2. OBJECTIVES
Upon completion of this session, you will be able
to:
• state the drugs commonly used in resuscitation
• outline the major actions of these drugs
• list 2 side effects related to the use of the drugs
ALS Subcommittee 2010
3. DRUGS USED IN RESUSCITATION
• Adrenaline
• Vasopressin
• Atropine
• Amiodarone
• Lignocaine
• Adenosine
• Dopamine
ALS Subcommittee 2010
4. ACCESS TO DRUG ADMINISTRATION
• Intravenous
Peripheral or central
• Intra-osseous
• Intra-tracheal
– Larger dose
– Only if intravenous and intraosseous not
available ALS Subcommittee 2010
5. TECHNIQUE FOR IV DRUG
ADMINISTRATION
• Use upper extremity veins
• Keep the access site elevated
• Each IV drug administration to be followed by
20-30mls bolus of normal saline
• The cannula should be as large as possible
• Use normal saline as the fluid of resuscitation
ALS Subcommittee 2010
6. TECHNIQUE FOR ENDOTRACHEAL
DRUG ADMINISTRATION
• Dilute the drug in 10 ml saline
• Thread a long catheter through the ETT
• Stop chest compressions
• Inject the drug through the catheter
• Follow with 3-4 manual lung inflations
• Dosage: 2-2.5x the recommended IV dose
ALS Subcommittee 2010
7. INTRAOSSEOUS
• Available for adult usage
• Site: Iliac crest, sternum
• As effective as intravenous line for resuscitation
ALS Subcommittee 2010
10. ADRENALINE
• Routes of administration:-
› IV push OR Intraosseus 1 mg
Infusion (3mg in 50 mls N/S at 1ml/hr
=1ug/min), titrate accordingly
› ETT (2-2.5X IV dose)
ALS Subcommittee 2010
11. ADRENALINE ---- ACTIONS
• increases contractile force of the heart thus
increasing cardiac output
• increases conduction of SA node, AV node and
ventricle thus increasing heart rate
• increases systemic vascular resistance through
peripheral vasoconstriction thus increasing
perfusion pressure
ALS Subcommittee 2010
12. ADRENALINE ---- SIDE-EFFECTS
• Ventricular irritability
– tachyarrthymias
• ↑ Myocardial Oxygen demand
- risk of ischaemia and MI
• Cerebrovascular event
ALS Subcommittee 2010
13. VASOPRESSIN
• A naturally occurring hormone
• At high doses of 40 units (recommended dosage
during resuscitation)
– shunting of blood to heart and brain
– intense vasoconstriction
– may not increase myocardial oxygen demand
-- unlike adrenaline
ALS Subcommittee 2010
14. VASOPRESSIN
• Indications for use
– Considered as an alternative to adrenaline for
shock due to refractory VF, asystole and PEA
– Used as a single bolus 40 units IV to replace 1st
or 2nd dose of adrenaline
– As a hemodynamic support in septic shock
ALS Subcommittee 2010
15. ATROPINE
• Anticholinergic (parasympatholytic)
– inhibits effect of acetylcholine on SA and AV
node
– increases SA node and AV node conduction
velocity
– decreases effective refractory period AV node
• Increases heart rate and cardiac output
ALS Subcommittee 2010
19. AMIODARONE
• Has characteristics of all 4 antiarrhythmic drug
classes
– affect sodium, potassium and calcium channel
– alpha and beta blocking properties
• Used in BOTH supraventricular and ventricular tachyarrthymias
– Refractory VT/VF
– Stable monomorphic or polymorphic VT
– PSVTs, atrial tachycardia, atrial fibrillation
– Wide complex tachycardia of uncertain origin
– Pre-excited atrial arrhythmia
ALS Subcommittee 2010
20. AMIODARONE
• VF, pulseless VT and refractory VT/VF
– Drug of Choice
• IV bolus dose 300 mg
• repeat IV bolus 150 mg in 3-5 mins
followed by IV Infusion 900 mg over 24h
• Other arrhythmias
› IV Infusion 150 mg over 10 min
followed by IV infusion 900 mg over 24h
ALS Subcommittee 2010
22. LIGNOCAINE ---- ACTIONS
• Raises fibrillatory threshold
• enhances the effect of DC shock
• Suppresses automaticity and shortens effective
refractory period and action potential duration
• slows down heart rate
• Inhibits reentry mechanism – halts arrhythmias
ALS Subcommittee 2010
23. LIGNOCAINE
• Routes of administration:-
– IV push (1.0 to 1.5 mg/kg)
Additional 0.5-0.75 mg/kg
Max: 3 mg/kg
Infusion 1 gm Lignocaine in 500 ml N/S
30 to 120 ml/hr (1 – 4 mg/min)
– ETT (2-2.5X IV dose)
ALS Subcommittee 2010
25. ADENOSINE
• A short acting agent that depresses SA node and
AV node function
• Used in narrow complex supraventricular
tachycardia
• Half life : 5 seconds
• Initial dose of 6 mg rapid IV push (may be
repeated at 12 mg ) ALS Subcommittee 2010
26. ADENOSINE - SIDE-EFFECTS
• Transient bradycardia or even ASYSTOLE
• Hypotension
• Chest pain
• Dyspnoea
• Bronchospasm (caution in asthma )
• Transient flushing
ALS Subcommittee 2010
27. DOPAMINE
Indications:
• cardiogenic shock
• septicaemic shock
• neurogenic shock
• anaphylactic shock
• hypovolaemic shock only after fluid resuscitation
has failed to raise BP
ALS Subcommittee 2010
31. SODIUM BICARBONATE
• A significant sodium load
• 8.4% solution is hypertonic => arterial
vasodilatation and hypotension
• Extravasation => tissue necrosis
• Not to be injected via same IV line as
catecholamines and calcium ALS Subcommittee 2010
32. SODIUM BICARBONATE
• only beneficial in hyperkalaemia
• probably beneficial in
- bicarbonate responsive acidosis
• possibly beneficial in
- protracted cardiac arrest with effective
ventilation
- postresuscitation acidosis with effective
ventilation ALS Subcommittee 2010
33. REVIEW OBJECTIVES
Are you be able to?
• State the drugs commonly used in resuscitation
• outline the major actions of these drugs
• list 2 side effects related to the use of the drugs
ALS Subcommittee 2010
34. THANK YOU
NATIONAL COMMITTEE ON RESUSCITATION TRAINING
SUBCOMMITEE FOR ADVANCED LIFE SUPPORT
Dr Tan Cheng Cheng
Dr Luah Lean Wah
Dr Ismail Tan
Dr Wan Nasrudin
Dr Chong Yoon Sin
Dr Priya Gill
Dr Ridzuan bin Dato’Mohd Isa
Dr Thohiroh Abdul Razak
Dr Adi Osman
ALS Subcommittee 2010
