0071643192.pdf

■ May be used for lidocaine, epinephrine, atropine, and naloxone (LEAN)

■ Achieves lower serum drug levels compared to IV routes

■ Use 2–2.5 times the IV dose (10 ×the IV dose in pediatrics), dilute in

10 mL NS, administer directly in ET tube and follow with 5 breaths.

EPINEPHRINE

First-line medication for cardiac arrest.

MECHANISM OFACTION

■ α- and β-adrenergic receptor stimulation →increased coronary and cere-

bral perfusion pressures during CPR.

■ Negative effects: Increased myocardial work and myocardial oxygen

consumption

DOSE

■ Adult: 1 mg IV/IO every 3–5 minutes

■ ET tube dose: 2–2.5 mg

■ Pediatric: 0.01 mg/kg IV/IO (maximum dose: 1 mg) every 3–5 minutes

■ ET tube dose: 0.1 mg/kg

■ Higher doses have notbeen shown to improve survival.

RESUSCITATION

TABLE 1.10. Medications for Cardiac Arrest

DRUG DOSE(IV/IO) MECHANISM

Epinephrine Adult: 1 mg α,β-Adrenergic receptor agonist → ↑

Pediatric: 0.01 mg/kg coronary and cerebral perfusion

pressures.

Vasopressin Adult: 40 U Nonadrenergic peripheral

vasoconstrictor

Atropine Adult: 1 mg Parasympatholytic

Pediatric: 0.02 mg/kg

(minimum 0.1mg, maximum 0.5–1mg)

Amiodarone Adult: 300 mg, repeat at 150 mg. Class III antidysrhythmic

Pediatric: 5 mg/kg, repeat up to (blocks K+channels)

15 mg/kg (maximum 300 mg).

Lidocaine Adult: 1–1.5 mg/kg, repeat at Class Ib antidysrhythmic

0.5–0.75 mg/kg every 5–10 minutes (blocks fast Na+channels)

PRN (maximum 4 mg/kg).

Pediatric: 1 mg/kg every 5–10 minutes

PRN (maximum 100 mg).

Magnesium Adult: 1–2 g ↑Mg levels →improved QT intervals.

Pediatric: 25–50 mg/kg

(maximum 2 g)

Central venous access

provides the fastest drug

delivery to the central

circulation, but is not

preferred because of required

delays in CPR to obtain access.

Epinephrine has been shown

to increase coronary and

cerebral perfusion pressures

during CPR.