Indications: Any hypoxic pt or situation with possible hypoxia

1. Cardiac arrest

2. Myocardial Pain

3. CHF / PE

4. Shock of any etiology

Precautions:

1. Use caution with COPD patients

2. May be damaging to neonates with long term exposure

3. May irritate nasal mucosa sans humidification.

True

False

T/F: High flow O2 provides total inspiratory volume?

T/F: Low flow O2 also provides total inspiratory volume?

Has a clinical response similar to that of alpha stimulation, but does not cause vasoconstriction via direct adrenergic stimulation of alpha receptors?

Does stimulate V1 receptor sites in vascular smooth muscle which promotes this elevation in SVR?

Precautions for this drug include increased myocardial workload due to elevated SVR or Possible uterine contractions in pregnant females.

Fortunately, when administered in the prehospital environment to a pt in Vfib, none of the aforementioned precautions apply.

__________ should not be adminstered concurrently with epinephrine.

Since the half life is thought to be about 10 minutes, the continued administration of epinephrine should come 10 minutes after _____________ in the absence of any clinical response.

The dosage of Vasopressin is a single dose of _______ via IV push for a patient in cardiac arrest with a presenting rhythm of Vfib, Pulseless V-tach, PEA or asystole.

This dose is to replace either the first or second dose of epinephrine.

What drug has the ability to depress both atrial and ventricular tachydysrhythmias via added properties of adrenergic blockade of alpha and beta receptors?

This results in some peripheral vasodilation.

What drug is indicated for:

- Supraventricular Tachycardias

- V-fib and pulseless V-tach resistant to electrical therapy

- Monomorphic and polymorphic V-Tach with a pulse (both stable and unstable)

- Idiopathic wide complex tachycardia

300 mg

150 mg in 3-5 minutes

150 mg over 10 minutes (15 mg / min)

1 mg / min to a max 24 hour dose of 2.2 grams

If a patient presents with V-Tach, Wide complex Tach or SVT, Amiodarone is administered at ____ mg over ___ minutes or (__mg/min).

The maintenance infusion for Amiodarone once suppression is achieved is ___ mg / min via constant IV infusion to a maximum 24 hour dose of ____ g.

Sick sinus syndrome

Induced Bradycardia

second degree AV block (Mobitz I or Mobitz II)

Complete 3rd degree AV block

1. Slow the infusion rate

2. Vasopressors

3. Atropine

Precautions:

1. Should Amiodarone induce or worsen hypotension or bradycardia, the first recommendation is to _________________.

2. Should Hypotension persist, you can consider either fluid administration or careful use of _____________.

3. If bradycardia is present, that can be countered with agents to increase rate (i.e. ___________) or consideration of transcutaneous pacing.

Potent alpha 1 and alpha 2 postsynaptic adrenergic receptor stimulator

Potent beta 1 and beta 2 receptor stimulator

Net effect of increased: heart rate, contractility, arterial BP, SVR, Myocardial Oxygen demand and Automaticity of ectopic foci.

May initiate electrical activity in asystole

Bronchodilation

This drug can be used as a Vasopressor agent, or for refractory bradycardia.

Also indicated for anaphylactic shock.

1 mg of 1:10,000 solution every 3-5 minutes

20 ml of fluid

The recommended dosage of epinephrine Hydrochloride is ___ mg of 1:10,000 solution every _______minutes during resuscitation.

Flush IV bolus with ____ ml of fluid to ensure delivery into core circulation.

2 to 2.5 times the IVP

2-10 mcg / min (1 mg in 500 ml)

(2mcg / ml concentration)

Epinephrine Hydrochloride can be given via Endotracheal route at ___ to ____ times the IVP route.

IV infusion dose of Epi is ___-___ mcg/min

(___ mg in 500 ml)

(___ mcg/ml concentration)

Precautions for this drug include:

- avoid mixing with alkaline meds (sodium bicarb)

- intramyocardial injection may precipitate v-fib

- inactivated in light

- increases myocardial workload and O2 requirements

- Only effective with oxygenated myocardium

- May exacerbate ventricular ectopy in digitalized pt

This drug has strong inotropic and chronotropic actions (increased cardiac output)

1. Increased heart rate

2. Increased contractility

3. Increased O2 consumption

4. Decreased peripheral vascular resistance

5. Bronchodilation

Indications include:

1. Symptomatic bradycardia after other sympathetic infusions

2. bradycardia with a deinervated myocardium

3. Refractory Torsades de Pointes

Contraindications of this drug are:

1. Not used to increase blood pressure in cardiogenic shock.

2. Not indicated for cardiac arrest.

This drug has several precautions including:

1. May precipitate or aggravate myocardial ischemia and / or infarction.

2. May decrease blood pressure due to dilatory effect.

The following precautions are listed for which drug?

1. Not for use in asymptomatic bradycardia

2. increase myocardial O2 requirements d/t rate acceleration

3. do not give less than .5mg as this may cause paradoxical slowing of the heart rate

4. May worsen intraocular pressure in glaucoma

5. Excessive doses can cause delerium, tachycardia, coma, flushed hot skin, ataxia, blurred vision, decreased GI motility, Urinary retention and pupil dilation.

0.5 - 1.0 mg

3 mg

Which drug is the chemical precursor of norepinephrine that has both alpha and beta receptor stimulating action?

Further pharmacodynamics:

- Stimulation of dopaminergic receptors

- Dose dependent response

What drug is indicated in hypotension that occurs with spontaneous circulation (cardiogenic shock)?

- septic shock

- spinal shock

- symptomatic brady unresponsive to Atropine or TCP