Pulseless Electrical Activity Medication

Updated: Jan 03, 2016
  • Author: Sandy N Shah, DO, MBA, FACC, FACP, FACOI; Chief Editor: Jeffrey N Rottman, MD  more...
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Medication

Medication Summary

Inotropic, anticholinergic, and alkalinizing agents are used in the treatment of pulseless electrical activity (PEA). As previously stated, resuscitative pharmacology includes epinephrine, vasopressin, and atropine. Vasopressin may replace either the first or second dose of epinephrine in patients with PEA. If the underlying rhythm is bradycardia (ie, heart rate < 60 bpm) associated with hypotension, then atropine should be administered. Sodium bicarbonate may be administered only in patients with severe, systemic acidosis, hyperkalemia, or a tricyclic antidepressant overdose.

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Inotropic Agents

Class Summary

Inotropic agents increase the central aortic pressure and counter myocardial depression. Their main therapeutic effects are cardiac stimulation, bronchial smooth muscle relaxation, and dilatation of skeletal muscle vasculature.

Epinephrine (Adrenalin)

Epinephrine has alpha-agonist effects that include increased peripheral vascular resistance and reversed peripheral vasodilatation, systemic hypotension, and vascular permeability. Beta-agonist effects of epinephrine include bronchodilatation, chronotropic cardiac activity, and positive inotropic effects.

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Anticholinergic Agents

Class Summary

Anticholinergic agents improve conduction through the atrioventricular (AV) node by reducing vagal tone via muscarinic receptor blockade.

Atropine IV/IM (Isopto)

Atropine is used for the treatment of bradyarrhythmias. It works to increase heart rate through vagolytic effects, causing increase in cardiac output. Total vagolytic dose is 2 mg; doses of under 0.5 mg may exacerbate bradycardia

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Alkalinizing Agents

Class Summary

These are useful in the alkalinization of urine. Routine administration of sodium bicarbonate is discouraged because it worsens intracellular and intracerebral acidosis and is not proven to reduce mortality rate.

Sodium bicarbonate (Neut)

Sodium bicarbonate is used only when the patient is diagnosed with bicarbonate-responsive acidosis, hyperkalemia, or tricyclic antidepressant or phenobarbital overdose. Routine use is not recommended.

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