The Use of Adrenaline in the Management of Cardiac Arrest (Coursework Sample)

The Use of Adrenaline in the Management of Cardiac Arrest.
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The Use of Adrenaline in the Management of Cardiac Arrest
Introduction
According to Ingersoll- Weng, Manecke and thistlethwaite 1, cardiac arrest is the sudden loss of the heart function. It may occur in patients diagnosed with a heart condition or seemingly normal individuals with no history of any heart ailments. However, the researchers draw a difference in cardiac arrest from heart attack- heart attack is due to a deficiency of blood in the heart caused by blockages of blood vessels. The blockage of major blood vessels leading blood to the heart, for instance the vena cava, is usually a result of an upsurge in the levels of Low density Lipoproteins (LDL). LDL, colloquially referred to as bad cholesterol, are insoluble leading to their accumulation in the blood vessels.
Cardiac arrest is a result of an abnormality in heart arrhythimia caused by a dysfunction of the heart’s electrical system 2. Unlike other organs that receive their neurological function from the brain, the heart has its own specialized cells called the sinus nodes responsible for generating electrical impulses. When the nodes generate rapid and erratic electrical impulses, they cause the "ventricles to quiver uselessly instead of pumping blood" 3. The result is the commonest form of cardiac arrest- ventricular fibrillation.
Cardiac arrest is a life- threatening condition, which could turn fatal in the absence of immediate mitigation measures. The recommended methods for dealing with a cardiac arrest case are as follows.
* Administering adrenaline into the vascular system
* Manual or mechanical chest compression to "jumpstart" the heart.
* Compression only or compression coupled with ventilation CPR.
For the purpose of this essay, my principal focus will be on the use of adrenaline in the management of cardiac arrest. The essay explores the benefits Vis a Vi the shortcomings associated with the use of adrenaline in the management of cardiac arrest.
Using adrenaline to manage cardiac arrest
The hormone adrenaline is secreted by the adrenal glands found at the medulla section of the brain. The hormone produces nerve impulses that have different impacts on different cells. The overall function of the hormone is to prepare the body for "fight or flight”. The hormone achieves this function by increasing the flow rate of blood, increasing the heartbeat, maximizing glucose levels, expanding the air passages of the lungs or redistributing blood to the muscles 4.
During the management of a cardiac arrest, adrenaline is usually the first drug to be administered by paramedics. The function of the drug in this context is to concentrate blood around the vital organs through peripheral vasoconstriction. Vital organs such as the brain and the heart need to maintain the blood flow to increase the chances of survival during the attack. The routes of administration include the central line, cannula in any peripheral vein or through intubation 4. Worth noting is the fact that this drug ought to be administered immediately a cardiac arrest occurs. If the condition of the victim worsens, the drug ought to be re- administered at intervals of 3-5 minutes.
The Efficacy of Adrenaline
In a research program conducted by Navaro 5, he found out that the use of counter- shock and cardiopulmonary resuscitation (CPR) was a slow way of managing cardiac arrest when compared to intravenous method such as IA. He gives an example of a man who had a cardiac arrest and his neighbors called the ambulance. When the paramedics arrived, they started by administering counter- shock and performing CPR in turns. Meanwhile, the paramedic that was supposed to administer adrenaline was having difficulty locating a vein. When they arrived at the hospital, the patient had already died. The medics could not help but wonder what could have happened if they had administered adrenaline earlier. Adrenaline works faster as compared to the aforementioned methods of managing cardiac arrest. The hormone travels very fast within the vascular system of the victim to reach the vital organs- the heart and the brain. Once in the target organs, it increases the rate of blood flow to them thereby keeping the patient alive until the ambulance gets to the hospital. Other Methods of CPR cannot increase the flow of blood to the heart and therefore cannot sustain the patient for long.
Epinephrine (adrenaline) is also easy to administer and requires little technique in comparison to CPR and counter- shock. All the paramedic needs to know about is the required dosage and the most appropriate vein. Unlike the rest that might need up to three medics, epinephrine needs only one person to administer. The need for more than one medic can create the difference between life and death. The use of counter- shock and CPR requires a minimum of two medics. In CPR, one medic presses against the chest patient while the other performs the resuscitation. In counter- shock, one medic monitors the meter while the other administers the shock. Such processes require the coordination of two people hence consuming much time.
Shortcomings of using Epinephrine
In a research project by Machida et. al 6, results revealed that administering adrenaline did not improve the rate of survival for out- of – hospital victims of cardiac arrest. In this particular study, the researchers categorized out- of- hospital cardiac arrest victims into two groups- administered AD and non- AD. The researchers then monitored the rate of recovery in the two groups of people by considering their spontaneous return of normal circulation, survival to the hospital admission and discharge. After a few months of extensive research and data analysis, the researchers found out that there was no difference in survival or discharge between the two groups. The conclusion was that administering AD did not increase the chances of survival for cardiac arrest victims. This report demystifies the past belief that adrenaline was more effective than CPR and manual chest compression. Many researchers have brought forward their findings to assert this claim further. In this regard, it is safe to conclude that administering adrenaline is not in any way better than the other methods used in the management of cardiac arrest.
The use of adrenaline has been found to have side effects on various organs of the body. As a medical requirement, health practitioners ought to administer adrenaline at intervals of 3- 5 minutes if the patent does not come out if the cardiac arrest. Research has shown that large dosages of the drug are a recipe for future complications in other organs of the body. Extensive use of epinephrine induces proliferation of cardiac muscles cells partly due to the activation of mitogen- activated proteins (MAP) 7. The proliferation of muscles may lead to cardiac hypertrophy and consequently, the reduction of the size of the heart chambers. Smaller heart chambers will have a problem in pumping blood to all peripheral parts of the body. The amount of blood that a smaller chamber can hold for the purpose of oxygenation is also small as compared to that of a normal- sized chamber. The use of adrenaline should be limited in order to avoid future heart complications.
Just like any drug, the correct use of epinephrine is associated with multiple side effects. When patients get out of the danger zone, the following are some of the side effects th...