home Thyroid Adrenaline revives the heart, but destroys the brain. Drug therapy for cardiac arrest

Adrenaline revives the heart, but destroys the brain. Drug therapy for cardiac arrest

– Dmitry Buinov

Myth: If you inject the medicine directly into the heart, it will begin to act as quickly and effectively as possible.

What a sense of drama there is in the tense scene in which the actor bravely plunges a syringe straight into the heart and miraculously instantly heals a dying patient. Despite the entertainment and tension of the scene, it practical value in reality it is deceptive and only creates a false medical stereotype.

The point is not even whether the result of the drug administered in this way will be truly effective. The problem is that even a tiny hole left by a needle on the heart leads to heavy bleeding and fall blood pressure. It's akin to balloon, pierced by a needle and rapidly losing air through a hole that cannot be plugged so easily. In addition, there is a considerable chance, especially for a non-specialist, of getting a thin syringe needle directly into the lungs. In this case, the victim of cinematic resuscitation will not only bleed, but also slowly but surely suffocate.

In fact, there are not so risky ways that allow you to deliver medicine directly to the heart. The most preferred method is infusion therapy, popularly called the capacious concept of “dropper,” where the drug is administered intravenously. Considering that in order to pump the entire volume of blood throughout the body, ordinary person It takes about a minute, the drug will reach the heart fairly quickly. Even if it is not possible to inject the drug intravenously, you can always inject the medicine intramuscularly, which will allow the medicine to enter the heart in about five minutes.

In general, in modern medicine There is no treatment that requires inserting a syringe needle directly into the heart. There is, however, a similar procedure called pericardial puncture. During this procedure, the doctor inserts a needle into the so-called sac around the heart (pericardium) to relieve it of excess liquid which creates excess pressure on the heart muscle (cardiac tamponade). This procedure is carried out with exceptional precision and caution, because doctors understand perfectly well that even a tiny hole in the heart is very, very bad.

Although this mythical method of drug therapy is easily debunked, one might want to know whether all the scenes with a therapeutic injection into the heart are really implausible (or true). Therefore, we will not force the reader to languish in doubt, and will shed light on this type emergency care using the example of two of the most famous Hollywood fragments in which a similar method of resuscitation takes place.

Scene No. 1 – “Pulp Fiction.”

In this scene, John Travolta's character needs to inject an "adrenaline" injection directly into the heart of Uma Thurman's character to reduce the harmful effects of an overdose of heroin, which she mistook for cocaine. After piercing the syringe through her heart and administering the drug, she immediately regains consciousness and feels great.

When a qualified healthcare professional gives a person an “adrenaline” injection, it is called an epinephrine injection. Epinephrine is often used in medicine in cases such as cardiac arrest, allergic reactions, asthmatic attacks, as well as in the relief of arterial hypotension.

Epinephrine is a hormone and neurotransmitter that affects different kinds nerve tissue. As a result of exposure, the nervous system is excited sympathetic system, which activates the physiological “fight or flight” stress response.

Thus, despite the many cases in which an “adrenaline” shot can be used, a heroin overdose is unlikely to be one of them. If a person’s heart stops due to an overdose of narcotic substances, then only then can the use of an epinephrine injection be justified, coupled with the complex use of a defibrillator and primary resuscitation efforts.

Heroin belongs to the opiate class. This group also includes codeine, morphine, oxycodone, methadone, and fentanyl.

A little bit of history: heroin was initially positioned as a non-addictive cough medicine from the German manufacturer Bayer. Another common use of heroin was to treat people addicted to morphine. And this despite the fact that heroin was recognized even more a strong drug. The funny thing is that when purified morphine was synthesized from opium in 1805, it was immediately used as a “non-addictive” drug to relieve people from opium addiction.

In any case, one of the most common reasons deaths associated with taking large doses similar drugs, is hypoventilation syndrome. When a person takes too large a dose of a drug orally, he begins to breathe more slowly and shallowly, until breathing stops completely.

