OBAT-OBATAN DALAM BANTUAN

HIDUP LANJUT
Cardiac Arrest
Cardiac arrest algorithm is used for two pathways :
• A shockable rhythm : Ventricular Fibrillation (VF) or pulseless
Ventricular Tachycardia (VT)
• A nonshockable rhythm : asystole, Pulseless Electrical Activity
(PEA)
FOR
VF/PULSELE
SS VT
Persistent VF/pulseless VT
Vasopressor drugs optimize cardiac output and blood
pressure.

Used during resuscitation primarily for its α-adrenergic

effects

EPINEPHRINE Vasoconstriction increases cerebral & coronary blood flow

during CPR by increasing mean arterial pressure and aortic
diastolic pressure

Increasing blood pressure and heart rate

1 mg IV/IO – repeat every 3 to 5 minutes

 Antiarrhythmic drugs, either before or after shock

1st line choice

Improves the rate of Return Of Spontaneous Circulation
(ROSC) and admission in adults with refractory VF/pulseless
AMIODARONE VT

Affects sodium, potassium, and calcium channel. And also α-

adrenergic and β-adrenergic blocking properties

300 mg IV/IO bolus and consider additional 150 mg IV/IO

If amiodarone is not available

1 to 1.5 mg/kg IV/IO first dose, then 0.5 to 0.75 mg/kg IV/IO
LIDOCAINE at 5- to 10- minutes interval, to a maximum dose of 3 mg/kg
Consider magnesium sulfate only for torsades de pointes
asspcoated with a long QT interval

Magnesium Loading dose 1 to 2 g IV/IO diluted in 10 mL (D5W or

sulfate normal saline) given as IV/IO bolus, typically over 5
to 20 minutes
FOR ASYSTOLE
/PEA
Asystole/PEA

Used during resuscitation primarily for its α-adrenergic

effects

EPINEPHRINE Vasoconstriction increases cerebral & coronary blood flow

during CPR by increasing mean arterial pressure and aortic
diastolic pressure

Increasing blood pressure and heart rate

1 mg IV/IO – repeat every 3 to 5 minutes

FOR
BRADYCARDIA
Bradycardia
The drugs is given if bradyarrhythmia causing :

• Hypotension
• Acutely altered mental status
• Signs of shock
• Ischemic chest discomfort
• Acute heart failure

First-line treatment
Atropine 0.5 mg IV – may repeat to a total dose of 3 mg

Use atropine cautiously in the presence of acute coronary

ATROPINE ischemia or MI

Do not rely on atropine in Mobitz type II second or third

degree AV block or in patients with third – degree AV block
with a new wide QRS complex
 If Atropine is ineffective, consider :

Transcutaneous
pacing

OR DOPAMINE
2 to 10 mcg/kg per minute
(chronotropic or heart rate dose)

OR EPINEPHRINE 2 to 10 mcg/min
 FOR
TACHYCARDIA
Tachycardia

CARDIOVERSION
Unstable Tachycardia
Sign & symptoms :
• Hypotension
• Acutely altered mental status Consider of giving
• Signs of shock adenosine, if
• Ischemic chest discomfort regular narrow
• Acute heart failure complex
ADENOSINE
First dose :
6 mg rapid IV push;
follow with NS flush

Second dose :
12 mg if required
Tachycardia
Stable Tachycardia

If QRS ≥ 0.12 second (wide) If QRS is not wide

Consider : - Vagal maneuvers

- Adenosine only if regular &
monomorphic
First dose: 6 mg rapid IV push; follow
with NS flush
Second dose: 12 mg if required
- Adenosine (if regular)
- β–Blocker or calcium channel
blocker

- Consider antiarrhytmic infusion

First dose: 150 mg over 10 minutes
Repeat as needed if VT recurs.
Follow by maintenance infusion of
1 mg/min for first 6 hours
Terima kasih