Cardiopulmonary resuscitation epinephrine

Cardiopulmonary resuscitation Epinephrine, vasopressin, and atropine according to ACLS guidelines Identification and treatment of cause including ... 

Among the antianaphylactic drugs, epinephrine (adrenaline) is the essential substance. In the acute treatment of the anaphylaxis in addition to the classical ABC (airway, breathing, circulation) rule for cardiopulmonary resuscitation [26, 27], one can apply the AAC rule (antigen off, adrenaline, cortisone) [18], Other drugs playing a role in the treatment of anaphylaxis include antihistamines (Hi-antagonists). 

Catecholamines such as isoproterenol and epinephrine have been used in the temporary emergency management of complete heart block and cardiac arrest. Epinephrine may be useful in cardiac arrest in part by redistributing blood flow during cardiopulmonary resuscitation to coronaries and to the brain. However, electronic pacemakers are both safer and more effective in heart block and should be inserted as soon as possible if there is any indication of continued high-degree block. 

If an i.v. line cannot be placed, the intraosseous drug administration route can be used for pediatric patients during, for example, cardiopulmonary resuscitation (CPR) because drug delivery by this route is similar to that for i.v. administration.If drug or fluid deliver by this route is sluggish, a saline flush can be used to clear the needle. Intraosseous administration is used to deliver medications such as epinephrine, atropine, sodium bicarbonate, dopamine, diazepam, isoproterenol, phenytoin, phenobarbital, dexametha-sone, and various antibiotics. ... 

Lindner KH, Anhefeld FW, Schuermann W, et al. Epinephrine and norepinephrine in cardiopulmonary resuscitation Effects on myocardial oxygen delivery and consumption. Chest 1990 97 1458-1462. 

Brown CG, Robinson LA, Jenkins J, et al. The effect of norepinephrine versus epinephrine on regional cerebral blood flow during cardiopulmonary resuscitation. Am J Emerg Med 1989 7 278-282. 

Wenzel V, Krismer AC, Arntz HR, et al. A comparison of vasopressin and epinephrine for out-of-hospital cardiopulmonary resuscitation. N Engl J... 

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. 

Lae C, Metzger J, Raphael V, Beruben A, Wenzel V, Guinhouya C, Vilhelm C, Marret E. Vasopressin and epinephrine vs. epinephrine alone in cardiopulmonary resuscitation. N Engl J Med 2008 359 21-30. 

Resuscitation from bupivacaine cardiovascular toxicity is extremely difficult. However, prompt resuscitation has been successful with standard cardiopulmonary support, including the prompt correction of acidosis by hyperventilation and administration of bicarbonate as well as epinephrine, atropine, and bretylium. Local anesthetics, especially bupivacaine, also inhibit basal and epinephrine-stimulated cAMP production. This finding places greater emphasis on aggressive epinephrine therapy during bupivacaine-induced cardiotoxicity. The (SJ-isomer, levobupivacaine, appears to have a lower propensity for cardiovascular toxicity than the racemic mixture or the (R)-isomer and has recently been approved for clinical use. Ropivacaine, another newer local anesthetic, has clinical effects similar to those of bupivacaine but may be associated with a lower potential for cardiovascular toxicity. Ropivacaine is available only as the (S)-stereoisomer, which has inherently less affinity for the cardiac sodium channel. 

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