Emergency

DRUGS
Epinephrine
Indication
 VF, pulseless VT, or asystole
1 mg I.V push every 3-5 min
Intermediate dosing: 2-5 mg IV push over 3-5 min
Escalating dosing: 1mg, 3mg, 5 mg IV push 3 min apart
High dosing: ,1 mg/kg IV push every 3 – 5 min
Symptomatic Bradycardia: continous infusion at 2-10 mcg/min;
titrate to hemodynamic response
Nsg. consideration
Each dose is followed by 20 mL iv fluid flush.
Can be given via ET tube 2-2.5 x the IV dose, followed
with 10 mL Flush PNSS
IC when no other route is available
It increases systemic vascular resistance, BP, Cardiac
elec. Activity, strenth of contraction, automaticity, and
myocardial O2 requirement
Lidocaine
Indication
 VF or Pulseless VT: Initially 1-1.5 mg/kg IV push:
every 3-5 mins, max of 3mg/kg
 Stable VT or Stable wide-complex tachycardia:
repeat doses half the original dose.
If lidocaine succesfully converts the VF/VT: begin
continous infusion at 2-4 mg/min
Nsg consideration
Toxicity( Slurred speech, altertered LOC, Muscle
twitching, and seizures), stop the drug/reduce dose
Via ET: 2-2.5 times the iv dose, flush with 10 ml PNSS
Don’t give if PVC occurs with bradycardia or escape
rhythm.
No longer recommended for VT/VF prophylaxis in
acute MI
Atropine
Symptomatic Bradycardia
 .5-1 mg iv push q 3-5 min, not to exceed .04 mg/kg
Asystole
 1 mg iv push q 3-5 min, not to exceed a total dose of .
04mg/kg
Nsg consideration
Don’t give less than .5 mg dose – may further slow
heart rate
Via ET: dilute 1-2 mg in 10 mL sterile water of PNSS,
flush with 10 mL PNSS
Adenosine
wide-complex tachycardia:
 Initially 6 mg rapid iv push; if no response in 1-2 min,
give 12 mg iv push; may be followed by a third 12 mg
dose given in 1-2 min.
Nsg consideration
Given rapidly over 1-3 sec
Follow dose with a 20 ml PNSS flush
If methylxanthines, dipyridamole and carbamazepine
are present higher dose may be needed
A brief period of Asystole is common after
administration
Bretylium
VF/ pulseless VT unresponsive to defibrilation, epi and
lido
 5mg/kg iv push; if arhythmia persists, increase to 10
mg/kg q 5-10 min, to a max dose of 35 mg/kg
Stable VT or Stable wide-complex tachycardia:
 5-10 mg/kg over 8-10 min, to max 35 mg/kg over 24 hrs,
if loading dose converts arhythmia start infusion of 2
mg/min.
Dobutamine
Heart Failure
 2-20 mcg/kg/min
Nsg considerations
May cause tachycardia and other arhythmias, BP
fluctuations, nausea and hypokalemia
Monitor heart closely; increases in heart heart rate
more than 10% may induce or exacerbate Myocardial
Ischemia
Dopamine
Hypotension with symptomatic bradycardia, heart
failure or after spontaneous return of circulation
 Initially, 1-5 mcg/kg/min; max is 20 mcg/kg/min
Enhances renal blood flow – 1-2 mcg/kg/min
Nsg consideration
May induce tachycardia, - dose reduction/withdrawal
Extravasation may cause severe tissue necrosis
Norepinephrine should be added is more than max
dose is needed to maintain BP
Use slowest infusion first
Can exacerbate pulmonary congestion and
compromise cardiac output
Eliminate hypovolemia as a cause of hypotension
before treating
Magnesium
VF/VT with hypomagnesemia
 1-2 grams diluted in 10 mL D5W given IV push over 1-2
min
Torsades de pointes: 5-10 grams iv
Acute MI with hypomagnesemia
 Intermitent of continous infusions
Nsg consideration
Flushing, sweating, mild bradycardia, and
hypotension may develop from rapid administration in
non arrest situations
Procainamide
PVCs or recurrent VT with pulse
 Initially, 20 mg/min until
Hypotension occurs
QRS complex
PR interval
QT interval is widened by 50 %
Total of 17mg/kg of the drug was administered
 Maintenance infusion 1-4 mg/min
Nsg consideration
Monitor BP closely during administration; may cause
precipitous hypotension, infuse cautiously in patients
with acute MI
Contraindicated in patients with preexisting long QT
intervals and torsades de pointes
Torsades de pointes, or simply torsades is a French
term that literally means "twisting of the points". It was
first described by Dessertenne in 1966 and refers to a
specific, rare variety of ventricular tachycardia that
exhibits distinct characteristics on the electrocardiogram
(ECG).
Characteristics
Rotation of the heart's electrical axis by at least 180º
Prolonged QT interval (LQTS)
Preceded by long and short RR-intervals
Triggered by an early premature ventricular contraction