22.2 Cardiac Emergency Drugs

Cardiac emergency drugs are the lifesavers of critical care. These fast-acting meds tackle life-threatening heart issues like cardiac arrest and severe arrhythmias. They work quickly through IV, IM, or ET routes to get your ticker back on track.

But with great power comes great responsibility. These drugs need close monitoring and can have serious side effects. They're often used alongside CPR and defibrillation as part of a full-on heart rescue mission.

Cardiac Emergency Drugs

Key characteristics

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• 

  Common Cardiac Medications During Surgical Procedures | Arun | Journal of Cardiology and Therapy View original

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• 

  Frontiers | Dexmedetomidine Improves Cardiovascular and Ventilatory Outcomes in Critically Ill ... View original

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• 

  Frontiers | Cardiac Regeneration: New Insights Into the Frontier of Ischemic Heart Failure Therapy View original

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• 

  Common Cardiac Medications During Surgical Procedures | Arun | Journal of Cardiology and Therapy View original

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  Frontiers | Dexmedetomidine Improves Cardiovascular and Ventilatory Outcomes in Critically Ill ... View original

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• Fast-acting medications used in life-threatening cardiac situations such as cardiac arrest, severe arrhythmias, and cardiogenic shock
• Administered through various routes, including intravenous (IV), intramuscular (IM), and endotracheal (ET) to ensure rapid absorption and onset of action
• Require close monitoring of patient's vital signs (blood pressure, heart rate, oxygen saturation) and response to treatment to assess effectiveness and detect potential complications
• May have significant side effects (hypotension, dysrhythmias) and potential for adverse reactions (anaphylaxis) due to their potent effects on the cardiovascular system
• Often used in combination with other interventions, such as cardiopulmonary resuscitation (CPR) and defibrillation, as part of a comprehensive treatment approach

Actions and indications

• Epinephrine
  • Alpha and beta-adrenergic agonist increases cardiac output, peripheral vasoconstriction, and bronchodilation by stimulating the sympathetic nervous system
  • Indicated for cardiac arrest, severe anaphylaxis, and bradycardia unresponsive to atropine to restore circulation and maintain blood pressure
• Atropine
  • Anticholinergic agent increases heart rate by blocking vagal stimulation of the sinoatrial node
  • Indicated for symptomatic bradycardia and asystole to improve cardiac output and perfusion
• Amiodarone
  • Antiarrhythmic agent prolongs action potential duration and refractory period in cardiac muscle cells, suppressing abnormal electrical activity
  • Indicated for ventricular fibrillation (VF) and pulseless ventricular tachycardia (VT) unresponsive to defibrillation to restore normal sinus rhythm
• Lidocaine
  • Antiarrhythmic agent suppresses ventricular ectopy by decreasing automaticity and conductivity in the myocardium
  • Indicated for VF and pulseless VT when amiodarone is unavailable as an alternative treatment option
• Dopamine
  • Catecholamine with dose-dependent effects: low doses increase renal and mesenteric perfusion; moderate doses increase cardiac contractility and heart rate; high doses cause vasoconstriction
  • Indicated for cardiogenic shock and symptomatic bradycardia unresponsive to atropine to improve cardiac function and tissue perfusion
• Vasopressin
  • Antidiuretic hormone analog causes vasoconstriction and increases systemic vascular resistance by stimulating V1 receptors in blood vessels
  • Indicated for cardiac arrest as an alternative to epinephrine when initial resuscitation efforts are unsuccessful

Critical nursing considerations

• Ensure proper dosing and administration route
  • Double-check drug, dose, and route against physician's order and facility protocol to prevent medication errors
  • Use appropriate injection sites and techniques for IV (large vein, rapid bolus), IM (deltoid, vastus lateralis), and ET (via endotracheal tube) administration to ensure optimal absorption
• Monitor patient's response and vital signs
  • Assess blood pressure, heart rate, rhythm, and oxygen saturation before and after administration to evaluate effectiveness and detect complications
  • Observe for signs of improvement, such as return of spontaneous circulation (ROSC) or increased perfusion (capillary refill, skin color), to guide further treatment
  • Watch for adverse reactions, including dysrhythmias (ventricular ectopy, bradycardia), hypotension, and anaphylaxis (rash, bronchospasm), and intervene promptly
• Maintain airway and ventilation
  • Ensure patent airway and provide oxygen therapy as needed to support oxygenation and ventilation
  • Assist with intubation and mechanical ventilation when indicated to protect the airway and optimize gas exchange
• Perform ongoing assessments and interventions
  • Continue CPR and defibrillation as per Advanced Cardiac Life Support (ACLS) guidelines to maintain circulation and correct shockable rhythms
  • Obtain and interpret 12-lead electrocardiogram (ECG) to guide further treatment based on underlying cardiac pathology
  • Administer additional medications (antiarrhythmics, vasopressors) and fluids (crystalloids, blood products) as ordered to support cardiovascular function
• Document administration and patient response
  • Record time, dose, route, and site of administration in the patient's medical record for accurate medication reconciliation
  • Note changes in vital signs, cardiac rhythm, and clinical status to assess treatment effectiveness and inform future care decisions
  • Communicate findings to healthcare team (physicians, nurses) and family members to ensure continuity of care and keep them informed of the patient's condition

Essential patient education

• Importance of taking medications as prescribed
  • Emphasize the need for strict adherence to dosing schedule and instructions to maintain therapeutic levels and prevent complications
  • Discuss consequences of missed doses or abrupt discontinuation (rebound hypertension, arrhythmias) to promote medication compliance
• Potential side effects and when to seek help
  • Inform patients of common side effects, such as dizziness, fatigue, and gastrointestinal upset (nausea, vomiting), and how to manage them
  • Advise patients to report severe or persistent side effects to their healthcare provider for evaluation and management
  • Instruct patients to seek immediate medical attention for signs of allergic reaction (hives, swelling), difficulty breathing, or chest pain, as these may indicate a serious adverse event
• Lifestyle modifications to support cardiovascular health
  • Encourage regular exercise (30 minutes per day), a healthy diet (low in saturated fat and sodium), and stress management techniques (deep breathing, meditation) to reduce risk factors for heart disease
  • Discuss the importance of smoking cessation and limiting alcohol consumption to prevent further damage to the cardiovascular system
  • Emphasize the need for regular follow-up appointments and monitoring (blood pressure, cholesterol levels) to detect and manage any ongoing cardiac issues
• Proper storage and disposal of medications
  • Instruct patients to store medications in a cool, dry place away from direct sunlight and moisture to maintain their potency and stability
  • Advise patients to keep medications out of reach of children and pets to prevent accidental ingestion and toxicity
  • Provide guidance on safe disposal of expired or unused medications (returning to pharmacy, using medication take-back programs) to prevent misuse and environmental contamination
• Emergency preparedness and response
  • Teach patients and caregivers how to recognize signs of cardiac emergency, such as chest pain, shortness of breath, and syncope (fainting), and when to seek immediate medical attention
  • Provide instructions on when and how to activate emergency medical services (calling 911) and what information to provide to the dispatcher (location, symptoms, medical history)
  • Encourage patients to carry a list of their medications, allergies, and medical history for emergency responders to facilitate accurate and timely treatment