CARDIAC DRUG THERAPY - PART 8

Beta-blockers có một vai trò trong bệnh nhân bị tái phát VF (19,20). Nếu lidocaine hoặc bretylium không và countershocks một số được yêu cầu, beta-blocker tiêm tĩnh mạch đôi khi có thể hữu ích, đặc biệt là với điện giật. | 294 Cardiac Drug Therapy Beta-Blockers Beta-blockers have a role in patients with recurrent VF 19 20 . If lidocaine or brety-lium fails and several countershocks are required an intravenous beta-blocker may occasionally be useful especially with electrocution. In general beta-blockers as well as all other agents that have a negative inotropic effect should be avoided in cardiac arrest. Drug name Propanolol Trade name Inderal Dosage USA 1 mg IV over 5 min every 5 min max. 5 mg UK 1 mg over 2 min every 2 min max. 5 mg Drug name Calcium chloride Supplied 10-mL prefilled syringe or ampule of 10 calcium chloride containing mEq mmol calcium 1 mL 100 mg Dosage IV mL of a 10 solution 5-7 mg kg Calcium chloride is no longer recommended. No benefit is derived from the use of calcium in cardiac arrest except in the management of severe hyperkalemia hypocalcemia calcium antagonist toxicity and weaning from cardiopulmonary bypass. Calcium chloride administration may cause dangerous increases in serum calcium levels range 12-18 mg dL mmol L . In addition digitalis is often used by cardiac patients and a raised serum calcium concentration is potentially dangerous in patients taking digitalis. Calcium gluconate 10 mL of a 10 solution is mainly used in the United Kingdom. Magnesium sulfate is reported to expedite ventricular defibrillation for polymorphic VT torsades de pointes dosage 1-2 g IV. REFERENCES 1. Cobb LA Fahrenbruch CE Olsufka M Copass MK. Changing incidence of out-of-hospital ventricular fibrillation 1980-2000. JAMA 2002 288 3008-3013. 2. The AHA guidelines Circulation 2005 112 IV-206-IV-211 . International Liaison Committee on Resuscitation. 2005 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Circulation 2005 112 III-1-III-136. 3. Zaritsky A Morley P. 2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. .