As a result, the heart also stops contracting after a short period of time. And an injection of epinephrine will do nothing in this case. Of course, theoretically, this can lead to increased breathing, but such cases are unknown in medical practice, since the adrenaline effect will pass much faster than the effect of the drug.

However, there is a drug in the world that works the same way as adrenaline in the film. It's called naloxone. Synthesized in 1960, it is known as the opium antidote. The drug is used to combat negative symptoms any opium overdose. When administered orally, naloxone blocks the action of opiates in brain receptors, thereby stopping the oppression respiratory process. The drug begins to act very quickly and is guaranteed to return a person to consciousness and the ability to breathe within a minute after administration. Although naloxone also has side effects.

The effects of this medication are not as long-lasting as those of opiates, so there is a possibility that your breathing may stop breathing again. It is worth considering that the action of naloxone can instantly relieve a person of all the effects of the opiate. Therefore, in an addicted person, such a sharp change in the physiological picture almost immediately causes withdrawal syndrome or the so-called. “breaking” effect.

As a result, the patient experiences nausea, vomiting, muscle cramps, diarrhea and chills. As shown medical practice, after instantly getting rid of the drug effects, people become furious with the realization that all the “high” has been taken away from them and immediately attack the “culprit”. Children, never use drugs!

Scene No. 2 – “The Rock”.

Here Nichols Cage's hero must inject atropine directly into his heart to stop the effects of poisonous VI gas.

In this scene, the filmmakers did almost everything right: the nerve agent V-Ex really exists and atropine is used as a treatment for those affected by it.

VI gas is classified as a chemical warfare agent with a nerve agent. Like most similar toxic substances, VI gas affects cholinesterase enzymes, resulting in increased levels of the neurotransmitter acetylcholine in the body.

Such an excess leads to overexcitation of the lymph nodes and muscles. As a result, expansion occurs blood vessels, decreased heart rate and compression of the bronchioles of the lungs. All this occurs in parallel with uncontrolled salivation, urination, bowel movements, vomiting and stomach irritation.

When affected by this toxin, breathing stops, since the overexcited diaphragm and other muscles are not able to function adequately, not to mention the fact that streams of not the most pleasant organic substances rush out from all the orifices of the body.

As noted above, atropine is used to treat injuries caused by this poisonous gas. In addition, the treatment also includes a drug called pralidoxime. It is a reactivator of the enzyme cholinesterase, which helps reduce acetylcholine levels in the body. And atropine, in turn, stops negative effects acetylcholine. Therefore the optimal healing effect uses atropine in combination with pralidoxime.

It is worth noting that although the drug is indicated correctly in the film, the method of its administration is again incorrect. This is understandable: a giant needle sticking out of the heart looks much more spectacular and clearly evokes more emotions. The main thing, kids, is not to try to repeat this at home.

Which is produced by the adrenal cortex and performs a number of functions in the human body. It is called the stress hormone because it large doses it is released in situations that are uncomfortable for a person.

Adrenaline has cardiotropic ( speeds up heart function, increases strength cardiac output ), vasoconstrictor and hyperglycemic effects. It also constricts blood vessels, increasing blood pressure and increasing blood glucose levels.

In medicine, adrenaline is used in the form of synthetic substitutes ( adrenaline hydrochloride or epinephrine). The drugs are similar in their effect and influence on target organs. Substitutes are used when anaphylactic reactions, toxic shock, vascular paresis, cardiac arrest and heart failure.

The use of adrenaline in intensive care

Epinephrine or adrenaline hydrochloride is used to resuscitate the patient.. Routes of administration vary depending on the patient’s condition; each has its own characteristics and causes complications. Adrenaline is administered during resuscitation, depending on the situation, intramuscularly, intravenously, intratracheally and intracardially.

The administration of adrenaline is accompanied medical care in specialized intensive care units. Controlled using diagnostic equipment: indicator monitoring blood pressure, pulse and saturation (oxygen concentration in the blood). If necessary, use a ventilator ( artificial ventilation lungs). Using a laryngoscope, the airways are cleared using mechanical or electrical suction.

At the first stage of medical resuscitation, the type of circulatory arrest is assessed. Connect an electrocardiograph and diagnose functional state heart to obtain objective readings.

