Page 690 - ACCCN's Critical Care Nursing

Resuscitation 667

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Adverse events Tachyarrhythmias; hypertension; coronary vasoconstriction; increased myocardial oxygen consumption. Vasodilation and hypotension, bradycardia, heart block. May have negative inotropic effects. Use with caution in renal failure. Avoid use in torsades de pointes and other causes of prolonged Q-T. Toxicity, slurred speech, psychosis, altered level of consciousness, muscle twitching, seizures and coma. Hypotension, heart bloc

VF and pulseless VT 10 mcg/kg after the 2nd shock then after every second cycle. PEA and asystole 10 mcg/kg immediately, then every second Initial dose of 5 mg/kg bolus over 2 minutes, which may be repeated to a maximum of 300 mg. Periarrest: IV infusion 5–15 µg/kg/ min as continuous infusion (max Initial dose of 1 mg/kg IV or IO.

Paediatric cycle. of 1.2 g in 24 h).

Dose

VF and pulseless VT 1 mg after the 2nd shock then after every second cycle. PEA and asystole 1 mg in the initial cycle, then every Initial bolus dose of 300 mg in 20 mL dextrose. A further 150 mg could be considered for refractory cases. Periarrest: An infusion of 15 mg/kg over 24 hours may be commenced. Bolus of 1 mg/kg at a rate of 25–50 mg/min. Periarrest: May be followed by an additional bolus of

Adults second cycle 0.5 mg/kg.

Medications (ARC & NZRC Guideline 11.5) 62 Indications VF and pulseless VT resistant to the three initial counter shocks. PEA and asystole. VT/VF refractory to three shocks. Polymorphic VT and wide complex tachycardia of uncertain origin. Control of haemodynamically stable VT when cardioversion unsuccessful (in the presence of LV dysfunction). Adjunct to electrical cardioversion of SVT. Prophylaxis of recurrent VF/VT. VF and pulseless VT whe

TABLE 24.8 Action Adrenaline is a catecholamine that increases aortic diastolic pressure and coronary artery perfusion by producing arteriolar vasoconstriction. It may facilitate defibrillation by improving myocardial blood flow during CPR. Traditionally the first-line medication for the treatment of VF and refractory VT, adrenaline has not demonstrated improved outcomes after cardiac arrest and has been associated with postresuscitation my