According to the 2010 ACLS Guidelines by AHA, which of the following pharmacological agents is not used in the management of cardiac arrest :
Correct Answer: Atropine
Description: Answer is C (Atropine) The use of Atropine for cardiac arrest (PEA / Asystole) has been removed from the ACLS 2010 Guidelines / Algorithm due to lack of any evidence showing therapeutic benefit. The primary Pharmacological agents included in the ACLS Algorithm for management of cardiac arrest include Epinephrine, Vasopressin and Amiodarone. The primary goal of pharmacologic therapy is to assist the achievement and maintenance of spontaneous circulation. The mainstay of pharmacologic interventions is vasopressor agents. Epinephrine ( I mg) is recommended by IV or the intraosseous (10) route every 3 to 5 minutes during resuscitative effos until spontaneous circulation is restored. If IV/10 access cannot be established, epinephrine can be administered an endotracheal tube at a higher dose (2 to 2.5mg). Vasopressin (40 mg iv/I0) could be substituted for the first or second dose of epinephrine if desired. The preferred antiarrhythmic agent for resuscitation is Amiodarone. Amiodarone is recommended in patients with VF/VT that does not respond to CPR, defibrillation, and vasopressor therapy. (first dose; 300mg 1V/I0; second dose; 150mg IV/10). It should be noted that The use of atropine far PEA/Asystole was recently removed from the ACLS algorithm. Evidence is insufficient to recommend routine administration of sodium bicarbonate during resuscitation. First dose; 300 mg bolus second dose; 150 mg Lidocaine is not pa of the ACLS 2010 Algorithm but may be used. The AHA recommends its administration after epinephrine; vasopressin and Amiodarone have been tried. But in clinical studies Lidocaine has not been demonstrated to improve rates of ROSC and hospital admission compared with Amiodarone. It is given in a bolus of ling/kg. A second loading dose of I mg/kg can be given in 10-15 minutes alter the first one. ACLS: Pharmacological agents Medications that have been changed Atropine: deleted from pulseless arrest algorithm Sodium Bicarbonate: Routine use not recommended Calcium: Routine administration for treatment of cardiac arrest not recommended Medications that have remained unchanged Epinephrine: dose, interval unchanged Vasopressin: dose, use unchanged Amiodarone: dose, indications unchanged Lidocaine: dose, indications unchanged
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