Region X Medications Part 3 CE October, 2006

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Region X Medications Part 3CE October, 2006

• Atropine
• Dopamine (Intropin)
• Epinephrine 110,000
• Amiodarone (Cordarone)
• Lidocaine (Xylocaine)
• Lasix (Furosemide)

Based on 2005 SOPs Sharon Hopkins, RN, BSN, EMT-P
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Atropine Sulfate

• Increases heart rate by increasing SA node rate
  of discharge enhancing conduction thru the AV
  node to decrease AV node block
• Used for symptomatic bradycardia
• Second drug used for asystole or bradycardic PEA
• Large doses used in organophosphate poisoning

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Atropine Sulfate

• Increase in heart rate in the setting of an MI
  may increase myocardial work demand and therefore
  increase hypoxia and myocardial ischemia
• Is not effective in second degree type II
  (Classical) or 3rd degree heart block with a wide
  QRS complex (may actually cause slowing of the
  ventricular rate)
• TCP used as an alternative instead of atropine

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Atropine Sulfate

• Dosing
• Symptomatic bradycardia
• initial dose 0.5 mg rapid IVP (when alive give
  0.5)
• currently, if needed, 1 mg rapid IVP in 2 minutes
• Asystole or PEA less than rate of 60
• 1 mg rapid IVP
• repeat every 3-5 minutes to a total of 3 doses
• Peds bradycardia
• 0.02 mg/kg (minimum 0.1mg) IVP/IO
• may be repeated once if no response
• always address airway compromise in the pediatric
  patient presenting with bradycardia

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Atropine Sulfate

• Patient may complain of dry mouth
  after drug received
• Pupils will become dilated
• Patients with transplanted hearts do not respond
  to atropine (nerves severed)
• TCP used in place of atropine

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Dopamine (Intropin)

• Used for hemodynamically
  significant hypotension in
  the absence of hypovolemia particularly
  in bradycardia and cardiogenic shock (supports a
  blood pressure)
• Response to drug dependent on dosage administered
• lower dose 2 - 10 mcg/kg/min - increased cardiac
  contractility with increased cardiac output
• higher dose 10 - 20 mcg/kg/min - renal,
  mesenteric, peripheral vasoconstriction

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Dopamine (Intropin)

• Hypovolemia needs to be corrected with volume
  replacement before dopamine given
• May cause excessive vasoconstriction especially
  at higher doses
• Dosing titrated to maintain a B/P at 100/systolic
  or greater
• must always be given IVPB attached to a primary
  line
• premixed IV bag 400 mg/250 ml D5W
• dosage based on patient body weight

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Dopamine (Intropin)

• Dosage table in protocol
• Quick way to calculate starting dosage
• Take patients weight in pounds, take 1st two
  numbers, subtract 2, this is starting
  drops/minute
  (example 180 18-216 microdrops/minute)

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Epinephrine 110,000

• Stimulates the sympathetic nervous system to
  increase heart rate, contractility, and cardiac
  force. Increases systemic vascular resistance
  which increases blood pressure
• Used during cardiac arrest anaphylactic shock
  pediatric arrest bradycardia
• Raising blood pressure and increasing heart rate
  may strain the heart and cause myocardial
  ischemia, angina and increase myocardial oxygen
  demand

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Epinephrine 110,000

• 110,000 strength is reserved for patients
  requiring aggressive intervention
• Dosing
• adult arrest (VF, pulseless VT, PEA, asystole)
• 1 mg IVP repeated every 3-5 minutes
• pediatric arrest (VF, pulseless VT, PEA,
  asystole)
• 0.01mg/kg IVP/IO
• pediatric bradyarrhythmias
• 0.01 mg/kg IVP/IO

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Epinephrine 110,000

• Conscious patients may
  complain of palpitations,
  nausea/vomiting, or have
  tremors
• Future direction is to avoid
  ETT route for drugs
• ETT absorption is less predictable and reliable
  than alternative routes becoming available (ie
  IO)

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Amiodarone (Cordarone)

