DRUGS USED IN CPR

 LESSON PLAN:
 Name of Teacher : Ms. Monika Makwana
 Name of Evaluator : Ms. Praneeta Christian
 Name of course : F.Y. M. Sc. Nursing
 Name of Subject : Child Health Nursing
 Name of Topic : Oxygeninhalation in pediatric patients
 Class : S.Y. B.Sc. (N)
 Size of the class : 40
 Date : 06/6/22
 Time : 60 min
 Venue : S. Y. B.SC. classroom
 Previous knowledge level : Students have Basic knowledge about drugs used in CPR
 Method of teaching : Lecture cum discussion, Demonstration
 Media of Teaching A.V. aids: Roller board, White board, leaflet, Live objects and flannel
graphs.

 GENERAL OBJECTIVE:
At the end of the class, students will gain in- depth knowledge regarding the drugs given in CPR.

 SPECIFIC OBJECTIVES:
At the end of the class, students will able to:

 To introduce the Drugs used in CPR.

 To explain the about how the injection Adrenaline used in emergency situation.
 To recognize the indications, available forms action, route and dose, side effects and
nursing responsibility of Atropine.
 To describe the indications, available forms action, route and dose, side effects and nursing
responsibility of Amiodarone.
 To identify the indications, available forms action, route and dose, side effects and nursing
responsibility of Lidocaine.
 To explain the indications, available forms action, route and dose, side effects and nursing
responsibility of calcium chloride.
 To recognize the indications, available forms action, route and dose, side effects and
nursing responsibility of Magnesium Suphate.
 To summarize the topic.
S. TIME SPECIFIC CONTENT TEACHING- A.V. AIDS EVALUATION
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1. 1 min To introduce the INTRODUCTION

topic. The collapse or sudden deterioration of a patient in a clinical
environment can have a number of possible causes. If it is identified as
being due to a cardiac arrest, the survival chances of the patient will be
increased by following guidelines established by the Resuscitation
Council (UK) (2005). These describe the sequence of actions that
should be undertaken at the various stages of the resuscitation attempt
and it is essential to give the required emergency drugs as per the
guidelines.

2. 2 min To explain the Adrenaline Lecture cum Live objects When to give
about how the Indications: discussion Flannel graph adrenaline and
injection This is the first drug given in all causes of cardiac arrest and should be Which route is
Adrenaline used readily available in all clinical areas and in emergency trolleys. suggested for
in emergency Available forms: injection 1mg/ml ampoules. administering
situation. Action of adrenaline: Adrenaline?
 Adrenaline 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.
 Adrenaline 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.
When to administer
 Adrenaline can be given repeatedly during a cardiac arrest until the
condition of the patient improves.

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 The Resuscitation Council recommends that it is given as soon as

possible once a cardiac arrest has been identified.
 This can be repeated1mg every 3-5 minutes.
 Route:
 The suggested administration route is by a central line, as it will then
reach the cardiac tissue more rapidly (Resuscitation Council UK,
2005).
 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.
Route
 If venous access cannot be obtained and the patient is intubated,
adrenaline can be given via the endotracheal tube directly into the
lungs. Manufacturers suggest that adrenaline may be injected
directly into the heart through the chest wall if no other route is
available
 This can be a difficult procedure and should only be attempted by a
competent clinician and when all other attempts to gain access have
failed.
 Once an organised rhythm has been established the use of adrenaline
must be reassessed as excess amounts can precipitate ventricular
fibrillation. It is also important to note that adrenaline 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.
Side effects:
CNS: nervousness, restlessness, tremor, headache, insomnia.
RESP: paradoxical bronchospasm (excessive use of inhalers)

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CV: angina, Arrhymias, hypertension, tachycardia.

