Epinephrine is the primary drug used in the cardiac arrest algorithm.

It is used for its potent vasoconstrictive effects and also for its ability to increase cardiac
output. Epinephrine is considered a vasopressor.

Indications for ACLS

1. Vasoconstriction effects: epinephrine binds directly to alpha-1 adrenergic receptors of

the blood vessels (arteries and veins) causing direct vasoconstriction, thus, improving
perfusion pressure to the brain and heart.
2. Cardiac Output: epinephrine also binds to beta-1-adrenergic receptors of the heart. This
indirectly improves cardiac output by:

 Increasing heart rate

 Increasing heart muscle contractility
 Increasing conductivity through the AV node

Epinephrine is used:
 cardiac arrest algorithm as a direct IV push
 Bradycardia algorithm as an infusion.

There are three medications used in the bradycardia algorithm: atropine, epinephrine,
and dopamine.

Atropine
Atropine is the first line medication for the treatment of bradycardia. The administration of
atropine typically causes an increase in heart rate. This increase in the heart rate occurs when
atropine blocks the effects of the vagus nerve on the heart. When the vagus nerve is blocked,
the SA node increases its rate of electrical discharge and this, in turn, results in the increased
HR.
Use atropine cautiously in the presence of myocardial ischemia and hypoxia because it
increases oxygen demand on the heart and can worsen ischemia.
The dosing for Atropine is 0.5 mg IV every 3-5 minutes as needed, and the maximum total
dosage for administration is 3 mg.
Atropine should be avoided caused by hypothermia with bradycardia and, in most cases, it
will not be effective for Mobitz type II/Second-degree block type 2 or complete heart block.