It would depend on whether or not the patient had recurrent VF, and the
underlying cause of the arrest. In the immediate period after MI one might
just watch and wait (assuming patient had received thrombolysis and probably
IV B-blocker). In RECURRENT VT/VF the American guidelines at least say that
lignocaine is indicated, with the alternative being Amiodarone (and
Procainamide or Bretylium third line). The serum potassium of 3.0 is
worrying, and risk of arrhythmia would be reduced if this was 4.0 or higher.
The patient's magnesium level should also be checked, and hypomagnesemia
treated if necessary. The ventricular ectopics themselves don't need
treatment, though in this patient's case could indicate an "irritable"
myocardium.
References
Chibber Chandra N, Weisfeldt, ML. Syncope, sudden death and cardiopulmonary
resuscitation. In: Wayne Alexander R et al.Eds. Hurst's The Heart Arteries
and Veins. 1998. McGraw Hill. New York.
Carey CF. Cardiopulmonary Resuscitation and Advanced Cardiac Life Support.
In: Carey CF et al. Eds. Washington Manual of Medical Therapeutics 1998.
Lippincott-Raven. Philadelphia.
A A J Adgey, P W Johnston. Approaches to modern management of cardiac
arrest. Heart 1998;80:397-401 ( October )
http://www.heartjnl.com/cgi/content/full/80/4/397
D A Chamberlain. Antiarrhythmic drugs in resuscitation. Heart
1998;80:408-411 ( October )
http://www.heartjnl.com/cgi/content/full/80/4/408
Andy Johnston
A McD Johnston
Cardiovascular Research Fellow
Acute Stroke Unit
Aberdeen Royal Infirmary
Aberdeen
AB25 2ZB
U.K.
Phone +44(0)1224 681818 Extn 59203
Fax +44(0) 840920
[log in to unmask]
> -----Original Message-----
> From: chris markwick [SMTP:[log in to unmask]]
> Sent: Wednesday, May 12, 1999 12:06 AM
> To: aemailing list
> Subject: lignocaine
>
> Is it no longer fashionable to give iv lignocaine to the resuscitated vf
> arrest patient?
> I was told this by a medical registrar yesterday as we counted the number
> of ventricular ectopics a 50 year old was having after the ambos had
> shocked him out of vf. His K+ was 3.0. Could someone point me in the
> direction of the relevant paper.
> Thanks
> Chris Markwick
> PRH
> Sussex
> [log in to unmask] <mailto:[log in to unmask]>
>
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