GI: nausea, vomiting.
ENDO: Hyperglycemias.
Nursing responsibilities
 Monitor arrhythmias, heart rate> 110 beats per minute and
hypertension.
 Monitor ECG.
 Assess hypersensitivity reactions.
 Consult the physician for adjusting dose and discontinue medication.
3. 5 min To recognise the ATROPINE Lecture cum Live objects Restate when to
indications, Indications: discussion and white repeat the
available forms In cardiac arrest it is given to reverse asystole and severe Bradycardia. board atropine?
action, route and The Resuscitation Council recommends that atropine be given for Flannel graph
dose, side effects pulseless electrical activity with a rate of less than 60 beats per minute
and nursing or in complete asystole.
responsibility of Available forms: injection, tablet, ophthalmic ointment, ophthalmic
Atropine. solution.
Generally used: Inj. 0.6 mg /ml ampoule or 8mg/20 ml vial
Mechanism of action:
 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.
Dose and Route:
 This drug should be administered intravenously and the dose
depends on the heart rhythm.
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 For bradycardia a dose of 0.5mg should be given and repeated every

five minutes until a satisfactory heart rate is achieved.
 In asystole a single dose of 3mg should be given and this should not
be repeated unless the cardiac rhythm changes to bradycardia or
pulseless electrical activity.
 If IV access cannot be obtained then atropine can be given by an
endotracheal tube at a dose two to three times as high as that given
intravenously.
Side effects:
CNS: headache, dizziness, confusion, restlessness, ataxia, insomnia,
disorientation, delirium, agitation.
CVS: Bradycardia, tachycardia, palpitations, hypotension.
GIT: dry mouth, difficulty in swallowing, constipation, nausea,
vomiting, thrist.
EYE/EAR: blurred vision, mydrasis, cycloplegia, photophobia,
increased intraocular pressure
GIT: urinary retension, erectile dysfunction.
Skin: rash, urticaria.
Others: anaphylactic reactions, fever.
Nursing responsibilities:
 Assess vital signs.
 Assess CBC,LFT,RFT and creatinine.
 Monitor input output chart.
 Monitor increased intraocular pressure: pain in eyes, nausea,
vomiting, watery eyes, and blurred vision.
 Assist the patient during ambulation if drowsiness and dizziness
occurs.

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3. 4 min. To describe the AMIODARONE Lecture cum Flannel graph Review the
indications, Indications discussion and white common side
available forms  This drug is mainly given during cardiac arrest to treat specific board. effects of inj.
action, route and cardiac arrthymias, Life threatening recurrent ventricular Amiodarone.
dose, side effects arrhythmias, such as ventricular fibrillation and hemodynamically
and nursing unstable ventricular tachycardia.
 The Resuscitation Council recommends that the first treatment for
responsibility of
ventricular fibrillation or ventricular tachycardia should be electrical
Amiodarone. defibrillation. If this is unsuccessful after three attempts amiodarone
should be given.
Available forms:
Tablets: 100mg, 200mg
Injection : 150 mg/ 3ml
Mechanism of action:
 Amiodarone has a complex effect on the heart but the main effect is
to slow down the metabolism of cardiac tissue.
 The drug also blocks the action of hormones that speed up the heart
rate. The overall effect is to slow the heart. This is important in a
cardiac arrest when the heart is beating too fast to produce a normal
circulation.
Dose and Route:
 The guidelines suggests that there should be an interval between
bolus doses of amiodarone of at least 15 minutes.
 This can be continued by an infusion over 24 hours.
 Amiodarone is not compatible with sodium chloride and must at all
times be diluted in 5% dextrose.
 It can be administered through a cannula situated in a peripheral
vein but localised irritation and discomfort are a common problem
and are more likely to occur if the drug is given as a continuous
infusion.

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 This is not quite so important in the emergency situation but if the

patient requires a prolonged infusion then central venous access
should be considered.

