Objectives: This presentation will help you to:

Transcription

1 emergency Drugs

2 Objectives: This presentation will help you to: Five rights for medication administration Recognize different cardiac arrhythmias and determine the common drugs used for each one List the common emergency medications used in CPR Understand the indication & contraindication of the drugs Know the different dosages, preparation, and the appropriate technique of administration for each drug

3 Five rights for medication administration One of the recommendations to reduce medication errors and harm is to use the five rights : The right patient The right drug The right dose The right route The right time

4 Common arrhythmias and medications

5 V F & Pulseless V T These are the only tow shock-able rhythms Epinephrine Vasopressin Amiodarone Lidocaine Magnesium

6 PEA & A Systole Epinephrine Vasopressin

7 Sinus Tachycardia Adenosine Diltiazem Beta Blockers Amiodarone Digoxin Verapamil Magnesium Sulphate

8 Sinus Bradycardia Atropine Epinephrine Dopamine

9 Acute Coronary Syndrome Treatment Oxygen Aspirin Nitroglycerine Morphine Heparin Beta Blockers Fibrinolytic Therapy

10 Common emergency drugs dosages, indications, contraindications, preparation, and technique of administration

11 Atropine Indication Bradycardia where the HR > 60 bpm. Asystole. Pulseless Electrical activity (PEA). 1st degree of heart block. Dosage Use 0.5 mg IV push repeated q 3-5 min to maximum of 3mg. Intraosseous (IO) 2-3 mg via ETT diluted in 10mL NSS.

12 Atropine Contraindication: MI and hypoxia due to increase O2 demand 2nd or 3rd degree HB because it may slow the rhythm Tachycardia Warning: Watch for Tachycardia because it may lead to VF.

13 Epinephrine Indications VF Pulseless VT Cardiac Arrest and A systole. Can be alternative infusion to dopamine in bradycardia Dose: IV/IO 1 mg followed by 20 ml flush every 3-5 min. elevate the arm for second after each dose. Via ETT 2 to 2.5 mg diluted in 10 ml NSS Contraindication: Increase HR and BP may lead to myocardial ischemia, angina, oxygen demand. High dose may need to treat poison/drug-induced shock.

14 Vasopressin Indications Use as an alternative drug for epinephrine in early CPR. It is the drug replace the first or second dose of epinephrine. Dose: can be given through (IV, IO, ETT). 40 Units IV/IO push, may be given for once. Asystole and Pulseless electrical activity (PEA) Contraindication: Not recommended for patients with coronary artery disease Not effective in sever acidosis.

15 Amiodarone Indication Dose Life threatening arrhythmias VF/ pulseless VT Unstable VT Shock refractory VF/VT after epinephrine Contraindication: 1st dose for cardiac arrest 300 mg IV/IO push 2nd dose if needed 150 mg push Slow infusion 300 mg in 100 ml/6h Most respiratory side effect are: cough, SOB, pulmonary fibrosis Rapid infusion may lead to hypotension Terminal elimination extremely long (half-life lasts up to 40 days)

16 Adenosine Indication First drug of choice for all stable narrow QRS Complex tachycardia (SVT). safe and effective in pregnancy. Dose 6 mg given rapidly over 1-3 second followed by 20 ml NS. Second dose of 12 mg after 1-2 min if needed. Contraindication: Hypotension Sinus bradycardia and some ventricle arrhythmias.

17 Lidocaine Indication Second choice after Amiodarone in cardiac arrest from VF/VT Polymorphic and monomorphic VT Dose Initial dose mg/kg via IV/IO For refractory VT give additional 0.5 to 0.75 mg/kg IV push. Repeat in 5-10 min 3 doses not > 3 mg/kg. Contraindication: Discontinue infusion immediately if signs of toxic develop.

18 Dopamine Indication Dose Hypoxemia PVC s (premature ventricle contraction Mixed 400mg/250D5W and could be given as 2-10mcg/kg/min or according to patient body weight. sever trauma During CPR Contraindication: DO NOT MIX WITH SODIUM BICARBONATE DUE TO DRUG INTERACTION

19 Oxygen Therapy Indication Used for hypotension with signs and symptoms of shock or bradycardia Dose Depending on medical situation, devices used, oxygen concentration needed, and patient comfort. Contraindication: There is no absolute contraindications of oxygen therapy exist when indications are present Oxygen toxicity to be avoided

20 Conclusion By the end of this presentation you are capable to treat the different cardiac arrhythmias with the common emergency drugs used in CPR. Also, you know most of the indications & contraindications of these drugs, different dosages, preparation, and the appropriate technique of administration for each drug.

21 References Advanced Cardiac Life Support Manual AHA. American Heart Association website. Emergency & Critical Care Pocket Guide. By Jones & Bartlett Learning; 8 edition (May 17, 2013). Critical Care Intravenous Infusion Drug Handbook, 3e Spiral-bound April 20, Egan's Fundamentals of Respiratory Care. Ninth edition. St. Louis, Missouri: Mosby Elsevier;

22 Thank You