l Dloukers are used to treat Martin is a 67 year old, obese, smoker that enters
ID: 210867 • Letter: L
Question
l Dloukers are used to treat Martin is a 67 year old, obese, smoker that enters the emergency room complaining of palpitations, dizziness, and shortness of breath. After a few minutes of waiting for attention, he collapses to the floor and the physicians determine that he is in cardiac arrest. Epinephrine is chosen as the drug of choice to treat Martin Briefly describe cardiac arrest and investigate how epinephrine works to resolve this condition in the patient. Based on the experiment, do you think Atropine could be beneficial in treating a patient in cardiac arrest and/or bradycardia? Explain either way. Investigate how this drug relates to vagal nerve stimulation and how this would be beneficial to a patient in cardiac arrest.Explanation / Answer
Cardiac Arrest:
A cardiac arrest is when the heart suddenly stops pumping blood round body, commonly because of a problem with electrical signals in the heart. It is triggered by an electrical malfunction in the heart that causes an irregular heartbeat ( arrhythmia) . with its pumping action disrupted, the heart cannot pump blood to the brain, lungs and other organs.
Epinephrine
This is the first drug given in all causes of cardiac arrest. Epinephrine concentrates the blood around the vital organs, specifically the brain and the heart, by peripheral vasoconstriction. These are the organs that must continue to receive blood to increase the chances of survival following cardiac arrest. Epinephrine also strengthens cardiac contractions as it stimulates the cardiac muscle. This further increases the amount of blood circulating to the vital organs, and also increases the chance of the heart returning to a normal rhythm.
Epinephrine can be given repeatedly during a cardiac arrest until the condition of the patient improves. The Resuscitation Council recommends that it is given as soon as possible once a cardiac arrest has been identified. This can be repeated every 3-5 minutes.
The suggested administration route is by a central line, as it will then reach the cardiac tissue more rapidly. If this is not available it may be administered through a cannula in a peripheral vein. If so, the cannula should be flushed with at least 20ml of 0.9% sodium chloride. This will ensure the entry of the drug into the circulation.
If venous access cannot be obtained and the patient is intubated, epinephrine can be given via the endotracheal tube directly into the lungs. Manufacturers suggest that epinephrine may be injected directly into the heart through the chest wall if no other route is available.
Once an organised rhythm has been established the use of epinephrine must be reassessed as excess amounts can precipitate ventricular fibrillation. It is also important to note that epinephrine reacts with sodium bicarbonate to produce solid material. For this reason, these two drugs should not be administered through the same IV route without adequate flushing with 0.9% sodium chloride.
Atropine
The action of this drug is to block the effect of the vagus nerve on the heart. This nerve normally slows heart rate and, during cardiac arrest, is a common cause of asystole. Atropine also acts on the conduction system of the heart and accelerates the transmission of electrical impulses through cardiac tissue.
In cardiac arrest, it is given to reverse asystole and severe bradycardia. The Resuscitation Council recommends that atropine is given for pulseless electrical activity with a rate of fewer than 60 beats per minute or in complete asystole.
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