Arrhythmias cardiopulmonary resuscitation

It is common to find a pharmacist as a member of the hospital cardiopulmonary resuscitation (CPR) team, which responds to emergent situations that may require immediate patient care. These scenarios usually involve a patient who suddenly becomes nonresponsive, ceases spontaneous respirations, and/or experiences a life-threatening cardiac arrhythmia. The CPR team responds to such patients by implementing advanced cardiac life support (ACLS), which involves quick provision of an airway and electrical (defibrillation) and/or pharmacologic interventions to sustain cardiac function. The pharmacist s role on such a team involves the preparation of intravenous infusions needed in an emergent situation, dose calculations, and consultation regarding appropriate medication use. 

The common ventricular arrhythmias include (1) premature ventricular complexes (PVCs), (2) ventricular tachycardia, and (3) ventricular fibrillation. Again, these arrhythmias may result in a wide variety of symptoms. PVCs often cause no symptoms or only mild palpitations. Ventricular tachycardia may be a life-threatening situation associated with hemodynamic collapse or be totally asymptomatic. Ventricular fibrillation, by definition, is an acute medical emergency necessitating cardiopulmonary resuscitation (CPR). 

Lidocaine is used in the therapy of non-life-threatening ventricular arrhythmias, such as non-sustained ventricular tachycardia and frequent premature ventricular beats. It is also used as an adjunct to defibrillation and cardiopulmonary resuscitation (CPR) in patients with ventricular tachycardia and/or fibrillation. 

During cardiopulmonary resuscitation, Epi and other a agonists increase diastolic pressure and improve coronary blood flow, a agonists also help to preserve cerebral blood flow. Thus, during external cardiac massage, Epi facilitates distribution of the limited cardiac output to the cerebral and coronary circulations. The optimal dose of epinephrine in patients with cardiac arrest is unclear. Once a cardiac rhythm has been restored, it may be necessary to treat arrhythmias, hypotension, or shock. Treatment of cardiac arrhythmias is detailed in Chapter 34. 

A. Check blood pressure and pulse rate and rhythm. Perform cardiopulmonary resuscitation (CPR) if there is no pulse and perform advanced cardiac life support (ACLS) for arrhythmias and shock. Note that some ACLS drugs may be ineffective or dangerous in patients with dmg- or poison-induced cardiac disorders. For example, procainamide is contraindicated in patients with tricyclic antidepressant overdose, and atropine and isoproterenol are ineffective in patients with beta-blocker poisoning. 

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