Download Atropine Dopamine Epinephrine

Ch05-A04750.qxd
8/3/06
214
11:01 AM
Page 214
Pediatric Advanced Life Support Study Guide
Drug Pearl boxes feature relevant
medication information in clearly
marked boxes.
Drug Pearl
Drug Pearl
Atropine
Epinephrine
• Atropine enhances AV conduction
and oxygenation and ventilation do
• Epinephrine is a direct-acting
and increases heart rate (positive
not correct the bradycardia. Give
endogenous catecholamine
chronotropic effect) by accelerating
atropine before epinephrine if the
with moderate β2-adrenergic
the SA node discharge rate and
bradycardia is due to increased
(bronchodilation) and
blocking the vagus nerve. Atropine
vagal tone or if AV block is present.
potent α-adrenergic
has little or no effect on the force
• Do not give atropine slowly or in
of contraction (inotropic effect).
(vasoconstriction) and
smaller than recommended doses
β1-adrenergic (↑ heart rate,
(0.1 mg) because paradoxic slowing
↑ force of contraction)
require large doses of atropine.
of the heart rate can occur.
properties.
• Epinephrine is the drug of choice
Paradoxic slowing may last
• Anticholinesterase poisonings may
if bradycardia is due to hypoxia
2 minutes.
• Although epinephrine’s β1
effects increase myocardial
oxygen consumption, it is
Drug Pearl
Dopamine
generally well tolerated in the
pediatric patient.
• In cardiac arrest, epinephrine
increasing myocardial contractility
produces beneficial effects
catecholamine with dose-related
and stroke volume, thereby
primarily because of its
actions (there is some “overlap” of
increasing cardiac output. At high
α-adrenergic stimulating
effects). At low doses (0.5 to
doses (10 to 20 mcg/
effects: ↑ peripheral vascular
5 mcg/kg/min), dopamine acts on
kg/min), dopamine acts on vascular
resistance (vasoconstriction)
dopaminergic receptors that are
α-adrenergic receptors, producing
→ ↑ diastolic pressure → ↑
located mainly in mesenteric, renal,
systemic vasoconstriction. Because
myocardial and cerebral
and coronary vessels, causing
of the extreme variation in dosages
blood flow during CPR.
vasodilation. At moderate doses
required to activate receptor sites
(5 to 10 mcg/kg/min), dopamine
in patients, it is impossible to
stimulates the β1-adrenergic
predict the infusion rate required
receptors on the myocardium
for an individual patient.
• Dopamine is an endogenous
• Use personal protective equipment.
• Perform an initial assessment and obtain a focused history.
• If the child is unstable (“sick”) (i.e., increased work of breathing with
altered mental status, hypotension, or congestive heart failure with
diminished peripheral perfusion) immediate intervention is necessary.
• Administer high-concentration oxygen; ensure effective ventilation and
oxygenation. Apply a pulse oximeter. Maintain oxygen saturation at
above 95%.
• Attach a cardiac monitor and identify the rhythm.
• If the HR is slower than 60 beats per minute and accompanied by
abnormal skin color, a decreased level of responsiveness, capillary refill
below 2 seconds, or hypotension despite adequate oxygenation and
ventilation, perform chest compressions.