| 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/VT: 300 mg dilute in 20 to 30 mL may repeat 150 mg in 3 to 5 min
| 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 | 500 mcg IM
Repeat every five minutes 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
Rapid bolus can cause
hypotension and bradycardia
Use with caution in renal failure
Calcium chloride can
reverse hypermagnesemia |
| 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 hypermagnesemia |
| 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 |