Circulatory arrest involves the use of adrenaline hydrochloride 0.5 ml 0.1%, atropine sulfate 0.5 ml 0.1%, sodium bicarbonate 0.2 ml 4% per 1 kg of body weight in resuscitation conditions. Intravenous drip is used along with sodium chloride (saline).

Adrenaline bicarbonate is also administered intramuscularly, intracardially and intratracheally.

Technique of intracardial injections. A shot in the heart

Intracardial administration is not currently used due to complications that arise during manipulation.

Only solutions of adrenaline hydrochloride, epinephrine, atropine sulfate and lidocaine are administered intracardially. An injection into the heart is carried out using a thin needle 7 to 10 cm long. The chest is pierced in the 4th intercostal space, 1.5 cm to the left of the sternum, along the upper edge of the rib.

At a depth of 4-5 cm, difficulty will be felt in the passage of the needle. This obstacle is the wall of the right ventricle. When you pull back the piston, blood will flow into the syringe, which will indicate a perforation of the wall of the ventricle of the heart. Medicines are then immediately administered. After completing the manipulations continue indoor massage hearts.

Technique of intratracheal injections

This manipulation is much easier. Adrenaline hydrochloride, atropine sulfate and lidocaine are drawn into a syringe for intramuscular injections and are inserted into the cricothyroid ligament, the needle penetrates the space between the tracheal rings.

Administration of drugs by intubation

The method of administering adrenaline or epinephrine is used by the intubation method if the patient is connected to artificial ventilation. The drug penetrates the alveoli of the lungs, where it is absorbed and enters the blood.

Method of administering the drug sublingually

A simple manipulation that consists of injecting adrenaline hydrochloride into the hypoglossal muscle using a syringe for intramuscular injection.

Still from the movie "Pulp Fiction"

The injection of epinephrine hydrochloride into the heart for drug overdose and cardiac arrest has been used in both domestic and foreign intensive care. Over time, this resuscitation technique was replaced by intratracheal injection of epinephrine and its injection into the hyoid muscle.

Adrenaline – medicinal product, which has a pronounced hypertensive (increases blood pressure), vasoconstrictor, cardiostimulating and bronchodilator (eliminating bronchospasm) effect. At intravenous administration therapeutic effect adrenaline is almost instantaneous, with subcutaneous administration it develops after 5-10 minutes, with intramuscular administration it can vary. Let's consider when adrenaline, an injection solution, is used.

Medicinal properties

When the drug is taken, blood vessels throughout the body begin to constrict. This happens in abdominal cavity, on the skin, in the kidneys and blood vessels of the brain. The heart rate also noticeably increases, the tone of the smooth muscles of the intestines decreases (and the opposite effect appears on the skeletal muscles).

Indications for use

The drug is indicated for use in the following cases:

Spontaneous allergic reactions (including urticaria and anaphylactic shock) from medicines, food, insect bites and other factors.
Bleeding (used as a vasoconstrictor).
Prolongation of the effect of local anesthetic drugs.
Bronchial asthma and bronchospasms.
A strong decrease in blood pressure (more than 1/5 of the norm for a person or in numerical terms below 90 for systolic or 60 for average blood pressure).
Asystole (cardiac arrest), both instantaneous and developed against the background of a previous arrhythmia.

Directions for use and dosage

The injection can be given several times various methods: in case of cardiac arrest, an injection is made into the heart; in other cases, depending on the specific situation, everything is administered locally, subcutaneously, intramuscularly or intravenously. Intramuscular administration gives more quick effect than subcutaneous.

The dosage varies depending on the age of the patient. For an adult, 0.3 to 0.75 ml is usually administered. The injections can be repeated every 10 minutes, monitoring the reaction of the human body. A single dose cannot exceed 1 ml (approximately 1 mg), and a daily dose cannot exceed 5 ml. If the patient’s condition is quite severe, it is necessary to dissolve adrenaline in a ratio of 1 to 2 in an isotonic sodium chloride solution (for example, 1 mg in a 2 mg solution) and administer it slowly intravenously.

