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Setelah menyelesaikan mata kuliah ini,
mhs dapat menjelaskan:
Obat yang biasa digunakan negara
dalam keadaan darurat jantung
Menguraikan tindakan utama
Obat yg dpt diberikan mll ETT
Daftar efek samping terkait dengan
penggunaan obat
DRUGS USED IN
CARDIAC EMERGENCIES
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Epinephrine (Adrenaline)
Norepinephrine (Noradrenaline)
Dopamine
Dobutamine
Amiodarone
Atropine
Nitroglycerin (GTN)
Verapamil
Diltiazem
Sodium bicarbonate
Vascular
Inotropic
Chronotropic
Constriction
+ ve
- ve
Dilatation
+ ve
+ ve
Drug
Dosage
0.5-1 g/
++
1-200 g/'
++
+++
2-80 g/'
+++
++
1-2 g/kg/'
2-10 g/kg/'
++
++
10-30 g/kg/'
+++
++
Vasopressin
40u IV bolus
+++
Dobutamine
2-30 g/kg/'
+++
Isoprenaline
2-10 g/kg/'
+++
Epinephrine
Norepinephrine
Dopamine
Administer
Furosemide IV 0.5 to 1.0 mg/kg
Morphine IV 2 to 4 mg
Oxygen/intubation as needed
Nitroglycerin SL, then 10 to 20 mcg/min IV if SBP
greater than 100 mm Hg
Dopamine 5 to 15 mcg/kg per minute IV if SBP 70 to
100 mm Hg and signs/symptoms of shock present
Dobutamine 2 to 20 mcg/kg per minute IV if SBP 70
to 100 mm Hg and no signs/symptoms of shock
Hypovolemia
Administer
Fluids
Blood transfusions
Cause-specific
interventions
Consider vasopressors
Arrhythmia
Bradycardia
Tachycardia
Systolic BP
Greater than 100 mm Hg
Systolic BP
70 to 100 mm Hg
NO signs/symptoms
of shock
Systolic BP
70 to 100 mm Hg
Signs/symptoms
of shock
Systolic BP
less than 70 mm Hg
Signs/symptoms of shock
Nitroglycerin
10 to 20 mcg/min IV
Dobutamine
2 to 20
mcg/kg per
minute IV
Dopamine
5 to 15
mcg/kg per
minute IV
Norepinephrine
0.5 to 30 mcg/min IV
ACE Inhibitors
Short-acting agent such as
captopril (1 to 6.25 mg)
Further diagnostic/therapeutic considerations (should be considered in
nonhypovolemic shock)
Diagnostic
Therapeutic
Pulmonary artery catheter
Intra-aortic balloon pump
Echocardiography
Reperfusion/revascularization
Angiography for MI/ischemia
Additional diagnostic studies
1. EPINEPHRINE
Routes of administration
IV 1 mg push (10 ml of 1:10,000), followed by 20 ml flush, at
interval of 3-5 min
ETT 2-2.5 times peripheral dose (1 ml of 1:1000)
Infusion 1 mg (1 ml of 1:1000) added to 500 ml NS or D5%,
titrate 2-10 /min
6
EPINEPHRINE - ACTIONS
increases contractile force (inotropic) of
the heart improving contractility increasing cardiac output
increases conduction of SA Node, AV
Node and ventricle thus increasing heart
rate
increases systemic vascular resistance
dengan cara peripheral vasoconstriction
- increasing perfusion pressure improving cerebral & coronary blood flow
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EPINEPHRINE Pencegahan
Tidak boleh diberikan mll infus yg berisi
cairan alkaline
Dapat menyebabkan iskemia eksaserbasi,
iritasi ventrikel; boleh diberikan pd stroke
dan IMA
tachycardia
PVCs
2. NOREPINEPHRINE
Indications:
cardiogenic shock
septicaemic shock
neurogenic shock
anaphylactic shock
hypovolemic shock setelah resusitasi cairan
gagal menaikkan BP
Route of administration:
3. DOPAMINE
Indications:
cardiogenic shock
septicaemic shock
neurogenic shock
anaphylactic shock
hypovolemic shock - after fluid
resuscitation has failed to raise BP
Route of administration:
infusion via vein/central vein
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DOPAMINE - ACTIONS
Dilates renal and mesenteric vessels
(1-2 ug/kg/min)
Meningkatkan aliran darah renal
Increases myocardial contractility
(2-10ug/kg/min)
increasing cardiac output
Causes peripheral vasoconstriction
(>10ug/kg/min)
elevating blood pressure
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Nursing Implications
monitor BP, cardiac rhythm
monitor tetesan infus
observe for onset of extravasation
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4. DOBUTAMINE
Indications:
Acute-on-chronic gagal jantung yg
sukar disembuhkan
Severe acute myocardial failure
Cardiogenic shock
Route of Administration
infusion via vein/central vein
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Actions
1 effects (predominant).
