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Emergencies





Category: Uncategorized
Source: Disturbances Of The Heart

5. Cardiac Emergency Drugs.--Besides some of the drugs already
mentioned (such as camphor hypodermically, nitroglycerin when
indicated, strophanthin hypodermically or intravenously, caffein and
strychnin), often ergot, suprarenal vasopressor principle, pituitary
vasopressor principle, atropin and morphin should be considered.

When there is low blood pressure, venous stasis, pulmonary
congestion, cyanosis and a laboring, failing heart, intramuscular
injections of ergot, with or without coincident venesection, may be
the most valuable method of combating the condition. Life has been
saved in this kind of sudden acute cardiac failure in valvular
disease. When venesection is not indicated in certain conditions of
low blood pressure and heart failure, ergot has saved life. It
causes contraction of the blood vessels and seems to tone the heart.
Incidentally it quiets the central nervous system. If the blood
pressure is much increased by it, the ergot should not be repeated,
as too much work should not be thrown on the heart muscle. Often,
however, it may be administered intramuscularly with advantage in
aseptic preparation as offered in ampules, at the rate of one ampule
every three hours for two or three times, and then once in six hours
for a few times, the future frequency depending on the indications.

Epinephrin and Pituitary Extract: The blood pressure-raising
substance of the suprarenals or of the pituitary gland (hypophysis
cerebri) has been much used in heart failure. These substances
certainly would not be indicated in high blood pressure; they are
indicated in low blood pressure. They have been given intravenously;
they are frequently given hypodermically. They often act rapidly
when a solution in proper dose is dropped on the tongue. The blood
pressure rise from epinephrin is quickly over; that from the
pituitary extract lasts longer. In large doses, or when it is too
frequently repeated, epinephrin depresses the respiration. Pituitary
extract acts as a diuretic. Sterilized solutions of both, put up in
ampules ready for hypodermic medication, are obtainable, the
strength offered generally being 1 part of the active principle to
10,000 of the solution. Hypodermic tablets of epinephrin may also be
obtained. Stronger solutions of 1 part to 1,000 may be dropped on
the tongue, or tablets may be dissolved on the tongue. The blood
pressure is temporarily raised and the heart stimulated by these
treatments, but epinephrin is not used so often for cardiac failure
as it was a short time ago.

The most satisfactory action, especially from the epinephrin, is
from small doses frequently repeated. Sometimes in serious
emergencies it has been found to be of value when given
intravenously in physiologic saline solution. The close, of course,
should be very small. In circulatory weakness in acute illness,
epinephrin has been given regularly, a few drops (perhaps the most
frequent dose is 5) of a 1: 1,000 solution, on the tongue, once in
six hours. Such a dosage may be of value, and certainly is better
than the administration of too much strychnin. Much larger or more
frequent doses are likely, as just stated, to depress the
respiration.

Besides the small amount of blood pressure-raising substance
secreted by the hypophysis cerebri. it has not been shown that any
other gland of the body furnishes vasopressor substance except the
suprarenals.

Atropin: When there is great cardiac weakness, atropin may be used
to advantage. The dose is from 1/200 to 1/150 grain hypodermically,
not repeated in many hours. It will whip up a flagging heart, more
or less increase the blood pressure, cause cerebral awakening, and
may often be of value. If there is any idiosyncrasy against atropin,
if the throat and mouth are made intensely dry, or if there is
serious flushing or cerebral excitement, the dose should not be
repeated.

Morphin: This would rarely be considered as an emergency drug in
cardiac weakness. A small dose of it, not more than one-eighth
grain, especially if combined with atropin, will often quiet and
brace a weak heart, especially when there is cardiac pain. Just
which drug or drugs should be used and just which are not indicated
can never be specifically outlined in a textbook, a lecture or a
paper. The decision can be made only at the bedside, and then
mistakes, many times unavoidable, are often made.

In all conditions of shock with cardiac failure, the blood vessels
of the abdomen and splauclinic system are dilated, and more or less
of the blood of the body is lost in these large veins, and the
peripheral and cerebral blood pressure fails. The advantage in such
a condition of firm abdominal bandages, and of raising the foot of
the bed or of raising the feet and legs, need only be mentioned to
be understood.

It is a pretty good working rule, in cardiac failure, not to do too
much. On the other hand, life is frequently saved by proper
treatment, and the physician repeatedly saves life as surely as does
the surgeon with his knife.





Next: Convalescence

Previous: Indications For Strychnin



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