OBAT OBAT EMERGENCY

PROGRAM STUDI S1 KEPERAWATAN

STIKES KARYA HUSADA KEDIRI

Tujuan
Setelah menyelesaikan mata kuliah ini,
mhs dapat menjelaskan:
Obat yang biasa digunakan negara
dalam keadaan darurat jantung
Menguraikan tindakan utama
Obat yg dpt diberikan mll ETT
Daftar efek samping terkait dengan
penggunaan obat

DRUGS USED IN
CARDIAC EMERGENCIES
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.

Epinephrine (Adrenaline)
Norepinephrine (Noradrenaline)
Dopamine
Dobutamine
Amiodarone
Atropine
Nitroglycerin (GTN)
Verapamil
Diltiazem
Sodium bicarbonate

Adrenergic Effects (Sympathomimetic Amines)

Receptor

Vascular

Inotropic

Chronotropic

Constriction

+ ve

- ve

Dilatation

+ ve

+ ve

Drug

Dosage

0.5-1 g/

++

1-200 g/'

++

+++

2-80 g/'

+++

++

1-2 g/kg/'

2-10 g/kg/'

++

++

10-30 g/kg/'

+++

++

Vasopressin

40u IV bolus

+++

Dobutamine

2-30 g/kg/'

+++

Isoprenaline

2-10 g/kg/'

+++

Epinephrine
Norepinephrine

Dopamine

Emergency Management of Complicated STEMI

Clinical signs: Shock, hypoperfusion, congestive heart failure, acute pulmonary edema
Most likely major underlying disturbance?

First line of action

Second line of action
Third line of action

Administer
Furosemide IV 0.5 to 1.0 mg/kg
Morphine IV 2 to 4 mg
Oxygen/intubation as needed
Nitroglycerin SL, then 10 to 20 mcg/min IV if SBP
greater than 100 mm Hg
Dopamine 5 to 15 mcg/kg per minute IV if SBP 70 to
100 mm Hg and signs/symptoms of shock present
Dobutamine 2 to 20 mcg/kg per minute IV if SBP 70
to 100 mm Hg and no signs/symptoms of shock

Check Blood Pressure

Systolic BP
Greater than 100 mm Hg
and not less than 30 mm Hg
below baseline

Low Output Cardiogenic Shock

Hypovolemia

Acute Pulmonary Edema

Administer
Fluids
Blood transfusions
Cause-specific
interventions
Consider vasopressors

Arrhythmia

Bradycardia

Check Blood Pressure

Tachycardia

See Section 7.7

in the ACC/AHA Guidelines for
Patients With ST-Elevation
Myocardial Infarction

Systolic BP
Greater than 100 mm Hg

Systolic BP
70 to 100 mm Hg
NO signs/symptoms
of shock

Systolic BP
70 to 100 mm Hg
Signs/symptoms
of shock

Systolic BP
less than 70 mm Hg
Signs/symptoms of shock

Nitroglycerin
10 to 20 mcg/min IV

Dobutamine
2 to 20
mcg/kg per
minute IV

Dopamine
5 to 15
mcg/kg per
minute IV

Norepinephrine
0.5 to 30 mcg/min IV

ACE Inhibitors
Short-acting agent such as
captopril (1 to 6.25 mg)
Further diagnostic/therapeutic considerations (should be considered in
nonhypovolemic shock)
Diagnostic
Therapeutic
Pulmonary artery catheter
Intra-aortic balloon pump
Echocardiography
Reperfusion/revascularization
Angiography for MI/ischemia
Additional diagnostic studies

Circulation 2000;102(suppl I):I-172-I-216.

1. EPINEPHRINE

1st drug in cardiac arrest

Endogenous catecholamine
Indications

Cardiac arrest from VF

pulseless VT unresponsive to initial counter shock
Asystole
symptomatic bradycardia sangat berat

Routes of administration
IV 1 mg push (10 ml of 1:10,000), followed by 20 ml flush, at
interval of 3-5 min
ETT 2-2.5 times peripheral dose (1 ml of 1:1000)
Infusion 1 mg (1 ml of 1:1000) added to 500 ml NS or D5%,
titrate 2-10 /min
6

EPINEPHRINE - ACTIONS
increases contractile force (inotropic) of
the heart improving contractility increasing cardiac output
increases conduction of SA Node, AV
Node and ventricle thus increasing heart
rate
increases systemic vascular resistance
dengan cara peripheral vasoconstriction
- increasing perfusion pressure improving cerebral & coronary blood flow
7

EPINEPHRINE Pencegahan
Tidak boleh diberikan mll infus yg berisi
cairan alkaline
Dapat menyebabkan iskemia eksaserbasi,
iritasi ventrikel; boleh diberikan pd stroke
dan IMA
tachycardia
PVCs

Dosis tinggi tidak dianjurkan

Digunakan dng perhatian pd bumil

2. NOREPINEPHRINE
Indications:

cardiogenic shock
septicaemic shock
neurogenic shock
anaphylactic shock
hypovolemic shock setelah resusitasi cairan
gagal menaikkan BP

Route of administration:

increasing cardiac output by increasing

myocardial contractility & causing peripheral
vasoconstriction (0.1-2 ug/kg/min)
9

3. DOPAMINE
Indications:
cardiogenic shock
septicaemic shock
neurogenic shock
anaphylactic shock
hypovolemic shock - after fluid
resuscitation has failed to raise BP
Route of administration:
infusion via vein/central vein
10