Mild 2 and 1 effects.
No specific effects on renal or splanchnic
blood flow, but may renal blood flow due to
an in cardiac output.
Efek buruk
Tachycardia
Irama ektopik
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Cautions
Acute myocardial ischaemia or MI
-Blockers (dobutamine)
How not to use dobutamine
Tidak ada monitoring jantung
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Kerugian
CHF
BP menurun
Resiko aritmia
perhatian
Hemodinamik atau monitor keadaan klinik
Cek natrium darah (mkn tinggi) aritmia
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5. Amiodarone
Amiodarone is an antiarrhythmic agent
used for various types of cardiac
dysrhythmias, both ventricular and atrial.
Indications
Takikardi yg kecil maupun besar
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Amiodarone - ACTIONS
Class III antiarrhythmic agent
Amiodarone shows beta blocker-like
and potassium channel blocker-like
actions on the SA and AV nodes,
increases the refractory period via
sodium- and potassium-channel effects,
and slows intra-cardiac conduction of
the cardiac action potential, via sodiumchannel effects.
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Amiodarone - ADMINISTRATION
Routes of administration:
IV 150mg IV over 10 min; can be repeated
once
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6. ATROPINE
Indications:
haemodynamically unstable
bradycardias
heart block
ATROPINE - ACTIONS
Meningkatkan konduksi
increasing heart rate and cardiac
output
Decreases secretions
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7. NITROGLYCERIN
Indications
unstable angina
AMI
pulmonary oedema with high BP
hypertensive crisis
Routes of administration:
sublingual
transdermal
IV infusion 10-200ug/min titrated to
response
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NITROGLYCERIN - ACTIONS
Vasodilator
Dilates coronary arteries
Relieves coronary spasm
Opens up collateral vessels
increases blood flow to
myocardium
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Headache
Flushing (muka merah)
Tachycardia
Hypotension
Use with caution in hypotension &
tachycardia
Nursing implications:
monitor BP and heart rate
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8. VERAPAMIL
Indications
PSVT
Acute atrial fibrillation or atrial
flutter with rapid ventricular
response (exclude WPW first)
Route of administration:
IV slow bolus - dilute 5mg in 5 ml at
1mg/min
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VERAPAMIL- ACTIONS
Blocks calcium channel- negative
inotropic effect
decreases force cardiac contraction
9. DILTIAZEM
Calcium Channel Blockers
negative chronotropic langsung yg kuat&
negative inotropic effects
Primary beneficial effects:
Both slow conduction and increase
refractoriness in the AV node
Produces less myocardial depression
than verapamil, but is equipotent as a
negative chronotrope
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DILTIAZEM
Indication:
Treatment of PSVT
Slow down ventricular respopnse in atrial
flutter & fibrillation (but NOT for AF with
WPW)
Primary beneficial effects:
Both slow conduction and increase
refractoriness in the AV node
Produces less myocardial depression
than verapamil, but is equipotent as a
negative chronotrope
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DILTIAZEM
Dosage:
IV 0.24mg/kg (approx 20 mg) over 2 min
May repeat 0.35 mg/kg 15 min later
Infussion 5-15 mg/hr titrate to heart rate for
control of ventricular response in AF
Precautions:
May cause hypotension
Not to use with IV beta blocker
AV block, or heart failure
Incompatible with simultaneous furosemide
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SODIUM BICARBONATE
Action:
Correct acidosis
Side Effects:
hyperosmolarity
hypernatremia
(Paradoxical alkalosis)
Should not be used unless blood gases
show severe metabolic acidosis or
patient collapse >10 mins.
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SUMMARY
Drugs used cardiac arrest
epinephrine
atropine
can be given via ETT if IV access
is not available
Vasopressin and Isoprenaline
has no longer in the main ACLS
algorithm
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