ACLS Meds

What is Epinephrine also called?

Adrenalin

What is the classification of Epinephrine?

Endogenous catecholamine and sympathomimetic

What effects does Epinephrine provide?

Vasoconstriction, chronotropy, inotropy, dromotropy, and bronchodilation

What is the cardiac arrest dose of Epinephrine?

1 mg IV/IO of 1:10,000 concentration

How often is Epinephrine given during cardiac arrest?

Every 3–5 minutes

In which cardiac arrest rhythms is Epinephrine used?

Both shockable and non-shockable rhythms

What is the shockable cardiac arrest algorithm?

CPR, defibrillate when available, IV/IO access, Epinephrine 1 mg every 3–5 minutes

What is the non-shockable cardiac arrest algorithm?

CPR, IV/IO access, Epinephrine 1 mg every 3–5 minutes

What is the classification of Amiodarone?

Class III antidysrhythmic

How does Amiodarone work?

Blocks potassium channels, increases refractory period, also blocks sodium channels and has calcium channel blocking properties

What are the indications for Amiodarone?

Recurrent Ventricular Fibrillation and Pulseless Ventricular Tachycardia

What is the first Amiodarone dose in refractory VF/pVT?

300 mg IVP

What is the second Amiodarone dose in refractory VF/pVT?

150 mg IVP

When is Amiodarone used in VF/pVT?

After two unsuccessful defibrillations

What is the Amiodarone dose for stable Ventricular Tachycardia?

150 mg over 10 minutes

What tachyarrhythmias may Amiodarone be used for?

SVT, VT, and A-Fib greater than 150 bpm

What is the classification of Lidocaine?

Antidysrhythmic

What are the indications for Lidocaine?

Ventricular Fibrillation and Pulseless Ventricular Tachycardia

What is the initial Lidocaine dose for VF/pVT?

1–1.5 mg/kg IV/IO

What is the second Lidocaine dose for VF/pVT?

0.5–0.75 mg/kg IV/IO

What is the maximum total Lidocaine dose?

3 mg/kg

What Lidocaine infusion is started after conversion?

2–4 mg/minute

What is the initial Lidocaine dose for stable Ventricular Tachycardia with a pulse?

1–1.5 mg/kg IV/IO

What is the second Lidocaine dose for stable Ventricular Tachycardia with a pulse?

0.5–0.75 mg/kg IV/IO

What is the classification of Atropine?

Parasympatholytic and anticholinergic

How does Atropine work?

Inhibits the parasympathetic nervous system and acts on the vagus nerve

What is the Atropine dose for symptomatic bradycardia?

1 mg

What is the maximum cumulative Atropine dose?

3 mg

How should Atropine be administered?

Push rapidly

Why should Atropine not be given slowly?

It may cause refractory bradycardia

What is the Atropine dose for organophosphate poisoning?

1 mg every 3–5 minutes until secretions are controlled

What bradycardic rhythms are treated with Atropine?

Sinus Bradycardia, Junctional Escape, and Second Degree Type I

What is the pacing rate for symptomatic bradycardia?

60 bpm, increase as needed

What vasopressor infusions may be used for symptomatic bradycardia?

Dopamine 5–20 mcg/kg/minute or Epinephrine 2–10 mcg/minute

What is the classification of Adenosine?

Antidysrhythmic

How does Adenosine work?

Delays conduction through the AV node

What is the indication for Adenosine?

Stable Supraventricular Tachycardia

What is the first Adenosine dose?

6 mg rapid IV push

What is the second Adenosine dose?

12 mg rapid IV push

What is the maximum Adenosine dose?

30 mg

How should Adenosine be administered?

Rapid IV push followed by a 10–20 mL saline flush

What is the half-life of Adenosine?

Approximately 10 seconds

Why is a proximal IV and flush important when giving Adenosine?

Because of its very short half-life

What is the treatment sequence for stable SVT?

Vagal maneuvers, Adenosine 6 mg, Adenosine 12 mg, repeat 12 mg if needed

What is the classification of Nitroglycerin?

Potent vasodilator

What are the indications for Nitroglycerin?

Chest pain and pulmonary edema

What should be obtained before Nitroglycerin administration?

A 12 lead ECG and IV access

How is Nitroglycerin used in pulmonary edema?

With CPAP

What is the sublingual Nitroglycerin dose?

0.4 mg

How often can Nitroglycerin be repeated?

Every 3–5 minutes

What is the traditional maximum Nitroglycerin dose?

1.2 mg total

What blood pressure should generally be present before Nitroglycerin administration?

Systolic BP greater than 100 mmHg

What is Nitro-Bid?

Nitroglycerin paste

How is Nitro-Bid applied?

1-inch circle (15 mg TD) to the upper left chest

Why should IV access be obtained before Nitroglycerin when possible?

To manage potential hypotension

Why should a 12 lead be obtained before Nitroglycerin?

To assess for Right Ventricular Infarction

What is the classification of Aspirin?

Antipyretic and antiplatelet aggregator

How does Aspirin work?

Blocks platelet aggregation

What are the indications for Aspirin?

Chest pain and acute coronary syndrome

What are the contraindications to Aspirin?

Children, known hypersensitivity, active ulcer disease, signs of or history of stroke

What is the Aspirin dose?

81–324 mg

How much Aspirin is in a baby aspirin tablet?

81 mg

How much Aspirin is in an adult tablet?

325 mg

If a patient already took Aspirin today, how much should be given?

Enough to total 324 mg

What is Morphine Sulfate?

An opioid analgesic

What protocol includes Morphine?

MONA

What does MONA stand for?

Morphine, Oxygen, Nitroglycerin, Aspirin

What opioid is increasingly used instead of Morphine?

Fentanyl

Why is Fentanyl often preferred over Morphine?

It has fewer hemodynamic effects

What is the classification of Procainamide?

Antidysrhythmic

How does Procainamide work?

Blocks sodium influx and slows conduction

What are the indications for Procainamide?

Stable tachycardic rhythms greater than 150 bpm

What is the Procainamide dose?

25–50 mg/minute

What medications may be used for stable Ventricular Tachycardia?

Amiodarone, Procainamide, or Sotalol

What is the classification of Sotalol?

Antidysrhythmic

What are the indications for Sotalol?

Stable tachycardic rhythms greater than 150 bpm

What is the Sotalol dose?

100 mg (1.5 mg/kg) over 5 minutes

What is the classification of Dopamine?

Endogenous catecholamine

What is the Dopaminergic Dopamine dose range?

0.5–2 mcg/kg/minute

What does Dopamine do at 0.5–2 mcg/kg/minute?

Dilates renal and mesenteric arteries

What is the Beta-dose Dopamine range?

2–10 mcg/kg/minute

What does Dopamine do at 2–10 mcg/kg/minute?

Increases inotropy, chronotropy, and dromotropy

What is the Alpha-dose Dopamine range?

10–20 mcg/kg/minute

What does Dopamine do at 10–20 mcg/kg/minute?

Causes vasoconstriction

What Dopamine dose is used for symptomatic bradycardia?

5–20 mcg/kg/minute

What is the classification of Sodium Bicarbonate?

Alkalinizing agent

What are the indications for Sodium Bicarbonate?

Dialysis patient cardiac arrest, prolonged downtime cardiac arrest, and TCA overdose

What is the Sodium Bicarbonate dose?

1 mEq/kg IV/IO

What capnography effect can Sodium Bicarbonate cause?

A transient increase in ETCO₂