For children, doses are much smaller and depend on how old the child is. If a one-year-old baby maximum dose is 0.15 ml, then at the age of up to 4 years it increases to 0.25 ml, at the age of up to 7 years - up to 0.4 ml, at the age of up to 10 years and older - up to 0.5 ml. The drug is administered to the child 1-3 times a day.

Also, if you simply need to stop a person’s bleeding, the drug is applied topically using tampons soaked in it and applied to the problem area.

Application nuances

It is important not to administer the drug from the ampoule intra-arterially, because this will lead to excessive narrowing of peripheral vessels, and this, in turn, to the development of gangrene.

If the liquid is used for in a state of shock, this does not replace other measures such as plasma, blood or saline transfusions.

Long-term use of the drug is strongly not recommended, because it can lead to the development of necrosis or gangrene. Also, the drug is not recommended for use during lactation. as it may be harmful to the child.

Side effects

IN in rare cases The following side effects may occur from adrenaline:

From the outside of cardio-vascular system there may be sudden painful sensations in the chest and disorders heart rate.
Occasionally in place intramuscular injection The drug may cause a burning sensation or pain.
From the outside digestive system side effects may include nausea and vomiting, excretory system sometimes adds to them discomfort and/or difficulty urinating.
Allergic reactions.
Increased sweating.
A severe drop in potassium levels in the blood (manifested as fatigue, weakness in the limbs; in severe cases in paralysis, intestinal obstruction and difficulty breathing).
Nervous state, weakness, fatigue, irritability, anxiety, sleep disturbances.

With the exception of nausea, vomiting and headaches, all other side effects occur no more often (and generally even much less often) than one case per 100 uses of the drug.

The use of adrenaline does not lead to an absolute ban on control vehicles and mechanisms, the doctor makes a decision in each specific case individually, based on the patient’s condition and the manifestations of side effects from the drug.

Overdose

In case of an overdose of adrenaline, the following may occur:

Nausea, vomiting.
Headache.
Pallor and low temperature skin patient's body.
Heart rhythm disturbances or pathological tachycardia (increased heart rate over 90 beats per minute).
In case of severe overdose or in poor health patients - pulmonary edema, heart attack, stroke and even death.

Let's sum it up

Adrenaline in the form of an injection solution can not only have a therapeutic effect, but, in some situations, even save a person’s life. But so that it does not harm a person, it is necessary to observe the correct dosage and adhere to precautions. However, experienced doctor, when contacting medical institution, will take them into account and use the injection solution (1 ml or lower dose) as effectively as possible.

The introduction of drugs into the heart cavity through the chest can be used only in exceptional cases, namely in a complex of resuscitation measures in case of cardiac arrest. Most often, adrenaline is used for this purpose.

But since this method does not have any great advantages over conventional injection into a vein, causes many complications, and also requires stopping cardiac massage to implement it, it is no longer widely used.

Read in this article

Effect of adrenaline on the heart

Adrenaline is one of the most powerful cardiac stimulants. Its effects are associated with interaction with beta1 receptors. Under the influence of this drug, the following changes in cardiac activity occur:

heart rate increases;
the force of contraction and the volume of blood ejected from the ventricles increases;
oxygen uptake by the myocardium increases;
the excitability of the heart muscle and signal transmission increases;
the duration of systole decreases, and the time of diastole remains unchanged;
the pacemaker may change;
when exposed to high doses, and also when combined with anesthetics, ventricular extrasystoles may appear;
reduces the manifestations of blockade of pathways.

ECG before and after injection of adrenaline into the heart

When administered intravenously or intracardiacly, myocardial cell death may occur and the risk may increase. Therefore, the use of Adrenaline should only be under control of the heart rhythm. In the presence of hypoxia, rhythm disturbances are observed more often. In this regard, the drug cannot be administered without prior respiratory resuscitation.

When is an intracardiac injection given?

