In ACLS which drug can be given following ventricular fibrillation after cardiac arrest in place of Epinephrine?
Correct Answer: High dose vasopressin
Description: (C) High dose vasopressinCPR Quality:-Push hard (>2:2") & fast (>=2:100/min) & allow complete chest recoil.-Minimize interruptions in compressions-Avoid excessive ventilation-Rotate compressor every 2 minutes-If no advanced airway, 30:2 compression-ventilation ratio-Quantitative waveform capnography-If PETCO2<10mmHg, attempt to improve CPR quality-Intra-arterial pressure: If relaxation phase (diastolic) pressure <20mmHg, attempt to improve CPR quality.Return of Spontaneous Circulation (ROSC):-Pulse and blood pressure-Abrupt sustained increase in PETCO2 (typically >40mmHg)-Spontaneous arterial pressure waves with intra-arterial monitoringShock Energy:-Biphasic: Manufacturer recommendation (120-200J); if unknown, use r maximum available. 2nd & subsequent doses should be equivalent, and higher doses may be considered.-Monophasic: 360 JDrug Therapy:-Epinephrine IV/10 Dose: 1 mg every 3-5 minutes-Vasopressin IV/10 Dose: 40 units can replace 1s' or 2nd dose of epinephrine-Amiodarone IV/10 Dose: First dose: 300 mg bolus. Second dose: 150 mg.Advanced Airway:-Supraglottic advanced airway or endotracheal intubation-Waveform capnography to confirm and monitor ET tube placement-8-10 breaths per minute with continuous chest compressionsReversible Causes:- Hypovolemia - Tension pneumothorax- Hypoxia - Tamponade, cardiac- Hydrogen ion (acidosis) - Toxins- Hypo-/hyperkalemia - Thrombosis, pulmonary- Hypothermia - Thrombosis, coronary[?]VASOPRESSIN:oVasopressin is an alternative vasopressor at high doses, causes vasoconstriction by directly stimulating smooth muscle V1 receptors.oAmerican Heart Association (AHA) guidelines states "Vasopressin is a reasonable first-line vasopressor in patients with ventricular fibrillation or pulse-less ventricular tachycardia.oAdditionally, the guidelines comment that one dose of vasopressin 40 U may replace the first or second dose of epinephrine in all pulse-less sudden cardiac arrest scenarios, including asystole and pulse-less electrical activity, Cardiac arrest scenarios, including asystole and pulse-less electrical activity.oContraindications/Precautions:-Potent peripheral vasoconstrictor (increased demand upon resuscitation)oDosing:-Single dose of 40 u that replaces either the 1st or 2nd dose of epinephrine. Epinephrine can be resumed 3-5 minutes after.-Can be used endotracheally; no suggested dose.-V-Fib or VF is the most common rhythm that occurs immediately after cardiac arrest. In this rhythm, the heart beats with rapid, erratic electrical impulses.oTreatment:-Shock/De-fibrillation: every 2 minutes in a single one shock, successive, shock-able increments-200 joules - Followed by immediate CPR for 2 minutes/give and circulate a drug(s)-300 joules - Followed by immediate CPR for 2 minutes/give and circulate a drug(s)-360 joules - Followed by immediate CPR for 2 minutes/give and circulate a drug(s)oDrugs:-Give Epinephrine 1mg of a 1:10,000 solution every 3 to 5 minutes -Give either:-Amiodarone : 300mg first dose/150mg second dose at 3 to 5 minutes increments.oLidocaine: First dose: 1mg/kg or 1.5mg/kg. Can repeat it at half the original dose up to a total of 3mg/kg .
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