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DRUGS AND

DEFIBRILLATIONDepartment of Anesthesiology & Reanimation

General Hospital Tasikmalaya

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(D) Defibrilate VF and VT (if identified)

The initial call for help should result

defibrillator

Hunt for VF/VT

90% who survives sudden non traumatic

cardiac arrest was resuscitated from VF

The success of defibrillation is remarkablytime dependent

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Survival rate of early defibrillation

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VF/VT Pulseless Algorithm

The most important algorithm in all of ACLS

The reason : VF/VT occur often, are lethal and

correctable more often than asystole and PEA

The first rule is shock early and often, continuing to

alternate defibrillation attempts with attempts at drug

therapy until you succeed or until the patient goes toanother algorithm

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Ventricular Tachycardia

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Ventricular Fibrillation

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Algorithm VF/VT :Defibrillate 200J

Defibrillate 200-300J

Defibrillate 360J

Hypothermic?

VF/VT Intubate

Continue CPR Obtain IV

access

Epinephrine 1mg every 3-5 min

Lidocaine 1.5-2 mg/kg repeat in 3-5 min

Bretylium 5 mg/kg repeat in 5 min at 10 mg/kg

MgSO4 1-2 gr in susp HypoMg or refractory VF

Procainamide 15 mg/kg at 30 mg/min

BicNat 1 meq/kg

HypothermiaYes

Spontaneous circulation

Vital Sign

Support breathing

Provide appropriate med.

PEA Asystole

Defibrillate 360Jafter 30-60 sec.

Choose medication

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Defibrillation

Used firstly 3 times in Ventricular

Fibrillation

Dose : 200 Joule 300 Joule 360 Joule

Drug Shock Drug Shock

Pediatric dose : 2 J/kg 4 J/kg

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Defibrillation

Used firstly 3 times in Ventricular Fibrilatin

Dose : 200 Joule 300 Joule 360 Joule

Drug Shock Drug Shock Pediatric dose : 2 mg/kg 4 mg/kg

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Epinephrine ( Adrenaline )

may help restore spontaneous

circulation in cardiac arrest of 1 2

minute duration

Alpha and beta receptor activity

Alpha receptor activity is the most important incardiac arrest

Dose : 1 mg IV, can be repeated every 3-5 min.

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Alfa adrenergic :

promote peripheral vascular

vasoconstriction

increase of diastolic pressure

improve coronary circulation

preserve myocardial oxygenation

greater possibilities of spontaneous heart

contraction

Epinephrine ( Adrenaline )

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Lidocaine

Pharmacologic action:

1. Decreases automaticity

2. Depresses conduction in reentrant pathways

3. May raise fibrillation threshold, especiallyin combination with bretylium

Uses:

The drug of first choice for ventriculararrhythmias

ventricular ectopy, and

wide complex tachycardias of unknown

origin.

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Lidocaine

Dose:

1- 2 mg/kg IV bolus, followed by additional

0.5-1.5 mg/kg every 5-10 min to a total of 3 mg/kg

Can be administered via the endotracheal tube.Use 2 to 2.5 times the intravenous dose.

Upon return of circulation, use continuous

infusion at 2 - 4 mg/min.

Reduce the maintenance dose if decreased cardiac outputor hepatic failure or more than 70 years of age.

Pediatric infusion: 20-50 mcg/kg per min

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Lidocaine

Potential complications:

Dizziness, drowsiness, disorientation,seizures

Hypotension - causes vasodilation;myocardial depression at higherconcentrations

Heart block - only rarely seen with high

levels

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Bretylium

Antiarrhythmic, as second line drug afterlidocaine

Dose : 5 mg/kg or as initial dose 500 mg

Repeat in 5 min at 10 mg/kg

Total dose : 35 mg/kg (or 2 more doses of 10mg/kg at 5-30 min)

At persistent VT, loading 500 mg/8 10min,followed by continous infusion at 2 mg/min

Initial : sympathomimetic , after steady state :sympatholytic

Side Efect : Hypertension Hypotension

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Magnesium Sulfate

Dose : 1 2 gr, if suspected

hypomagnesemia or refractory VT

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Procainamide

Antiarrhythmic

Dose 15 mg/kg at 30 mg/min

Indication : VF, VT, Atrial tachyarrhythmia Second line drug during arrest

Third line antiarrhythmic used after

lidocaine and bretylium Second line drug in VT after lidocaine

failed

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Sodium Bicarbonate

Pharmacologic action:

Acid neutralization

Uses:

1. Preexisting metabolic acidosis (pH < 7)

2. Hyperkalemia

3. Tricyclic or phenobarbital overdose

Dose:

Initial: 1 mEq/kg IV bolus

Subsequent doses: 0.5 mEq/kg IV every 10 min

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Sodium Bicarbonate

Potential complications:

1. Metabolic alkalosis

2. Hypercarbia

3. Hyperosmolar state

Note:

Since HCO3- does not cross cell membranesand CO2 does, the administration ofbicarbonate may actually make tissues moreacidotic.

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