Side-effect
CNS: TREMORS, PERIPHERAL NEUROPATHY, paresthesia,
fatigue, malaise, ataxia, headache, dizziness, sleep disturbances
CVS: Bradycardia, heart block, QT prolongation, hypotension,
arrhythmias, heart failure.
GIT: nausea, vomiting, constipation, anorexia, abdominal pain,
diarrhea, abnormal taste
HEP: increased liver enzymes, hepatic dysfunction, hepatic failure.
RESP: pulmonary toxicity, pulmonary fibrosis, acute respiratory
distress syndrome, hypersensitivity pneumonitis.
Thyroid: hypothyroidism, hyperthyroidism.
Skin: photosensitivity, dermatitis, blue skin discoloration, rash,
alopecia.
Others: flushing, edema, abnormal smell, coagulation abnormalities,
impotence.
Nursing responsibilities:
 For this reason a patient receiving an infusion of IV amiodarone
should be monitored in a critical care environment such as a
coronary care or intensive care unit.
 This reduced heart rate can be reversed by atropine and this drug
should be available when amiodarone is being administered
intravenously.
 Assess chest x ray, lung field, peripheral edema ,
 Assess CNS status.

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4. 4 min To identify the LIDOCAINE Lecture cum Flannel graph What are the
indications, Indications: discussion and white indications of inj.
available forms This drug is similar to amiodarone in that it is given to treat specific board. Lidocaine?
action, route and cardiac arrythmias, including ventricular fibrillation and ventricular
dose, side effects tachycardia caused by acute MI or cardiac manipulation (eg., cardiac
and nursing surgery)
responsibility of Available forms: injection 1%,2%
Lidocaine. Mechanism of action:
 It reduces the electrical activity of cardiac tissue and so is able to
slow down a very fast heart rate.
 The Resuscitation Council recommends that lidocaine only be given
in situations where amiodarone is not available.
 It should not be given at the same time as amiodarone, and should
not be given if amiodarone has already been administered.
Dose/ route-
Loading dose: 1-4mg/ kg or 50-100 mg by IV bolus
It is recommended that IV lidocaine is given as a bolus dose over 2-4
minutes at least a 5 minutes interval between subsequent doses and
there will also be a recommended maximum dose is 300 mg over 1
hour period.
Maintenance dose: 1-4mg /min.
Bolus intravenous infusions have a short duration of action (15 to 20
minutes), so if the patient’s condition demands it a repeat bolus should
be given within this time period and then a continuous infusion
commenced. It is not normally recommended that the infusion be
continued for longer than 24 hours.
Side effects:

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Most commo side effects of lidocaine are neurological that include

tremors, paresthesia, light headedness and slurred speech
CNS: nervousness, restlessness, confusion, dizziness , drowsiness,
nystagmus, somnolence, seizures, muscle twitching, anxiety,
hallucination, blurred vision.
GIT: nausea, vomiting
CVS: hypotension, Bradycardia, arrhythmias, cardiac arrest.
RESP: respiratory depression and arrest.
SKIN: irritation and erythema at the injection site.

Nursing responsibilities:
 Assess history of 2nd degree and 3rd degree heart block,
 Monitor cardiac system- BP, heart rate, cardiac rhythm, ECG.
 Monitor bone marrow suppression.
 Monitor I/O and electrolyte levels.
5. 5 min To explain the CALCIUM CHLORIDE Lecture cum Flannel graph Tell the available
indications, Indication discussion. and white dose of calcium
available forms  Calcium is essential for the contraction of muscular tissue board chloride
action, route and throughout the body, and is especially important for the strength of
dose, side effects contraction of cardiac tissue.
and nursing  If given during cardiac arrest it can stabilise the contraction of
cardiac tissue after metabolic changes have caused instability and
responsibility of
arrhythmias.
calcium chloride.  It has been suggested that calcium can improve weak or inefficient
myocardial contractions when adrenaline has failed. This is
especially the case following open-heart surgery .
 Calcium can also be used to protect against a number of metabolic
conditions that cause pulse less electrical activity, including raised

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blood potassium levels, lowered blood calcium levels and overdose

of magnesium or calcium channel blocking drugs.
Available dose: 1gm in 10 ml vial.

