6/20/2018

1. To correct Hypoxemia
2. To reestablish spontaneous circulation
3. To optimize cardiac function
4. To suppress sustained ventricular
arrhythmia
5. To correct acidosis
6. To relieve pain
7. To treat congestive
heart failure
6/20/2018
 A. OXYGEN
•It is an essential component of cardiac
resuscitation and emergency cardiac care.
•Supplemental oxygen is obligatory during
resuscitation.
•In hypoxic patients oxygen administration
elevates arterial oxygen tension and
increases arterial oxygen content thereby
improving oxygenation.

6/20/2018
 1. INDICATIONS:
•acute chest pain that may be due to cardiac ischemia
•suspected hypoxemia of any cause
•cardiopulmonary arrest
2. DEVICE USED FOR SUPPLEMENTAL OXYGEN:
A. Face Mask - 8 - 10 L/min. = 40 - 60 % O2
concentration
B. Venturi Mask - provides a high gas flow with a
fixed O2 concentration. Used in COPD patients.
C. Face Mask with Oxygen Reservoir - 10L/min. = 100
% O2
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 B. EPINEPHRINE (ADRENALINE)
•endogenous catecholamine with both alpha and
beta adrenergic activity.
•Cardiovascular responses increases in:
a. systemic vascular resistance
b. arterial blood pressure
c. coronary cerebral blood flow.
d. myocardial contraction
e. myocardial oxygen requirement
f. automaticity
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 Epinephrine……...

INDICATIONS:
•used for treating asystole and ventricular
fibrillation.
•Produces a favorable redistribution of blood
flow.
•Post cardiopulmonary bypass,
vasoactive, inotropic agent
in rare selected refractory
patients with circulatory shock.
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 Epinephrine……...
DOSAGE:
data suggest that higher rather than lower doses
may be optimal
•recommended dose: 0.5 to 1 mg/IV repeated at
least every 3 minutes.
•Route
a. intravenous b. intratracheal c. intracardiac
PRECAUTION:
-should not be mixed in the same infusion bag or
line with alkaline solution.
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E.g. Sodium Bicarbonate
 C. ATROPINE
-parasympathetic drug that enhance both sinus
node automatically and AV conduction via its direct
vagolytic action.
INDICATIONS:
•symptomatic bradycardia
DOSAGE AND ADMINISTRATION:
1. Without cardiac arrest - 0.5 mg IV and maybe
repeated 5 minutes interval until desired response.
2. With cardiac arrest - 1 mg repeated once if
necessary.
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 D. LIDOCAINE HCL
-cardiac antiarrhythmic agent
- increases electrical stimulation threshold of
the ventricle during diastole.

INDICATIONS:
•acute management of ventricular arrhythmia's
occurring during cardiac manipulation. Ex.
Cardiac surgery
•life threatening arrhythmia's particularly those
which are ventricular in origin. Ex. Acute MI
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 DOSAGE & ADMINISTRATION:
stocks:
1 % = 10 mq/cc = 500 mq/50 ml = 0.5 qm
2 % = 20 mq/cc = 1000 mq/50 ml = 1 qm
dose:
Bolus = 25 mq to 50 mq / minute
IV Drip = 1 - 4 mq

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 E. VERAPAMIL (ISOPTIN)
•decreases myocardial contractility, causing
peripheral vasodilation leading to reduction of
myocardial oxygen consumption.
•Anti-anginal effect includes dilation of coronary
arteries and arterioles.
Used: chronic and stable angina
treatment of SVT
stock dose: 5 mg/2 ml

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 F. SODIUM BICARBONATE
during Cardiopulmonary arrest, hypoxia -
induced anaerobic metabolism results in
the generation of lactic acid and
generates development of metabolic
acidosis
Used: correction of
metabolic acidosis
Stock dose:
50 meq/ 50 cc
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 G. NITROGLYCERINES
•dilates the peripheral vascular smooth muscle of
smaller vessels which decrease the cardiac
preload & afterload leading to decrease
myocardial O2 needs.
•Selectively dilates the large coronary arteries
which helps to decrease anginal pain and
hypoxia of the myocardium.
INDICATIONS: treatment of anginal pectoris,
CHF associated with acute MI
6/20/2018 Intra and post op hypertension
 ROUTES: oral, sublingual, topical, transdermal,
intravenous
RECOMMENDED DOSE:
oral: 2.5 mg TID
SL: 0.15 - 0.6 mg at the onset of attack or
anticipation of the attack
topical ointment: 1-2 inches every 8 hour up
to 4.5 inched every 4 hour
IV: 5 mg in D5W or NSS every 3-5 minutes
until response.
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 H. NIPRIDE
•highly POTENT vasodilator
•relaxes both the arterial and venous smooth
muscle.
DOSAGE & ADMINISTRATION
stocks: 50 mg / 2 ml
dose: 0.3 - 10 ug/kg/min
concentration: SC = 200 ug/cc
DC = 400 ug/cc
6/20/2018
 Nipride……..

