Thursday, December 1, 2022
HomeNurses Note Quick ListAdvanced Life Support Medications:...

Advanced Life Support Medications: Adrenaline, Amiodarone, Atropine, Bicarbonate, Lidocaine, Magnesium, Calcium

Adrenaline Advanced Life Support Medications

The vasoconstrictor adrenaline is known to enhance both myocardial and cerebral perfusion, although there is no evidence that it increases the survival to hospital discharge in cardiac arrest. It has a very short half-life and so repeated intravenous (IV) doses (1mg for adults) are given every 3–5min during CPR. In children, the corresponding IV/intraosseous (IO) dose is 10mcg/kg. Adrenaline should be given as soon as circulatory access is obtained in non-shockable rhythms and after the third shock (once chest compressions have been resumed) in shockable rhythms. Adrenaline may be contraindicated in arrests secondary to solvents, cocaine or other sympathomimetic drugs.

Amiodarone Advanced Life Support Medications

Amiodarone is given for refractory VF/pulseless VT after the third shock (once compressions have been resumed). It stabilises cell membranes and thus increases the duration of the action potential and refractory period in both atrial and ventricular myocardial cells. As an antiarrhythmic agent, it prolongs the Q–T interval and slows conduction through both the atrioventricular (AV) node and any accessory pathways. Amiodarone has less negative inotropic effects and fewer proarrhythmic actions than most similar drugs. An initial IV bolus of 300mg should be given in adults; the equivalent IV/IO dose for children is 5mg/kg. A further dose of 150mg may be given for persistent or recurrent VF/VT, followed by an infusion of 900mg over 24h.

Atropine Advanced Life Support Medications

Atropine is no longer recommended in cardiac arrest. Pulseless patients with extreme bradycardia or isolated P waves may benefit from pacing.

Bicarbonate Advanced Life Support Medications

Bicarbonate therapy is contraindicated in early resuscitation. Acidosis develops but aids oxyhaemoglobin dissociation; temporary buffering of pH is achieved by hyperventilation. Sodium bicarbonate is reserved for cardiac arrests that are associated with the following:

1 Hyperkalaemia

2 Poisoning with tricyclic antidepressants.

The initial dose is 50–100mmol (or 1–2mmol/kg). Prolonged arrest (i.e. over 20–25min) causes profound intracellular acidosis and so may also be treated with alkalising agents, especially in children.

Lidocaine Advanced Life Support Medications

Lidocaine reduces ventricular automaticity and ectopic activity and increases the threshold for the development of VF. However, it also causes an in -crease in:

• the energy required for defibrillation

• the incidence of post-shock asystole.

In addition, it is a negative inotrope. For these reasons, it is not routinely used for refractory VF/VT unless amiodarone is unavailable. The initial IV/IO dose for both adults and children is 1.0–1.5mg/kg to a maximum total dose of 3mg/kg in the first hour. Lidocaine and amiodarone should not be used together.

Magnesium Advanced Life Support Medications

Magnesium is an important intracellular cation and co-factor. It should be given for refractory VT that could be associated with low serum magnesium levels, e.g. in a patient known to be taking potassium-losing diuretics. Similar indications include arrests after episodes of torsade de pointes or in patients with digoxin toxicity. The usual dose of magnesium sulphate is 8mmol (2g or 4mL of a 50% solution). For children, the dose is 25–50mg/kg by IV infusion over several minutes. These doses may be repeated after 10–15min.

Calcium Advanced Life Support Medications

Calcium influx occurs at the time of cell death and thus it is illogical to give calcium to patients in cardiac arrest. Exceptions occur during resuscitation from PEA or asystole when there is thought to be one of the following conditions:

1 Hyperkalaemia

2 Hypocalcaemia

3 Poisoning with calcium antagonists

4 Overdosage with magnesium (e.g. during treatment of eclampsia).

The initial IV dose in these situations is 10mL of 10% calcium chloride (6.8mmol calcium ions), repeated as necessary. For children the dose of 10% calcium chloride solution is 0.2mL/kg. Calcium may form a precipitate if given in the same IV line as bicarbonate and is dangerous in the digitalised patient. Calcium channel blocking drugs have not fulfilled their early promise and do not improve outcome after cardiac arrest.

- A word from our sponsors -

spot_img

Most Popular

LEAVE A REPLY

Please enter your comment!
Please enter your name here

More from Author

Specimen Collection Papanicolaou (Pap) Smear: Overview, Indication, Procedure

Specimen Collection Papanicolaou (Pap) Smear: The Pap smear is a tool...

