[Pharmacological routes of administration in circulatory collapse]

A review of different ways of injecting drugs during cardiopulmonary resuscitation (CPR) and during states of shock is presented. On the basis of this review, central or peripheral intravenous injection is recommended as first choice. If a peripheral vein is used, the drug injection should be followed by infusion of a large volume of normal saline to facilitate the entry of the drug into the central circulation. In case of endotracheal intubation, several drugs can be injected into the tracheal tube. Atropine, lidocaine and naloxone are shown to be effective when given by this route. Adrenalin is probably not effective when injected endotracheally. Intraosseous injection of drugs, crystalloids and colloids is an alternative in all states except for hypovolaemic shock due to lower infusion rates. Intracardiac injection of drugs during CPR is recommended as a last resort.