• An antiarrhythmic that works on all cardiac
  tissues
• Relaxes vascular smooth muscle, decreases
  peripheral vascular resistance, increases
  coronary blood flow
• May decrease automaticity, conductivity, and
  contractility
• Used in ventricular fibrillation when not
  responding to defibrillation and vasopressor
  therapy

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Amiodarone (Cordarone)

• Do not mix use of antidysrhythmics
• pick and stick with amiodarone or lidocaine
• mixing drugs increases irritability
• Dosing
• VF/pulseless VT
• 300 mg rapid IVP
• dilution recommended - irritating to veins
• Medical control may order 150
  mg IVP repeated in 3-5 minutes

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Amiodarone (Cordarone)

• Amiodarone can be used in other tachycardia
  settings (currently medical control order)
• If used in patients with a pulse, initial dose
• 150 mg slow IVP over 10 minutes
• Patient must be monitored for hypotension
• Hospital may establish a drip infusion to follow
  the bolus
• Half life is very long (up to 40 days)

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Lidocaine (Xylocaine)

• Antidysrhythmic that depresses depolarization and
  automaticity in the ventricles
• Raises the ventricular fibrillation threshold
• Not to be used prophylactically in the setting of
  acute myocardial infarction
• To be avoided in bradycardic rhythms
• Bolus effects last approximately 10 minutes
• Effects maintained by drip infusion

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Lidocaine (Xylocaine)

• Allergic reactions to amide-type anesthetics
  alone are rare usually reaction is to
  preservative (PABA)
• Avoid if hypersensitive to amide-type local
  anesthetics
• lidocaine
• mepivacaine (carbocaine)
• prolocaine (citanest)
• bupivacaine (marcaine)
• phenocaine
• dibucaine
• etidocaine (duranest)

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Lidocaine (Xylocaine)

• Lidocaine not related to novocaine (an ester type
  anesthetic
• Ester type anesthetics (can tolerate lidocaine)
• benzocaine (hurricaine)
• novocaine
• tetracaine
• cocaine
• chloroprocaine
• propoxycaine
• No cross sensitivity between amide ester
  anesthetics

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Lidocaine (Xylocaine)

• Dosing
• ?VF/pulseless VT 1.5 mg/kg IVP
  may repeat in 3-5 minutes
  (max 3 mg/kg or 2 doses)
• Drip if resuscitation successful
  2 mg/min (30mcgtts/min)
• ?Stable VT with pulse 0.75 mg/kg IVP
• medical control needs to order the drip
• ?Pediatric arrest 1 mg/kg IVP/IO repeated every
  3-5 minutes to max 3 mg/kg

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Lidocaine (Xylocaine)

• Signs of toxicity
• CNS depression (decreased level of consciousness)
• muscle twitching or seizures
• irritability, confusion
• drowsiness, hypotension
• Dosage should be kept at a minimum for the
  patient with a slowed metabolic rate for clearing
• hepatic (liver) disease
• congestive heart failure
• age over 70

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Lidocaine (Xylocaine)

• Use in conscious sedation
• eliminates the cough reflex
• during coughing, intrathoracic pressures raise
  which are transmitted to increase intracranial
  pressures
• (remember a time you had a headache and
  coughing worsened the headache?)
• bolus is all that is required to blunt the cough
  reflex during ETT insertion
• Dosing 1.5 mg/kg IVP one time bolus

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Lasix (Furosemide)

• Diuretic
• Stimulates venous dilation which will
  pool blood away from the heart
• Useful in congestive heart failure, pulmonary
  edema and hypertensive crisis
• Vasodilation onset in 5-10 minutes diuresis
  onset in 5-30 minutes
• Avoid use in patients
• allergic to sulfa drugs
• with preexisting hypotension or dehydration

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Lasix (Furosemide)

• Dosing
• Stable pulmonary edema hypertensive crisis
• 40 mg IVP (80 mg IVP if patient on lasix)
• Side effects
• headache, dizziness
• hypotension
• electrolyte imbalance
• nausea vomiting
• temporary hearing loss/ringing in ears with
  repeated doses given rapid IVP

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Questions?