Intracardial administration of medications can be done to increase the effectiveness of resuscitation measures in case of clinical death. This method is usually used if, after 3 - 5 minutes from cardiac arrest, external massage does not lead to the start of cardiac activity. Contraindications for intracardiac injections include trauma or injury to the heart.

Heart massage should not be interrupted for more than 10 - 15 seconds. Therefore, to carry out an injection you need to be proficient in this method. Anesthesia is not used when contractions are stopped.

What injections are given into the heart?

Most often, Adrenaline solution is used in complete asystole to restore myocardial contractility and increase pressure. The maximum single dose is 1 ml, and the daily dose is no more than 5 ml. In addition, the doctor can perform the following injections:

Atropine solution 0.1% 0.5 ml to reduce the tone of the parasympathetic system, improve conductivity and increase heart rate.
Calcium chloride 5 ml 10% to increase myocardial excitability and accelerate impulse conduction, prolonging the time of systolic contraction.

Instead of Adrenaline, it is possible to administer Noradrenaline, as well as a mixture: 1 ml of Adrenaline and Atropine, 10 ml of Calcium chloride and isotonic solution. First use half the mixture, and after 10 minutes the injection can be repeated.

For ventricular fibrillation, an injection of Adrenaline in combination with Novocaine is indicated.

How to make a direct injection

The drugs can be administered into the right ventricle. In this case, choose the following places:

the fourth intercostal space for young and fifth – for elderly patients;
the distance from the edge of the sternum is 0.5 cm for a narrow chest and 1 cm for a wide chest.

The needle should be long (10 - 12 cm) and thin, it moves perpendicular to the sternum along the upper edge of the rib. After 3 - 5 cm there is a feeling of failure, and blood enters the syringe. This means that the injection was performed correctly.

The left ventricle is punctured in the 4th or 5th intercostal space between the line in the middle of the clavicle and the axilla.

Why is the method no longer used?

If previously Adrenaline for injection into the heart cavity was recommended as the most effective method, then upon deeper study they began to abandon it everywhere. This is due to the lack of efficiency and great danger such technology. Possible complications:

Penetration of medications into cavities - pleural, cardiac sac, mediastinum or myocardium. Calcium chloride can cause tissue death.
If the needle gets into the sinus node, then it is impossible to restore contractions due to the destruction of the pacemaker cells.
If the needle is not inserted sufficiently into the contracting heart, the myocardium is injured.
With repeated injections through the holes, bleeding may begin during intense cardiac massage.
Puncture of the lung causing pneumothorax.
Damage to blood vessels between the ribs, chest or pulmonary artery, aorta, coronary branches.

Adrenaline administration may also activate parasympathetic function nervous system, which has an inhibitory effect on cardiac activity, as well as its negative effect is a rhythm disturbance.

How to resuscitate a cardiac arrest

The resuscitation team doctors carry out the following measures to start the heart:

Ensuring cross-country ability respiratory tract– tilt the patient’s head back, push it forward lower jaw and open your mouth.
Oxygen supply using a breathing bag.
in an almost continuous manner. It has been established that movements chest enough to supply air, and a pause impairs blood supply to the brain. Therefore, a breathing break is taken no more often than after 30 pressures on the sternum; its duration does not exceed 10 seconds.
The neurological status is then assessed and medications are administered to restore consciousness.

Watch the video about first aid for cardiac arrest:

If there are no signs of contraction in the case of ventricular fibrillation, it is used. It provides an electrical shock to temporarily stop the heart. This restarts it, after which the physiological rhythm is restored. With asystole, the method is ineffective.

If there is a need to administer drugs, the intravenous route is used.

The injection is carried out into any accessible peripheral vein, which is closest to the heart - jugular, ulnar. If the patient has an endotracheal tube, the drug is infused through it after aspiration of the mucus.

An injection into the heart can be used for resuscitation if there is no other way to administer the medication, and chest compressions and respiratory resuscitation have no effect within 7 minutes. For intracardiac administration, Adrenaline, Norepinephrine, Atropine, and Calcium chloride are used. This method leads to complications due to damage to blood vessels and myocardium. Therefore, doctors prefer the intravenous or endotracheal method of drug delivery.