ACLS Meds

Epinephrine drug class

Endogenous catecholamine and sympathomimetic

Epinephrine mechanism

Provides vasoconstriction, chronotropy, inotropy, dromotropy, and bronchodilation

Epinephrine cardiac arrest dose

1 mg IV/IO

Epinephrine cardiac arrest concentration

1:10,000

Epinephrine frequency during cardiac arrest

Every 3–5 minutes

Epinephrine is used in which arrest rhythms?

Shockable and non-shockable rhythms

Shockable rhythms for epinephrine use

Ventricular fibrillation and pulseless ventricular tachycardia

Non-shockable rhythms for epinephrine use

Asystole and pulseless electrical activity

What should be done immediately in VF/pVT?

Begin CPR

CPR duration between rhythm checks in VF/pVT

2 minutes or 5 cycles

When should VF/pVT be defibrillated?

When available

When should IV/IO access be established in VF/pVT?

As soon as possible

What medication is given after two defibrillations in refractory VF/pVT?

Amiodarone

First amiodarone dose for refractory VF/pVT

300 mg IVP

Second amiodarone dose for refractory VF/pVT

150 mg IVP

Amiodarone brand name

Cordarone

Amiodarone drug class

Class III antidysrhythmic

Amiodarone mechanism

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

Amiodarone first dose for recurrent VF/pVT

300 mg IVP

Amiodarone second dose for recurrent VF/pVT

150 mg IVP

Amiodarone dose for stable VT with pulse

150 mg infused over 10 minutes

When should amiodarone be administered during refractory VF/pVT?

During second round of CPR after epinephrine

Lidocaine brand name

Xylocaine

Lidocaine drug class

Antidysrhythmic

Lidocaine first dose for VF/pVT

1–1.5 mg/kg IV/IO

Lidocaine second dose for VF/pVT

0.5–0.75 mg/kg IV/IO

Maximum lidocaine dose

3 mg/kg

Lidocaine infusion after conversion

2–4 mg/minute

Lidocaine first dose for stable VT with pulse

1–1.5 mg/kg IV/IO

Lidocaine second dose for stable VT with pulse

0.5–0.75 mg/kg IV/IO

Lidocaine post-conversion dose for stable VT

0.5 mg/kg IV/IO in 10-minute increments two times

Atropine drug class

Parasympatholytic and anticholinergic

Atropine mechanism

Inhibits parasympathetic nervous system and acts on vagus nerve (CN X)

Atropine dose for symptomatic bradycardia

1 mg

Maximum cumulative atropine dose for symptomatic bradycardia

3 mg

How should atropine be administered?

Push rapidly

What can slow atropine administration cause?

Refractory bradycardia

Atropine dose for organophosphate poisoning

1 mg every 3–5 minutes

Atropine goal in organophosphate poisoning

Control secretions

What mnemonic is associated with organophosphate poisoning?

SLUDGE

Adenosine brand name

Adenocard

Adenosine drug class

Antidysrhythmic

Adenosine mechanism

Delays conduction through the AV node

Adenosine indication

Stable supraventricular tachycardia

First adenosine dose

6 mg

Second adenosine dose

12 mg

Third adenosine dose

18 mg

Maximum adenosine dose

30 mg

How should adenosine be administered?

Rapid IV push followed by saline flush

Saline flush volume after adenosine

10–20 mL

Adenosine half-life

10 seconds

Why are IV site and flush critical with adenosine?

Because adenosine has a 10-second half-life

Procainamide brand name

Pronestyl

Procainamide drug class

Antidysrhythmic

Procainamide mechanism

Blocks sodium influx and slows conduction

What does procainamide decrease?

Atrial and ventricular rates

Procainamide indication

Stable tachycardic rhythms >150 bpm including SVT, VT, and A-Fib

Procainamide dose

25–50 mg/minute

Sotalol brand name

BetaPace

Sotalol drug class

Antidysrhythmic

Sotalol indication

Stable tachycardic rhythms >150 bpm including SVT, VT, and A-Fib

Sotalol dose

100 mg (1.5 mg/kg) over 5 minutes

Aspirin drug class

Antipyretic and antiplatelet aggregator

Aspirin mechanism

Blocks platelet aggregation and reduces clot formation risk

Aspirin indication

Chest pain and acute coronary syndrome

Aspirin contraindications

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

Aspirin dose

81–324 mg

One baby aspirin tablet equals

81 mg

One adult aspirin tablet equals

325 mg

If patient took aspirin within the last 24 hours, what should be given?

Remaining tablets to total 324 mg

Dopamine brand name

Intropin

Dopamine drug class

Endogenous catecholamine

Dopamine dopaminergic dose

0.5–2 mcg/kg/minute

Dopaminergic dose effect

Dilates renal and mesenteric arteries

Dopamine beta dose

2–10 mcg/kg/minute

Beta dose effect

Positive inotropy, chronotropy, and dromotropy

Dopamine alpha dose

10–20 mcg/kg/minute

Alpha dose effect

Vasoconstriction

Dopamine uses

Symptomatic bradycardia and high-degree heart blocks

Nitroglycerin drug class

Potent vasodilator

Nitroglycerin indications

Chest pain and pulmonary edema

What should be obtained before nitroglycerin for chest pain?

12-lead EKG

What should be established before nitroglycerin when possible?

IV access

How should nitroglycerin be administered for pulmonary edema?

With CPAP

Nitroglycerin dose

0.4 mg SL

Nitroglycerin frequency

Every 3–5 minutes as needed

Maximum total nitroglycerin dose

1.2 mg

What should be monitored with each nitroglycerin dose?

Blood pressure

Do not administer nitroglycerin if systolic blood pressure is below what?

100 mmHg

Why should a 12-lead be obtained before nitroglycerin?

To rule in or out RVI

Nitro-Bid paste dose

15 mg TD

Nitro-Bid paste application site

1-inch circle on upper left chest area

Sodium bicarbonate drug class

Alkalinizing agent

Sodium bicarbonate indication in cardiac arrest

Known dialysis patients or prolonged downtime

Sodium bicarbonate dose in cardiac arrest

1 mEq/kg IV/IO

Sodium bicarbonate indication in TCA overdose

Tricyclic antidepressant overdose

Sodium bicarbonate dose in TCA overdose

1 mEq/kg IV/IO

What may sodium bicarbonate cause on capnography?

Transient increase in capnography