenance
o
1 2 4mg/min

Pr!&aina"ide

Precautions

!ypotension

Reduce to 10mg/7g max in patient ,ith

heart / renal failure

Prolong <T interval

Pro6arrhythmic: esp? in "$(: G: $g

Ma'nei(" S(lpha#e

&rug of choice for Torsades de Pointes

&osage

160g ( over 8605min

Then infusion 5?8 2 1g/hr

Titrate to control torsades

Aden!ine / ATP

$EC!")(%$ O* "CT(O)

%" node and " node

%hort half6life D 8s

()&(C"T(O)

Termination of P%T

&iagnostic maneuver for stable narro,

complex %T

Aden!ine / ATP

&O%"JE

3mg adenosine / 15mg "TP: follo, by 05ml

)%

10mg adenosine / 05mg "TP in 160min if no

response

" third dose of 10mg / 05mg "TP in 160min

PREC"@T(O)%

*lushing: dyspnoea: chest pain

Dil#ia)e"

$EC!")(%$ O* "CT(O)

Ca channel bloc7er

automaticity

conduction

()&(C"T(O)

Rate control for "*

Terminate stable re6entry %T if

adenosine fails

Dil#ia)e"

&O%"JE

18605mg ( over 0 min

Repeat in 18 min at 05608mg ( PR)

Then 8618mg/hr

Titrate to effect

PREC"@T(O)%

)ot to be used in

Bide complex tachycardia of uncertain origin

&rug induced tachycardia

BPB syndrome ,ith "*

DRUGS *!r AMI

K$O)" greets all $( patientsL

$ F $orphine

O F Oxygen

) F )itrate

" F "spirin

M!rphine

$EC!")(%$ O* "CT(O)

Relieve pain

myocardial oxygen demand

()&(C"T(O)

Chest pain no responding to nitrate

Pulmonary edema

M!rphine

&O%"JE

064mg ( <86=5min

Titrate to effect

PREC"@T(O)%

!ypotension

C)% / respiratory depression

Ni#r!'l%&erin

$EC!")(%$ O* "CT(O)

asodilation

preload: afterload

Coronary artery vasodilation

()&(C"T(O)

(schemic chest pain

Ongoing or recurrent ischaemia in $(

Pulmonary edema: hypertensive urgency

Ni#r!'l%&erin

&O%"JE

%# ; 5?8mg < 8min

( ; start ,ith 15605g/min

PREC"@T(O)%

Phosphodiesterase inhibitor for erectile

dysfunction

!ypotension

!eadache

Apirin

$EC!")(%$ O* "CT(O)

(nhibit platelet action

()&(C"T(O)

"ll patient ,ith "C%

&O%"JE

1306=08mg PO +=55mg.

Che,ing

PREC"@T(O)%

Peptic ulcer: asthma

Fi+rin!l%#i&

$EC!")(%$ O* "CT(O)

Reperfusion of myocardium

()&(C"T(O)

%T elevation $( or ne, #BBB

D10hr from onset

C!O(CE

%trepto7inase

"lteplase

PREC"@T(O)%

%creen for contraindications

Cal&i(" Chl!ride

()&(C"T(O)

!yper G

!ypo Ca

Ca channel bloc7er / 6bloc7er overdose

&O%"JE

8615ml 15I CaC(0

S!di(" ,i&ar+!na#e

()&(C"T(O)

!yper G

Bicarbonate responsive acidosis +&G".

Tricyclic antidepressant overdose

&O%"JE

1mmol/7g ( bolus

$onitor "BJ

PREC"@T(O)%

)ot routine for cardiac arrest

THAN- YOU