Advanced Medical Certification

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Pharmacological Tools

Please purchase the course before starting the lesson.

Only use the ACLS medication shown in Table 1 if it is within your scope of practice, and only after you have thoroughly studied the side effects and actions involved. This table is more of a reminder for those who are already experienced with the following medications. Table 1 also only describes adult routes of administration, indications, and doses for the most widely used ACLS drugs.

Table 1: Doses, Routes, and Uses of Common Drugs

Drug Main ACLS Use Dose/Route Notes
Adenosine
  • Narrow PSVT/SVT
  • Wide QRS tachycardia, 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
  • Tachycardia, 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/IO 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/IO 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)
  • 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
  • Rapid bolus can cause hypotension
    and bradycardia
  • Use with caution in renal failure
  • 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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