Tracheostomy Dressing Care: Procedure and Indications

A tracheostomy is a surgical opening into the trachea and hence a potential route of infection, so the area should be kept clean. Tracheostomies can also cause damage to the surrounding tissues through pressure and the presence of irritant secretions

- A word from our sponsors -

spot_img

Intestinal Obstruction: Types, Causes, Symptoms, Diagnosis, Management, Complications Nursing Diagnosis

Intestinal obstruction is an interruption in the normal flow of intestinal contents along the intestinal tract. The block may occur in the small or large intestine, may be complete or incomplete, may be mechanical or paralytic, and may or may not compromise the vascular supply. Obstruction most...

Specimen Collection Papanicolaou (Pap) Smear: Overview, Indication, Procedure

Specimen Collection Papanicolaou (Pap) Smear: The Pap smear is a tool for screening of cervical cancer. Appropriate smear collection is paramount to the detection of cancer cells. In addition, if a lesion is seen or palpated, other tests, such as an ultrasound examination of the pelvis or...

Tracheostomy Dressing Care: Procedure and Indications

A tracheostomy is a surgical opening into the trachea and hence a potential route of infection, so the area should be kept clean. Tracheostomies can also cause damage to the surrounding tissues through pressure and the presence of irritant secretions

Nursing Mock Test, Nursing MCQ, DHA, HAAD, MOH PROMETRIC, AIIMS, ESI, NHM NURSING EXAM PREPARATION

Nursing Mock Test, Nursing MCQ, DHA HAADMOH PROMETRIC AIIMS ESI NHM NURSING EXAM PREPARATION Nursing Exam Preparation Nursing Mock Test Series Nursing Online Examination Free Nursing exam questions

Appendicitis: Causes, Symptoms, Diagnosis, Management, Nursing Interventions

Appendicitis is inflammation of the vermiform appendix caused by an obstruction of the intestinal lumen from infection, stricture, faecal mass, foreign body, or tumour.

Induction of labour: Indications, Method, Management, Complications, Bishop score

Induction of labour is initiated using mechanical and pharmacological methods. The intervention is necessary when the well-being of the mother or baby may be at risk if the pregnancy is continued. The parents should be in agreement and fully informed of the procedures. Indications of Labour • Post-maturity.  • PROM...

Nursing Mock Test, Nursing MCQ, DHA HAADMOH PROMETRIC AIIMS ESI NHM NURSING EXAM PREPARATION NO: 09

Nursing Mock Test, Nursing MCQ, DHA HAADMOH PROMETRIC AIIMS ESI NHM NURSING EXAM PREPARATION NO: 09 Nursing Exam Preparation Nursing Mock Test Series Nursing Online Examination Free Nursing exam questions

Psoriasis: Symptoms, Causes, Diagnosis, Treatment

Psoriasis is a chronic skin disorder characterized by excessive proliferation of keratinocytes, resulting in the formation of thickened scaly plaques, itching, and inflammatory changes of the epidermis and dermis. The various forms of psoriasis include guttate, pustular, and arthritis variants. SIGNS AND SYMPTOMS OF PSORIASIS • Approximately 85% of...

Ovarian Cancer: Causes, Symptoms, Diagnosis, Management, Nursing Diagnosis

Ovarian cancer is a gynecologic malignancy with high mortality because of advanced disease by time of diagnosis. It is the leading cause of morbidity of gynecologic cancers.  Pathophysiology and Causes of Ovarian Cancer  1. Median age is 60 years. One of 70 women will develop ovarian cancer.   2. Cause is...

Pericardiocentesis: Preparation Procedure Complications

Pericardiocentesis: Echocardiography-directed pericardial drainage is required for cardiac tamponade due to excess pericardial fluid and to obtain samples of pericardial fluid for the purposes of investigation. Preparation and equipment required for Pericardiocentesis Establish peripheral venous access, and check that full facilities for resuscitation are available. Pre-prepared pericardiocentesis sets may...

Hysteroscopy: Test Overview, Indication, Procedure, Normal Findings, Complication

Hysteroscopy test allows direct visualization of the endometrial cavity. It is indicated for women with an abnormal Papanicolaou (Pap) test, dysfunctional uterine bleeding, or postmenopausal bleeding. NORMAL FINDINGS OF HYSTEROSCOPY Normal structure and function of the uterus. TEST EXPLANATION OF HYSTEROSCOPY Hysteroscopy is an endoscopic procedure that provides direct visualization...

Levothyroxine: Action, Uses, Dosage, Side Effects Nursing Consideration

Levothyroxine: CLASSIFICATION: PHARMACOTHERAPEUTIC: Synthetic isomer of thyroxine. CLINICAL: Thyroid hormone (T4). USES OF LEVOTHYROXINE Levothyroxine: PO treatment of hypothyroidism, pituitary thyroid-stimulating hormone (TSH) suppression. IV: Myxedema coma. OFF LABEL: Management of hemodynamically unstable potential organ donors. ACTION OF LEVOTHYROXINE Converts to T3, then binds to thyroid receptor proteins exerting...