A Textbook of Clinical Pharmacology and Therapeutics

BASIC LIFE SUPPORT

When a person is found to have collapsed, make a quick check
to ensure that no live power lines are in the immediate vicin-
ity. Ask them, ‘Are you all right?’, and if there is no response,
call for help. Do not move the patient if neck trauma is sus-
pected. Otherwise roll them on their back (on a firm surface if
possible) and loosen the clothing around the throat. Assess
airway, breathing and circulation (ABC).
Tilt the head and lift the chin, and sweep an index finger
through the mouth to clear any obstruction (e.g. dentures).
Tight-fitting dentures need not be removed and may help to
maintain the mouth sealed during assisted ventilation.
If the patient is not breathing spontaneously, start mouth-
to-mouth (or, if available, mouth-to-mask) ventilation. Inflate
the lungs with two expirations (over about 2 seconds each)

CARDIOPULMONARYRESUSCITATION ANDCARDIACARREST: BASIC ANDADVANCEDLIFESUPPORT 219

Table 32.1:Anti-dysrhythmic drugs: the Vaughan–Williams/Singh classification

Class Example Mode of action Comment

I Rate-dependent block of Naconductance

a Quinidine Intermediate kinetics between b and c Prolong cardiac action potential

Procainamide

Disopyramide

b Lidocaine Rapid dissociation from Nachannel Useful in ventricular tachydysrhythmias

Mexiletine

c Flecainide Slow dissociation from Nachannel Prolong His–Purkinje conduction: worsen

Propafenone survival in some instances

II Atenolol Beta blockers: slow pacemaker Improve survival following myocardial

depolarization infarction

III Amiodarone Prolong cardiac action potential Effective in supra-, as well as ventricular

Sotalol tachydysrhythmias. Predispose to torsades de

Dofetilide pointes (a form of ventricular tachycardia)

Ibutilide

IV Verapamil Calcium antagonists: block cardiac Used in prophylaxis of recurrent SVT. Largely

Diltiazem voltage-dependent Ca^2 conductance superseded by adenosine for treating acute

attacks. Negatively inotropic

Table 32.2:Drugs/ions not classified primarily as anti-dysrhythmic, but used
to treat important dysrhythmias

Digoxin (rapid atrial fibrillation)

Atropine (symptomatic sinus bradycardia)

Adenosine (supraventricular tachycardia)

Adrenaline (cardiac arrest)

Calcium chloride (ventricular tachycardia caused by
hyperkalaemia)

Magnesium chloride (ventricular fibrillation)

Unresponsive?

Shout for help

Open airway

Not breathing normally?

30 chest compressions

2 rescue breaths

Check pulse

No pulse?

Precordial thump if

arrest witnessed

2 breaths

30 compressions

Continue until breathing and pulse restored

of emergency services arrive

Figure 32.1:Adult basic life support.