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Advanced Life Support > Peri-arrest and Second Line Drugs > Flashcards

Peri-arrest and Second Line Drugs Flashcards

(65 cards)

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1
Q

Action of atropine

A

Anticholinergic muscarinic receptor blocker
Blocks action of vagal nerve on the heart
Reduces refractory period of SA and AV node, increasing rate of discharge and enhancing conduction

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2
Q

Indications of atropine

A

Severe bradycardia with haemodynamic compromise
NO LONGER RECOMMENDED ASYSTOLE

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3
Q

Dosage of atropine

A

Symtomatic bradycardia 0.5-1mg

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4
Q

Dosage of atropine (paediatric)

A

20mcg/kg
40mch/kg ETT

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5
Q

Administration atropine

A

IV or IO bolus
can repeat every 3-5 minutes
Max 3mg

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6
Q

Administration atropine (paediatric)

A

IV or IO bolus
can repeat evert 5 minutes
Max 600mcg

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7
Q

Contraindications of atropine

A

Glaucoma

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8
Q

Adverse effects of atropine

A

Anticholinergic effects
Dries secretions
Urinary retention
Dilated pupils
Hyperthermic (large doses)
Delirium
Excitement
Tachycardia

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9
Q

Atropine considerations

A

Doses given too slowly or <0.5mg in adults can cause transient paradoxical slowing of heart rate and may cause arrythmias

Avoid large doses in coronary patients as excessive tachycardia can occur, aggravating myocardial ischemia and/or precipitating ventricular arrythmias

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10
Q

Action of lignocaine

A

1b antiarrhythmic
Sodium channel blocker, reducing action potential, slowing cardiac conduction
also LA effect

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11
Q

Indications of lignocaine

A

Failure of defibrillation and adrenaline to revery pulseless VT/VF
Can be used as prophylaxis in setting of recurrent VT/VT
Conscious VT

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12
Q

Dosages of lignocaine

A

1mg/kg
0.5mg/kg may be considered as additional bolus
2mg/kg ETT

administered between 3rd and 4th shock

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13
Q

Dosages of lignocaine (paediatric)

A

1mg/kg
2mg/kg ETT

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14
Q

Administration of lignocaine

A

IV/IO bolus 25-50mg/min
Max 300mg

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15
Q

Adverse effects of lignocaine

A

Hypotension
Bradycardia
Heart block
Seizures
Asystole
Slurred speech
Altered consciousness
Muscle twitching

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16
Q

Action of magnesium

A

Smooth muscle relaxation and cell membrane stabilisation through inhibition of calcium channels resulting in reduced intracellular calcium

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17
Q

Indications of magnesium

A

Torsades de Pointes
Hypomagnesaemia (particularly when associated with hypokalemia)
Documented hypokalemia
Cardiac arrest due to digoxin toxicity

May be requested in event of defib and adrenaline failure to revert VF and pVT

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18
Q

Dose of magnesium

A

5mmol - can repeat once

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19
Q

Dose of magnesium (paediatrics)

A

0.1-0.2mmol/kg

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20
Q

Administration of magnesium

A

IV/IO bolous

consider 10-20mmol infusion over 1-2hr per electrolytes

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21
Q

Administration of magnesium (paediatrics)

