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Adenosine is a naturally occurring agent that
can "chemically cardiovert" PSVT into normal sinus rhythm. It has a half life of 10-seconds and does not cause hypotension.
Narrow, complex, paroxysmal supraventricular tachycardia refractory to vagal manuevers.
2nd and 3rd degree heart block, sinus node disease, or asthma.
It may cause transient dysrhythmias, especially asystole, COPD
- - Dosage/Route: 6 mg rapidly (over 1 to 2 seconds) IV, then flush line rapidly with saline. If ineffective, 12 mg in 1 to 2 mins, may be repeated.
- -Pedi: 0.1 mg/kg (over 1 to 2 seconds) IV, followed by rapid saline flush, then 0.2 mg/kg in 1 to 2 mins to max 12 mg.
Amiodarone (Cordarone, Pacerone)
Anti-Dysrhythmic (KCl Blocker)
Amiodarone is an anti-dysrhythmic that prolongs the duration of the action potential and refractory period and relaxes smooth muscles, reducing peripheral vascular resistance and increasing coronary blood flow.
Life-threatening ventricular and supraventricular dysrhythmias, frequently atrial fibrillation.
Cardiogenic shock, severe sinus bradycardia, or advanced heart block.
- Precautions: Hepatic impairment, pregnancy, nursing mothers, children
- - Dosage/Route: 150 to 300 mg IV over 10 mins, then 1 mg/min over next 6 hours.
- -Pedi: 5 mg/kg IV/IO then 15 mg/kg/day.
Anti-dysrhythmic (KCL Blocker)
- Description: Bretylium causes a release of norepinephrine, depresses ventricular fibrillation, and reduces ectopy. Bretylium suppresses ventricular tachydysrhythmias including vfib with re-entry mechanisms.
- Indications: Ventricular fibrillation and ventricular tachycardia refractory to lidocaine.
- Contraindications: None
- Precautions: Digitalized patients, digitalis induced dysrhythmias.
- Dosage/Route: 5 mg/kg IV then 10 mg/kg/10 to 15 mins to a max of 30 mg/kg
Anti-dysrhythmic/ NA+ blocker
Lidocaine is an anti-dysrhythmic that suppresses automaticity and raises stimulation threshold of the ventricles. It also causes sedation, anticonvulsant, and analgesic effects.
Pulseless ventricular tachycardia, ventricular fibrillation, ventricular tachycardia (w/ pulse)
Hypersensitivity to amide-type local anesthetics, supraventricular dysrhythmias, Stokes-Adams syndrome, 2nd and 3rd degree heart blocks, and bradycardias.
Hepatic or renal impairment, CHF, hypoxia, respiratory depression, hypovolemia, myasthenia gravis, shock, elderly.
- - Dosage/Route:
- Cardiac Arrest: 1 to 1.5 mg/kg slow IV, repeated every 3 to 5 mins, up to 3 mg/kg. Follow conversion with a drip of 2 to 4 mg/min.
- Pedi: 1 mg/kg slow IV, repeated every 3 to 5 mins, up to 3 mg/kg. Follow conversion with a drip of 20 to 30 mcg/kg/min.
- Ventricular Tachycardia (w/ pulse): 1 to 1.5 mg/kg slow IV. Consider lower dose for elderly. May repeat 1/2 dose every 5 to 10 mins until conversion up to 3 mg/kg. Follow conversion with 2 to 4 mg/min.
- Pedi: 1 mg/kg followed by a drip of 20 to 50 mcg/kg/min.
Anti-arrhythmic (NA+ blocker)
Procainamide prolongs ventricular repolarization, slows conduction, and decreases myocardial excitability.
Ventricular fibrillation, pulseless ventricular tachycardia refractory to lidocaine.
Hypersensitivity to procainamide or procaine, myasthenia gravis, 2nd and 3rd degree heart block,
Hypotension, cardiac enlargement, CHF, AMI, ventricular disrhythmias from digitalis, hepatic or renal impairment, or bronchial asthma.
- - Dosage/Route: 20 to 30 mg/min IV drip Stop points: (1) up to 17 mg/kg to effect, then 1 to 4 mg/min. (2) ectopy resolves (3) QRS complex widens more than 50% from original. (4) Hypotension ensues.
- Pedi: 15 mg/kg IV/IO over 30 to 60 mins.