Pharmacological Tools

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Use of any of the ALCS medication in Table 1 should be done within your scope of practice and after thorough study of the actions and side effects. This table only provides a brief reminder for those who are already knowledgeable in the use of these medications. Moreover, the tablet contains only adult doses, indication, and routes of administration for the most common ACLS drugs.

Table 1: Doses, Routes and Uses of Common Drugs

Drug Main ACLS Use Dose/Route Notes
Adenosine
  • Narrow PSVT/SVT
  • Wide QRS Tachy – avoid adenosine in irregular wide QRS
  • 6 mg IV bolus, may repeat with 12 mg in 1 to 2 min.
  • Rapid IV push close to the hub, followed by a saline bolus
  • Continuous cardiac monitoring during administration
  • Causes flushing and chest heaviness
Amiodarone
  • VF/pulseless VT
  • VT with pulse
  • Tachy rate control
  • VF/pulseless VT: 300mg dilute in 20 to 30ml., may repeat 150mg every 3 to 5 minutes
  • Stable VT with a pulse: 150mg bolus followed by amiodarone drip (300 mg should only be used in a code situation)
  • Anticipate hypotension, bradycardia, and gastrointestinal toxicity
  • Continuous cardiac monitoring
  • Very long half life (up to 40 days)
  • Do not use in 2nd or 3rd degree heart block
  • Do not administer via the ET tube route
Atropine
  • Symptomatic Bradycardia
  • 0.5 mg IV/ET every 3 to 5 minutes
  • Max Dose: 3 mg
  • Cardiac and BP monitoring
  • Do not use in glaucoma or tachyarrhythmias
  • Minimum dose 0.5 mg
  • Specific Toxins/overdose (e.g. organophosphates)
  • 2 to 4 mg IV/ET may be needed
Dopamine
  • Shock/CHF
  • 2 to 20 mcg/kg/min
  • Titrate to desired blood pressure
  • Fluid resuscitation first
  • Cardiac and BP monitoring
Epinephrine
  • Cardiac Arrest
  • Initial: 1.0 mg (1:10000) IV or 2 to 2.5 mg (1:1000) ETT every 3 to 5 min
  • Maintain: 0.1 to 0.5 mcg/kg/min Titrate to desire blood pressure
  • Continuous cardiac monitoring
  • NOTE: Distinguish between 1:1000 and 1:10000 concentrations
  • Give via central line when possible
  • Anaphylaxis
  • 0.3-0.5 mg IM
  • Repeat every 5 mins as needed
  • Symptomatic bradycardia/Shock
  • 2 to 10 mcg/min infusion
  • Titrate to response
Lidocaine
(Lidocaine is recommended when Amiodarone is not available)
  • Cardiac Arrest (VF/VT)
  • Initial: 1 to 1.5 mg/kg IV loading
  • Second: Half of first dose in 5 to 10 min
  • Maintain: 1 to 4 mg/min
  • Cardiac and BP monitoring
  • Do not use in wide complex bradycardia
  • May cause seizures
  • Wide Complex Tachycardia with Pulse
  • Initial: 0.5 to 1.5 mg/kg IV
  • Second: Half of first dose in 5 to 10 min
  • Maintain: 1 to 4 mg/min
Magnesium Sulfate
  • Cardiac Arrest/pulseless Torsades
  • Cardiac Arrest: 1 to 2 gm diluted in 10 mL D5W IVP
  • Cardiac and BP monitoring
  • Rapid bolus can cause hypotension and bradycardia
  • Use with caution in renal failure
  • Calcium chloride can reverse
  • Torsades de Pointes with pulse
  • If not Cardiac Arrest: 1 to 2 gm IV over 5 to 60 min Maintain: 0.5 to 1 gm/hr IV
Procainamide
  • Wide QRS Tachycardia
  • Preferred for VT with pulse (stable)
  • 20 to 50 mg/min IV until rhythm improves, hypotension occurs, QRS widens by 50% or MAX dose is given
  • MAX dose: 17 mg/kg
  • Drip = 1 to 2 gm in 250 to 500 mL at 1 to 4 mg/min
  • Cardiac and BP monitoring
  • Caution with acute MI
  • May reduce dose with renal failure
  • Do not give with amiodarone
  • Do not use in prolonged QT or CHF
Sotalol
  • Tachyarrhythmia
  • Monomorphic VT
  • 3rd line anti-arrhythmic
  • 100 mg (1.5 mg/kg) IV over 5 min
  • Do not use in prolonged QT
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