A

IV/IO bolus
followed by 0.3mmol/kg infusion

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22
Q

Contraindications of magnesium

A

AV blocks
Magnesium toxicity

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23
Q

Adverse effects of magnesium

A

Muscle weakness
Respiratory depression/fatigue
Hypotension

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24
Q

Magnesium considerations

A

1g calcium gluconate to reverse hypermagnesemia

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25
Action of potassium
Essential for stability of cell membranes
26
Indications of potassium
Persistent VF/VT due to documented hypokalemia Hypomagnesemia
27
Dosage of potassium
5mmol
28
Dosage of potassium (paediatric)
0.05mmol/kg
29
Administration of potassium
Slow IV or IO bolus
30
Contraindications of potassium
N/A
31
Adverse effects of potassium
Hyperkalemia Bradycardia Hypotension Tissue necrosis with extravasation
32
Action of sodium bicarbonate 8.4%
Alkalizing solution, combines hydrogen ions to form carbonic acid to reverse acidosis
33
Indications of sodium bicarbonate 8.4%
Hyperkalemia Documented metabolic acidosis (pH<7/0 or BE>-10,,ol/L) Overdose of tricyclic antidepressants or phenobarbitone Protracted cardiac arrest lasting >15minutes
34
Dosage of sodium bicarbonate 8.4%
1mmol/kg
35
Dosage of sodium bicarbonate 8.4%
1mmol/kg
36
Administration of sodium bicarbonate
IV/IO bolus over 2-3min Then as guided by ABG usually pH<7.1
37
Administration of sodium bicarbonate (paediatrics)
IV/IO bolus over 2-3min Then as guided by ABG usually pH<7.1
38
Contraindications of sodium bicarbonate
Nil
39
Adverse effects of sodium bicarbonate
Hypernatremia and hyperosmolality Hypokalemia Paradoxical cerebral acidosis Depressed cardiac contractility Metabolic alkalosis shifts O2/hb curve to left
40
Sodium bicarbonate considerations
INCOMPATIBLE WITH ALL OTHER DRUGS - requires dedicated IV line in the prolonged arrest >15min May be indicated after confirmation of severe acidosis (ABG)
41
Action of calcium
Electrolyte essential for normal muscle and nerve activity Increases myocardial excitability, contractility and peripheral resistance
42
Indication of calcium
Hyperkalemia Hypocalcaemia Overdose of calcium-channel blockers Hypermagnesiumaemia
43
Dosage of calcium
5-10ml of 10% calcium chloride or calcium gluconate
44
Dosage of calcium (paediatric)
0.2ml/kg of 10% calcium chloride OR 0.7ML/KG OF CALCIUM GLUCONATE
45
Administration of calcium
IV/IO bolus (adults and paediatrics)
46
Contraindications of calcium
N/A
47
Adverse effects of calcium
Possible increased myocardial and cerebral injury by mediating cell death Tissue necrosis by extravasation
48
Calcium considerations
Incompatible with range of drugs - may precipitate in IV lines
49
Action of isoprenaline
Acts exclusively on beta-adrenergic receptors B1 effects include increased cardiac contracility and heart rate B2 effects include bronchodilation and vasodilation
50
Indications of isoprenaline
Symptomatic bradycardia - particularly when originating below AV node AV blocks unresponsive to atropine Pharmacological pacing in Torsades de points
51
Dosage of isoprenaline
Bolus 20mcg - 60mcg Infusion 0.5-10mcg/min
52
Dosage of isoprenaline (paediatric)
Bolus not recommended Infusion 0.05-2mcg/kg/min
53
Isoprenaline infusion
3mg in 50ml 5% dextrose OR 6mg made up to 100ml 5% dextrose = 60mcg/ml
54
Administration routes of isoprenaline
IV/IO adults and paeds
55
Contraindications of isoprenaline
N/A
56
Adverse effects of isoprenaline
Tachyarrhythmia Hypotension - diastolic BP may fall due to reduction in peripheral vascular resistance Myocardial iscaemia
57
Considerations of isoprenaline
Sometimes referred to as "pharmacological pacing" Use continuous cardiac monitoring when administering
58
Action of adenosine
Depresses node activity, slowing conduction AV nod, causing transient AV block, interrupting re-entry circuit - allows restoration normal sinus rhythm
59
Indications of adenosine
SVT - acute treatment Diagnostic aid for broad and narrow complex tachycardia Wolfe Parkinson White Syndrome
60
Dosage of adenosine
Initial: 3mg rapid IV bolus If unsuccessful after 1-2min: rapid 6mg bolus If unsuccessful after 1-2min: rapid 12mg bolus
61
Dosage of adenosine (paediatric)
All ages 1st dose 0.1mg/kg (max 6mg) 2nd 0.2mg/kg (max 12mg) 3rd 0.3mg/kg (max 12mg)
62
Administration of adenosine
IV/IO bolus (adults and paeds) Administer into large IV cannula rapid IV bolus followed by rapid N/S flush
63
Contraindications of adenosine
N/A
64
Adverse effects of adenosine
Bradycardia Chest pain Dizziness Nausea "Impending doom" Facial flushing Headache
65
Considerations of adenosine
ECG during drug administration is required due to transient AV block determining atrial activity

Advanced Life Support (7 decks)

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