Drug Usage in Peri Arrest Arrhythmias

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Asthma Free Forever By Jerry Ericson

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The administration of drugs and their adverse side effects are summarised in Figure RS.11. Complications of CPR

Iatrogenic complications of CPR are relatively common and may pose post resuscitation problems. Rib and sternal fractures occur frequently. Other complications of chest compressions may include visceral trauma (usually liver) and cardiac trauma. Complications related to poor airway and ventilatory management are inhalation of gastric contents, inadvertent oesophageal intubation and rarely gastric rupture. Other post arrest problems (not necessarily caused by CPR) are pulmonary oedema, recurrent cardiac arrest, cardiogenic shock, renal failure and adverse neurological outcome. Figure RS.12 shows examples of ECG tracings.

DRUGS USED IN PERI-ARREST ARRYTHMIAS

Drug

See Algorithm

Dose and administration

Comments

(CI = contra-indication)

Adenosine

Narrow complex tachycardia

As in algorithm Fast IV injection Flush with saline

Unpleasant side effects CI Asthma

Verapamil

Narrow complex tachycardia

As in algorithm Slow IV bolus

CI VT

CI with betablockers CI AF & WPW syndrome CI 2nd or 3rd° AV block

Digoxin

Narrow complex tachycardia

As in algorithm IV infusion over 30 min

Check serum potassium CI 2nd or 3rd° AV block CI SVT & WPW syndrome

Esmolol

Narrow complex tachycardia

As in algorithm IV bolus then infusion

CI Asthma

Amiodarone

Narrow & broad complex tachycardia

300 mg (ERC 1996) at rate according to algorithm

Avoid in respiratory and cardiac failure

Lidocaine

Broad complex tachycardia

As in algorithm IV bolus then infusion

CI myocardial failure CI AV block

Bretylium tosylate

Broad complex tachycardia

5-10 mg/kg IV infusion over 10-30 min

Slow onset of action

Not with sympatho-mimetics

Flecainide

Broad complex tachycardia

1-2 mg/kg IV infusion over 10-30 min

Pro-arrhythmic

Use only if other drugs fail

Isoprenaline

Bradycardia and heart blocks

2 mg in 500 ml dextrose at 0.2-2.0 ml/min

Caution in myocardial ischaemia Preferably pace

Figure RS.11

Resuscitation of the Pregnant Patient

Causes of Arrest

These can be the same as in the non pregnant population (such as pre-existing heart disease) but other causes must be considered. These include severe haemorrhage revealed or concealed, pulmonary embolism, toxaemia, amniotic fluid embolism and placental abruption. Resuscitation in early pregnancy should be conducted as recommended for other adults and directed towards maternal considerations. After the 24th gestational week when the foetus is potentially viable, there are two lives to save; obstetric and paediatric help should be sought early and after five minutes of unsuccessful resuscitation, caesarean section should be considered while advanced life support continues. Differences between maternal resuscitation and that of the non pregnant patient are outlined below.

Figure RS.12 Examples of electrocardiogram tracings

Basic Life Support

To avoid venacaval compression by the gravid uterus, the patient must be placed with a wedge or sandbag under the right hip. Chest compression is feasible in this position.

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