alpha-adrenergic actions of adrenaline cause vasoconstriction, which increases myocardial and cerebral perfusion pressure during cardiac arrest
adrenaline is given immediately after confirmation of the rhythm and just before shock delivery (drug–shock–CPR–rhythm check sequence)
have adrenaline ready to give so that the delay between stopping chest compression and delivery of the shock is minimised
adrenaline that is given immediately before the shock will be circulated by the CPR that follows the shock
when the rhythm is checked 2 min after giving a shock, if a non-shockable rhythm is present and the rhythm is organised (complexes appear regular or narrow), try to palpate a pulse
rhythm checks must be brief, and pulse checks undertaken only if an organised rhythm is observed
if an organised rhythm is seen during a 2 minute period of CPR, do not interrupt chest compressions to palpate a pulse unless the patient shows signs of life suggesting return of spontaneous circulation (ROSC)
if there is any doubt about the existence of a pulse in the presence of an organised rhythm, resume CPR
if the patient has ROSC, begin post-resuscitation care
if the patient’s rhythm changes to asystole or pulseless electrical activity (non-shockable rhythms), give adrenaline 1 mg IV immediately intravenous access is achieved
in both VF/VT and PEA / asystole, give adrenaline 1 mg IV every 3-5 min (approximately every other two-minute loop). In patients with a spontaneous circulation, doses considerably smaller than 1 mg IV may be required to maintain an adequate blood pressure
Reference:
Resuscitation Council (UK). Adult Advanced Life Support. Resuscitation Guidelines 2005.
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