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Drugs:
Drugs can be administered via a peripheral IV catheter; jugular catheter; intraosseous catheter; or transtracheally. If IV access is not possible transtracheal method
should be considered, in which case the dose should
be increased to 3 – 10 x the standard dose. When administering drugs transtracheally, a ridged canine urinary catheter should be advanced via the ET tube to the bronchial bifurcation. The drug is administered via the urinary catheter followed by air or sterile water to flush the content of the urinary catheter. Drugs which can be administered transtracheally include adrenaline, atropine, vasopressin, naloxone and lidocaine.
Adrenaline (Epinephrine) (0.1 mg/kg):
Adrenaline is an α and β adrenergic receptor agonist which results in vasoconstriction, coronary dilation, bronchodilation and positive inotropy and chronotropy. It is the vasoconstrictive effect of the peripheral vasculature which is desired, as it will improve circulation of the major body organs (heart, lung, brain). The 1:10000 concentration is used as the 1:1000 volume is too
small for dosing. Adrenaline should be administered immediately, then every 3 – 4 minutes (or every second cardiac cycle).
Vasopressin (0.8 U/kg):
Vasopressin causes vasoconstriction by acting
on the v1 receptors on the endothelium. It can be
used interchangeably with adrenaline. The benefits
of vasopressin are that it can work in an acidaemic environment and has a different mechanism of action to adrenaline. However, it is much more expensive and not proven to be more beneficial that adrenaline.
Atropine (0.05 mg/kg):
Atropine is a parasympatholytic (decreases vagal tone), which will help improve the sympathetic nervous system (i.e. vasoconstriction, inotrope, chronotrope). Atropine should also be administered immediately. However compared to adrenaline it is much longer acting and the ideal frequency of administration is unknown. The author administers atropine every 6 – 8 minutes.
Lidocaine (2 mg/kg):
Lidocaine is a sodium channel blocker which is commonly used to treat ventricular tachycardia (VT)
or used as an analgesic. Lidocaine is indicated if there
is ventricular fibrillation or pulseless VT (VT during a cardiac arrest) when defibrillation and precordial thump is unsuccessful.
Naloxone (0.04 mg/kg):
Naloxone is an opiate antagonist, and should be administered to any animal in cardiac arrest which have received a pure mu agonist or partial agonist opiate (even if it is not the cause of the arrest).
An Urban Experience
Butorphanol (0.1 mg/kg):
Butorphanol is a partial opiate agonist/antagonist. If naloxone is unavailable, butorphanol can be used instead to reverse some of the effect of opiates.
Atipamezole (50 mcg/kg):
Atipamezole is an α adrenergic antagonist, which can 2
be administered to reverse the effect of medetomidine, dexmedetomidine and xylazine.
Flumazenil (0.01 mg/kg):
Flumazenil is a benzodiazepine antagonist, which can be administered to reverse the effects of any benzodiazepines.
50% Glucose (Dextrose) (1 mL/kg):
When placing an IV catheter blood should be collected to measure blood glucose, electrolytes and blood gas. Glucose administration is indicated in any hypoglycaemic or hyperkalaemic patients. Although 50% glucose is normally diluted, dilution is not necessary during CPR.
Sodium bicarbonate (1 mEq/kg):
Sodium bicarbonate is indicated in patients with diagnosed or suspected metabolic acidosis. These can include diabetes with ketoacidosis, urethral obstructions, azotaemia just to name a few. The author also administers sodium bicarbonate 20 minutes into CPR.
10% Calcium gluconate (1 mL/kg):
Calcium gluconate is indicated in any hypocalcaemic or hyperkalaemic patients. Although standardly it is given over 20 minutes, it can be given more rapidly over 1-2 minutes during CPR.
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