Meds for V-Tach and V-Fib
- Vasopressors (Epi)
2. Antiarrhythmics (Amiodarone, Lido)
Meds or Actions for Tachycardia
Stable: Vagal, Adenosine
Unstable: Cardiovert
Meds for Bradycardia
- Atropine
- Epi gtt
- Dopamine gtt
Meds or Actions for PEA/Asystole
- CPR
- Epi
ACLS Medication Access
- Peripheral (preferred)
2. Introosseous
“A” + “C”
Alpha + Contrict
“B” + “D”
Beta + Dilate
Epi
VF/VT
- Natural catecholamine
- Alpha properties: Vasoconstriction, increased SVR= increased BP, routing blood to brain and heart, increased CO, HR, and contractility
- Beta 2 properties: bronchodilator
- No Max dose
Amiodarone
(Cordarone)
- Works on Na+ and K+ channels
- Alpha and Beta properties
- Two doses during arrest
- IV drop dosing is complex
- continuous EKG monitoring
- Hypotension is common
Lidocaine
- Alternative to Amiodarone
- Suppresses ventricular ectopy
- Suppresses conduction of reentry pathways
- IV Push
- IV gtt - maintenance
- Max dose 3 mg/kg
Procainamide
(Pronestyl)
-Suppresses ventricular ectopy
-Slows conduction through
myocardium
- IVorPO
- Initial loading dose
- Gtt thereafter
- DC if QRS widens > 50% of baseline
Torsade de Pointes tx
Magnesium 1-2gms IV
Code Sequence
Shock Drug Shock Drug Shock
Vasopressor
Anti-arrhythmic
Vasopressor
Antiarrhythmic
Tachycardia Stable
- Attempt Vagal maneuvers
- cough, bear down, gag, carotid massage (not RN scope)
- Adenosine
- Beta Blockers
- Calcium Channel Blockers
Tachycardia Unstable
- Synchronized Cardioversion
- Amiodarone
Bradycardia Symptomatic
- Atropine
- Epi gtt
- Dopamine gtt
Adenosine
- Slows conduction through SA & AV nodes
- Depresses left ventricular function
- Converts tachycardic rhythms to NSR
- Given rapid IV push over 1-3 seconds
- Brief Asystole or Bradycardia
- Transient flushing +/or CP
- Dosing 6gm-12mg
Beta Blockers
-Control Rate & Ventricular Response
-↓HR, Force of Contraction, BP, AV
Conduction & Myocardial O2 Consumption
-End in “OLOL”
-Metoprolol, Atenolol, Propranolol,
Esmolol, Labetolol
-Caution with CHF & Pulmonary Disease
Calcium Channel Blockers
- Controls ventricular rate in Afib & Aflutter
- Inhibits Ca+ ion influx into myocardial cells
- Slow SA & AV conduction
- May decrease contractility
- Vasodilates smooth muscle to decrease afterload and BP
- Antidote = CaCl 10% solution
Verapamil
(Calan)
Calcium Channel Blockers
- given after adenosine use with normal/elevated BP
- not to be used with hypotension
- may repeat doses
Dilitiazem
(Cardiazem)
Calcium Channel Blockers
- given after adenosine
- IV loading then IV gtt
- Caution with CHF
Synchronized Cardioversion
- slows the rhythm down
- 50-100 jules
Amiodarone
- preserved cardia function
- avoid AV blocking agents
Atropine
- increases HR
- blocks the parasympathetic nervous system
- enchances conduction at the SA and AV nodes
- IVP
- Prepare for transcutaneous pacing
