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ADENOSINE
- (Adenocard) Antidysrhythmic
- Des: can “chemically cardiovert” PSVT to a normal sinus rhythm. half-life of 10 sec & does not cause hypotension.
- Ind: narrow, complex paroxysmal supraventricular tachycardia refractory tovagal maneuvers.
- CI: 1)2nd & 3rd degree heart block 2)sinus node disease 3)asthma.
- PC: may cause transient dysrhythmias - especially asystole, COPD.
- Dose: 6 mg IV (rapidly - over 1-2 sec), then flush line rapidly w/ NS. If ineffective, 12 mg (over 1-2 min, may be repeated. Ped: 0.1 mg/kg IV (rapidly - over 1-2 sec), then flush line rapidly w/ NS. If ineffective, 0.2 mg/kg (over 1-2 min) [max 12 mg].
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EPINEPHRINE
- (Adrenalin) Sympathomimetic
- Des: naturally occurring catecholamine that increases 1)heart rate 2)cardiac contractile force 3)myocardial electrical activity 4)systemic vascular resistance 5)systolic BP; decreases 1) airway resistance 2)automaticity. Via bronchial artery constriction, may reduce pulmonary congestion & increase tidal vol. & vital capacity.
- Ind: 1)restore rhythm in cardiac arrest 2)severe allergic reactions
- CI: 1)narrow angle glaucoma 2)hemorrhagic, traumatic, or cardiac shock 3)during labor
- PC: none
- Dose: Arrest: 1.0mg of 1:10,000 IV 3-5 min (ET: 2.0-2.5mg of 1:1,000). Ped: 0.01mg/kg of 1:10,000 IV/IO (ET: 0.1mg/kg of 1:1,000). All subsequent doses 0.1 mg/kg IV/IO [no max). Allergic: 0.3-0.5mg of 1:1,000 SQ 5-15 min as needed or 0.5-1.0mg of 1:10,000 IV if SQ dose ineffective or severe reaction. Ped: 0.01 mg/kg of 1:1,000 SQ 10-15 min or 0.01 mg/kg of 1:10,000 IV if SQ dose ineffective or severe reaction.
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VASOPRESSIN
- (Pitressin) Hormone, Vasopressor
- Des: hormone w/ strong vasopressive & antidiuretic properties, may precipitate angina &/or AMI.
- Ind: 1)to increase peripheral vascular resistance in arrest (CPR) 2)control bleeding from esophageal varices
- CI: 1)PVCs 2)1st stage of labor.
- PC: 1)epilepsy 2)migraine 3)heart failure 4)angina 5)vascular disease 6)hepatic impairment 7)elderly 8)children
- Dose: Arrest: 40units IV Esophagealvarices: 0.2-0.4 units/min IV drip.
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ATROPINE
- (Atropine) Parasympatholytic
- Des: 1)blocks the parasympathetic nervous system, specifically the vagal effects on heart rate 2)may increase myocardial oxygen demand 3)decreases airway secretions
- Ind: 1)hemodynamically significant bradycardia 2) brady asystolic arrest 3)organophosphate poisoning
- CI: none in emergency setting. 2nd degree type 2 & above heart blocks are class 2B (not recommended)
- PC: 1) AMI 2)glaucoma
- Dose: Symptomatic Bradycardia: 0.5mg IV (ET 1.0mg) repeat 3-5 min to 3 mg Ped: 0.02 mg/kg IV (ET 0.04mg/kg) may repeat in 5 min up to 1 mg Asystole: 1.0mg IV (ET 2.0mg) may repeat 3-5 min up to 3 mg Organophosphate Poisoning: 2.0-5.0mg IV/IM/IO 10-15 min Ped: 0.05 mg/kg IV/IM/IO 10-15 min
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