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Emergency Drugs

This document provides information on emergency drugs used to treat cardiac conditions including epinephrine, lidocaine, atropine, adenosine, bretylium, dobutamine, dopamine, magnesium, and procainamide. It lists the indications, dosages, and nursing considerations for each drug. Torsades de pointes is defined as a specific type of ventricular tachycardia characterized by rotation of the heart's electrical axis by at least 180 degrees on ECG and preceded by irregular heartbeats.

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Audi Kyle Saydoven
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262 views19 pages

Emergency Drugs

This document provides information on emergency drugs used to treat cardiac conditions including epinephrine, lidocaine, atropine, adenosine, bretylium, dobutamine, dopamine, magnesium, and procainamide. It lists the indications, dosages, and nursing considerations for each drug. Torsades de pointes is defined as a specific type of ventricular tachycardia characterized by rotation of the heart's electrical axis by at least 180 degrees on ECG and preceded by irregular heartbeats.

Uploaded by

Audi Kyle Saydoven
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPTX, PDF, TXT or read online on Scribd
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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

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