INDICATIONS:
1. For rapidly & effective lowering of BP in
hypertensive crises
2. In situations requiring immediate
lowering of BP or vasodilator
•hypertensive encephalopathy
•cerebral hemorrhage
•acute glomerular nephritis
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 Nipride……..

INDICATIONS:
3. For enhancing C.O. and decreases
myocardial O2 requirements in heart failure
secondary to acute MI, Mitral or Aortic
Valvular dose. Cardiomyopathy, & intra/post-
op treatment of patients
who underwent heart surgery.
4. Controlled hypotension
during surgical interventions
while the patients
is under anesthesia.
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 I. DOPAMINE
•inotropic action on the myocardium
resulting in increase C.O. it causes less
myocardial O2 consumption.
•Produce dilation of the
renal vasculature which
is accompanied by increase
in GFR, Renal blood
flow and Na Excretion.

6/20/2018
 DOPAMINE……...

INDICATIONS:
•correction of hemodynamic imbalances
present in shock due to MI, trauma, open
heart surgery, Renal Failure and chronic
cardiac decompensation as in CHF.
•To improve perfusion to the vital organs
•to increase Cardiac Output (CO)
•to correct hypotension
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 DOPAMINE……...

DOSAGE & ADMINISTRATION

stocks: (premix) 200 mq/ 250 ml
400 mq/ 250 ml
concentration: SC = 800 ug/ml
DC = 1600 ug/ml
dose: 3 - 5 ug/kg/min = Renal dose
5 - 10 ug/kg/min = Cardiac dose
10 - 20 ug/kg/min = maximum dose
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 DOBUTAMINE HCL
•direct acting inotropic agent
•directly stimulates Beta 1 receptors of
the heart to
increase
myocardial
contractility
and stroke volume
to increase cardiac
output.
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 DOBUTAMINE……...

DOSAGE & ADMINISTRATION

stocks: 250 mq/ 20 ml
concentration:
SC = 1000 ug/ cc
DC = 2000 ug/ cc
dose:
2.5 - 10 ug/kg/min
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 K. PROPANOLOL (Inderal)
•beta adrenergic blockers that decreases heart
rate force of contraction, myocardial irritability
and conduction velocity and decreases
automaticity.
USE : cardiac arrhythmias caused by excessive
cardiac stimulation of symphatetic nerve
impulses anginal pectoris
ADVERSE EFFECT :
dizziness, insomnia,
bradycardia, drowsiness,
rashes, heart block.
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 PROPANOLOL……..
NURSING IMPLICATONS:
•Monitor V/S especially the apical pulse
•Gradualy reduce dose before discontinuing
•Change position slowly
•Record I & O and weight and notify MD for
significant changes
•Inform patient client that smoking may
reduce the effectiveness of drug
•Evaluate the rate and the rhythm of the client
regularly
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 L. FUROSEMIDE
•acts by inhibiting reabsorption of sodium
and chloride at the proximal portion of
the ascending loop of Henle increasing
water absorption.
ADVERSE EFFECT:
•fluid and electrolytes
imbalance
•nausea and vomiting,
•Hypotension
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 NURSING IMPLICATIONS:
•monitor I & O frequently
•Monitor weight daily
•monitor the electrolytes
•monitor the V/S closely especially BP

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 M. MORPHINE
•increases venous & systemic vascular
resistance, relieving pulmonary congestion
•decreases intramyocardial wall tension
without myocardial O2 requirement
TREATMENT: effective
for ischemic chest
pain & for acute pulmonary
edema.
-pain & anxiety associated with acute MI
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 DOSAGE & ADMINISTRATION
dosage: 2.5 mg 5 - 30 minutes until
desired response is achieve
precaution: respiratory depression
(narcotic analgesic)
NURSING IMPLICATION:
•watch of signs and symptoms
of respiratory depression
•monitor BP
6/20/2018