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Cardiopulmonary resuscitation
Pharmacological treatment of significant cardiac arrhythmias
  1. G Mccann
  1. Department of Medicine and Therapeutics, Gardiner Institute, Western Infirmary, Glasgow G11 6NT, United Kingdom

    https://doi.org/10.1136/bjsm.34.5.401

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      For life threatening cardiac arrhythmia, the administration of drugs should be by the intravenous route. Drugs delivered through a peripheral vein should always be followed by a 20 ml bolus of saline to aid delivery to the central circulation. Where no venous access is possible, drugs (particularly adrenaline (epinephrine)) may be delivered by the endotracheal route in double or triple doses.

      Ventricular fibrillation (VF)/pulseless ventricular tachycardia (VT)

      The pharmacological treatment of VF/pulseless VT is of secondary importance to early defibrillation. Administration of antiarrhythmic drugs is considered in cases of refractory VF/pulseless VT—that is, when cardioversion does not occur after 12 DC shocks with appropriate advanced life support provided. Drugs recommended by the European Resuscitation Council are those outlined for use in VT.

      Ventricular tachycardia

      LIGNOCAINE (LIDOCAINE)

      Lignocaine is a class IB antiarrhythmic drug and is the first choice for VT. It is given intravenously in a dose of 1–3 mg/kg. For cardiac arrest, a 100 mg bolus is given, which may be repeated after 5–10 minutes. If successful cardioversion occurs, plasma levels can be maintained by an intravenous infusion of 2–4 mg/min. Lignocaine has no effect on supraventricular tachycardia (SVT). Like most antiarrhythmic drugs, lignocaine depresses myocardial contractility, and toxic levels can produce paraesthesia, drowsiness, muscular twitching, or seizure.

      AMIODARONE

      Amiodarone is an effective class III antiarrhythmic drug. It has a long half life, up to 100 days, and is associated with …

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