Dose and route:

IV 500mg- 1gm give <1ml /min.
Due to a chemical interaction calcium chloride should not be given
through the same venous access point as sodium bicarbonate.

Side effects:
CV: shortened QT, heart block, hypotension, Bradycardia,
dysrhythmias, cardiac arrest.
GI: vomiting, nausea, constipation.
HYPERCALCEMIA: Drowsiness, lethargy, muscle weakness,
headache, constipation, coma, anorexia, nausea, vomiting, polyuria,
thirst
INTEG: pain, burning at IV site, severe venous thrombosis, necrosis,
extravasations.
There are two main side-effects of calcium that are important in the
emergency cardiac arrest situation. The first is that repeated injections
can increase blood acidity and should be used with caution in patients
who have lowered blood pH. As this is found in a large number of
patients following a cardiac arrest frequent monitoring of arterial blood
pH is advised. Second, IV administration of calcium chloride can
cause hypotension due to peripheral vasodilatation and, less
commonly, Bradycardia and cardiac arrhythmias.

Nursing Responsibilities:
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ECG for decreased QT and T wave inversion: hypercalcemia, product

should be reduced or discontinued, consider cardiac monitoring.
Monitor calcium levels during treatment; urine calcium if hypercaluria
occurs.
To add food high in vitamin D

6. 5 min To recognise the MAGNESIUM SULPHATE Lecture cum White board List out the side
indications, Indication: discussion And flannel effects on
available forms  Magnesium is an important electrolyte involved in the contraction graph Cardiovascular
action, route and of muscular tissue, including cardiac muscle. A reduction in blood system.
dose, side effects levels of this element can frequently cause cardiac arrhythmias,
and nursing often leading to cardiac arrest.
 magnesium can help stabilise arrhythmias caused by low potassium
responsibility of
levels and digoxin toxicity
Atropine. available forms: 10%, 25%, 50%.
Dose and route:
IV 1-2 g in 50-100ml given over 5-20 min in emergent cases over 5-
60 min.
Side effects:
CNS: muscle weakness, flushing, sweating, confusion, sedation,
depressed reflexes, flaccid paralysis, hypothermia.
CV: hypotension, heart block, circulatory collapse, vasodilation.
GI: nausea, vomiting, anorexia, cramps, diarrhea.
HEMA: prolonged bleeding time
META: electrolyte, fluid imbalances
RESP: Respiratory depression, paralysis.
Nursing responsibilities:
 Monitor I/O

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 monitor the ECG and vitals.

 When giving magnesium intravenously it is important that there is
close monitoring of blood pressure, urine output and respiratory
rate.

7. 3 min. To summarise the Summary : Discussion White board Summarise the

topic.  The drugs used in CPR are classified under emergency drugs topic.
because they are needed immediately in case of cardiac arrest or
other emergency conditions.
 One should know the proper placement of each drugs in crash cart
also.
 The nurse must know the correct route, dose and indications of
these drugs.

 ASSIGNMENT:

List out the emergency drugs used during CPR.

 REFERENCES:

1. Linda skidmore-roth, MOSBY’S NURSING DRUG REFERANCE, Elesveir publications; 2018.

2. Ghai S, et al. Clinical Nursing Procedures, 2nd edition. New Delhi: CBC Publishers; 2020. pp. 897-902.

3. Jacob A, Rekha R. Tarachand JS. Clinical Nursing Procedure: The Art of Nursing Practice, 2nd edition. New Delhi: Jaypee Brothers Medical
Publishers Pvt Ltd.; 2010. pp. 735-9.

4. Kozier B, Erb G, Berman A, et al. Fundamentals of Nursing: Concepts, Process and Practice, 7ih edition. Pearson Education, Singapore; 2005. pp.
1347-50.

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