Drug Main ACLS Use Dose/Route Notes

 Rapid IV push
close to the hub,
followed by a
 Narrow PSVT/SVT
 6 mg IV bolus, saline bolus
 Wide QRS
may repeat with  Continuous cardiac
tachycardia, avoid
Adenosine 12 mg in 1 to 2 monitoring during
adenosine in
min. administration
irregular wide QRS
 Causes flushing
and chest
heaviness

 VF/pulseless  Anticipate
VT: 300mg hypotension,
dilute in 20 to bradycardia, and
30ml., may gastrointestinal
repeat 150mg toxicity
every 3 to 5  Continuous cardiac
 VF/pulseless VT
minutes monitoring
 VT with pulse
 Stable VT with  Very long half-life
Amiodarone  Tachycardia rate
a pulse: 150mg (up to 40 days)
control
bolus followed  Do not use in 2nd
by amiodarone or 3rd-degree heart
drip (300 mg block
should only be  Do not administer
used in a code via the ET tube
situation) route

 0.5 mg IV/IO
every 3 to 5
 Symptomatic  Cardiac and BP
minutes
Bradycardia monitoring
 Max Dose: 3
 Do not use in
mg
glaucoma or
Atropine
tachyarrhythmias
 Specific
 Minimum dose 0.5
Toxins/overdose  2 to 4 mg IV/IO
mg
(e.g. may be needed
organophosphates)

 2 to 20
 Fluid resuscitation
mcg/kg/min
first
 Shock/CHF  Titrate to
Dopamine  Cardiac and BP
desired blood
monitoring
pressure

Epinephrine  Cardiac Arrest  Initial: 1.0 mg  Continuous cardiac

(1:10000) IV or monitoring
2 to 2.5 mg  NOTE: Distinguish
(1:1000) between 1:1000
 Drug Main ACLS Use Dose/Route Notes
 Maintain: 0.1 to
0.5 mcg/kg/min
Titrate to desire
blood pressure

 0.3-0.5 mg IM and 1:10000

 Anaphylaxis  Repeat every 5 concentrations
mins as needed  Give via central
line when possible
 2 to 10
mcg/min
 Symptomatic
infusion
bradycardia/Shock
 Titrate to
response

 Initial: 1 to 1.5
mg/kg IV
loading
 Cardiac Arrest  Second: Half of
(VF/VT) first dose in 5
 Cardiac and BP
to 10 min
Lidocaine monitoring
 Maintain: 1 to 4
(Lidocaine is  Rapid bolus can
mg/min
recommended cause hypotension
when and bradycardia
 Initial: 0.5 to
Amiodarone is  Use with caution in
1.5 mg/kg IV
not available) renal failure
 Wide Complex  Second: Half of
Tachycardia with first dose in 5
Pulse to 10 min
 Maintain: 1 to 4
mg/min

 Cardiac Arrest:
 Cardiac  Cardiac and BP
1 to 2 gm
Arrest/pulseless monitoring
diluted in 10
Torsades  Rapid bolus can
mL D5W IVP
cause hypotension
and bradycardia
Magnesium  If not Cardiac
 Use with caution in
Sulfate Arrest: 1 to 2
renal failure
 Torsades de Pointes gm IV over 5 to
 Calcium chloride
with pulse 60 min
can reverse
 Maintain: 0.5 to
hypermagnesemia
1 gm/hr IV

Procainamide  Wide QRS  20 to 50  Cardiac and BP

Tachycardia mg/min IV monitoring
 Preferred for VT until rhythm  Caution with acute
with pulse (stable) improves, MI
hypotension  May reduce dose
 Drug Main ACLS Use Dose/Route Notes
occurs, QRS
widens by 50%
or MAX dose is with renal failure
given  Do not give with
 MAX dose: 17 amiodarone
mg/kg  Do not use in
 Drip = 1 to 2 prolonged QT or
gm in 250 to CHF
500 mL at 1 to
4 mg/min

 Tachyarrhythmia
 100 mg (1.5
 Monomorphic VT  Do not use in
mg/kg) IV over
Sotalol  3rd line anti- prolonged QT
5 min
arrhythmic

THERAPEUTIC HYPOTHERMIA

 Recommended for comatose individuals with the return of spontaneous circulation

after a cardiac arrest event.
 Individuals should be cooled to 89.6 to 93.2 degrees F (32 to 36 degrees C) for at least
24 hours.

OPTIMIZATION OF HEMODYNAMICS AND VENTILATION

 100% oxygen is acceptable for early intervention but not for extended periods of time.
 Oxygen should be titrated, so that individual’s pulse oximetry is greater than 94% to
avoid oxygen toxicity.
 Do not over ventilate to avoid potential adverse hemodynamic effects.
 Ventilation rates of 10 to 12 breaths per minute to achieve ETCO2 at 35 to 40 mmHg.
 IV fluids and vasoactive medications should be titrated for hemodynamic stability.

PERCUTANEOUS CORONARY INTERVENTION

 Percutaneous coronary intervention (PCI) is preferred over thrombolytics.

 Individual should be taken by EMS directly to a hospital that performs PCI.
 If the individual is delivered to a center that only delivers thrombolytics, they should
be transferred to a center that offers PCI if time permits.
NEUROLOGICAL CARE

 Neurologic assessment is key, especially when withdrawing care (i.e., brain death) to
decrease false-positive rates. Specialty consultation should be obtained to monitor
neurologic signs and symptoms throughout the post-resuscitation period.