Common Drugs Used In CPR

DRUG MAIN ACLS USEDOSE/ROUTENOTES
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