DOPAMINE - ACTIONS
Dilates renal and mesenteric vessels
(1-2 ug/kg/min)
Meningkatkan aliran darah renal
Increases myocardial contractility
(2-10ug/kg/min)
increasing cardiac output
Causes peripheral vasoconstriction
(>10ug/kg/min)
elevating blood pressure

11

DOPAMINE - SIDE EFFECTS

Nursing Implications
monitor BP, cardiac rhythm
monitor tetesan infus
observe for onset of extravasation
12

4. DOBUTAMINE
Indications:
Acute-on-chronic gagal jantung yg
sukar disembuhkan
Severe acute myocardial failure
Cardiogenic shock
Route of Administration
infusion via vein/central vein

13

Actions
1 effects (predominant).
Mild 2 and 1 effects.
No specific effects on renal or splanchnic
blood flow, but may renal blood flow due to
an in cardiac output.
Efek buruk
Tachycardia
Irama ektopik

14

Cautions
Acute myocardial ischaemia or MI
-Blockers (dobutamine)
How not to use dobutamine
Tidak ada monitoring jantung

15

Kerugian
CHF
BP menurun
Resiko aritmia
perhatian
Hemodinamik atau monitor keadaan klinik
Cek natrium darah (mkn tinggi) aritmia

16

5. Amiodarone
Amiodarone is an antiarrhythmic agent
used for various types of cardiac
dysrhythmias, both ventricular and atrial.
Indications
Takikardi yg kecil maupun besar

17

Amiodarone - ACTIONS
Class III antiarrhythmic agent
Amiodarone shows beta blocker-like
and potassium channel blocker-like
actions on the SA and AV nodes,
increases the refractory period via
sodium- and potassium-channel effects,
and slows intra-cardiac conduction of
the cardiac action potential, via sodiumchannel effects.

18

Amiodarone - ADMINISTRATION
Routes of administration:
IV 150mg IV over 10 min; can be repeated
once

Use with caution:

Hypovolemia state
Hyperthyroid (Amiodarone resembles T4 thyroid
hormone, and its binding to the nuclear thyroid
receptor)

19

6. ATROPINE
Indications:
haemodynamically unstable
bradycardias
heart block

acute cholinergic poisoning

(organophosphates)
Routes of administration:
IV push - murni
ETT aliran cpt- tanpa pengenceran
maximum 2.4 mg
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ATROPINE - ACTIONS
Meningkatkan konduksi
increasing heart rate and cardiac
output

Decreases secretions

21

ATROPINE - SIDE EFFECTS

Tachycardia
Palpitations
bradycardia
(if dose<0.5mg)
Hypertension
Respiratory failure
Use with caution in MI cases
22

7. NITROGLYCERIN
Indications
unstable angina
AMI
pulmonary oedema with high BP
hypertensive crisis
Routes of administration:
sublingual
transdermal
IV infusion 10-200ug/min titrated to
response
23

NITROGLYCERIN - ACTIONS
Vasodilator
Dilates coronary arteries
Relieves coronary spasm
Opens up collateral vessels
increases blood flow to
myocardium

24

NITROGLYCERIN - SIDE EFFECTS

Headache
Flushing (muka merah)
Tachycardia
Hypotension
Use with caution in hypotension &
tachycardia

Nursing implications:
monitor BP and heart rate
25

8. VERAPAMIL
Indications
PSVT
Acute atrial fibrillation or atrial
flutter with rapid ventricular
response (exclude WPW first)
Route of administration:
IV slow bolus - dilute 5mg in 5 ml at
1mg/min
26

VERAPAMIL- ACTIONS
Blocks calcium channel- negative
inotropic effect
decreases force cardiac contraction

Slows conduction & prolongs

refractory period at AV Node
slows down heart rate

Dilates coronary, systemic and

peripheral vessels
increases blood flow and lowers
blood pressure
27

VERAPAMIL - SIDE EFFECTS

Hypotension
Prolongation of PR intervals,
bradycardia - asystole
PVCs
Ritme nodus hilang
Heart blocks
VF in patient with WPW
Nursing implications
monitor cardiac rhythm and BP
28

9. DILTIAZEM
Calcium Channel Blockers
negative chronotropic langsung yg kuat&
negative inotropic effects
Primary beneficial effects:
Both slow conduction and increase
refractoriness in the AV node
Produces less myocardial depression
than verapamil, but is equipotent as a
negative chronotrope
29

DILTIAZEM
Indication:
Treatment of PSVT
Slow down ventricular respopnse in atrial
flutter & fibrillation (but NOT for AF with
WPW)
Primary beneficial effects:
Both slow conduction and increase
refractoriness in the AV node
Produces less myocardial depression
than verapamil, but is equipotent as a
negative chronotrope
30

DILTIAZEM
Dosage:
IV 0.24mg/kg (approx 20 mg) over 2 min
May repeat 0.35 mg/kg 15 min later
Infussion 5-15 mg/hr titrate to heart rate for
control of ventricular response in AF
Precautions:
May cause hypotension
Not to use with IV beta blocker
AV block, or heart failure
Incompatible with simultaneous furosemide
31

10. SODIUM BICARBONATE

Indication
profound severe metabolic
acidosis
Route of administration
IV infusion
1ml/kg based on blood gas results
do not mix with other drugs

32

SODIUM BICARBONATE
Action:
Correct acidosis
Side Effects:
hyperosmolarity
hypernatremia
(Paradoxical alkalosis)
Should not be used unless blood gases
show severe metabolic acidosis or
patient collapse >10 mins.
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SUMMARY
Drugs used cardiac arrest
epinephrine
atropine
can be given via ETT if IV access
is not available
Vasopressin and Isoprenaline
has no longer in the main ACLS
algorithm

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