ACLS review: Pulseless VF/VT Part 4

Peripheral IVs

·         Adults peak drug concentrations are lower and circulation times longer

·         Does not require interruption of CPR

·         Administer the drug by bolus injection and follow with a 20-mL bolus of IV fluid

·         Elevate the extremity for 10 to 20 seconds to facilitate drug delivery to the central circulation.

 

Endotracheal Drug Administration

·         Results in lower blood concentrations than the same dose given via intravascular route

·         Give 2 to 2½ times the recommended IV dose.

·         Providers should dilute the recommended dose in 5 to 10 ml of water or normal saline and inject the drug directly into the endotracheal tube

Note:  If IV or IO access cannot be established, epinephrine, vasopressin, and lidocaine may be administered by the endotracheal route during cardiac arrest (Class IIb, LOE B). The optimal endotracheal dose of most drugs is unknown, but typically the dose given by the endotracheal route is 2 to 2½ times the recommended IV dose.

Central IV Drug Delivery

·         Peak drug concentrations are higher and drug circulation times shorter

·         Central line placement can interrupt CPR.

·         A central line extending into the superior vena cava can be used to monitor ScvO2 and estimate CPP during CPR, both of which are predictive of ROSC

Intraosseous Drug Delivery

·         Enables drug delivery similar to that achieved by peripheral venous access at comparable doses.

·         Is safe and effective for fluid resuscitation, drug delivery, and  blood sampling

·         Is attainable in all age groups



Reviewed 2/28/16