Emergency Drugs for Abnormal Heart Rhythms

Action Indication Loading/ Initial Dose Route Repeat Dose

Digitalis Glycosides • A-fib 0.25 to 0.5 mg Slow IV infusion
Positive inotrope: increase • A- flutter Mix in 50 mL of
Digoxin myocardial contractility D5W or NS and
Negative chronotrope: decrease administer over 5 -
heart rate 10 minutes
Calcium Channel Blockers • A-fib 5 to 10 mg (0.075 to 0.15 Very slow 10 mg (0.15 mg/kg body
relaxing the blood vessels; • A- flutter mg/kg) intravenous weight) 30 minutes after the first
increases the supply of blood and • SVT Injection over at dose
oxygen to the heart and slows least a two-minute
Verapamil electrical activity in the heart to period of time
control the heart rate. under
continuous ECG
and blood pressure
monitoring
Calcium Channel Blocker • V-fib 150 mg (V-tach with Slow IVtt After 2nd Shock: 150 mg →
relaxing the blood vessels so the • V-tach pulse) amiodarone drip
heart does not have to pump as • A- fib
hard. It also increases the supply of 300 mg (pulseless V-tach IV bolus
blood and oxygen to the heart. and V-fib after defib)

Amiodarone Amiodarone drip →

Lidocaine (next DOC)
Preparation: 600 mg
Amio in 250 mL D5W (21
cc/hr for 6 hours, then
13cc succeeding hours
for 24 hours)
Calcium Channel Blockers • SVT 0.25 mg/kg (usual adult IV Infusion after 15 minutes, may repeat
relaxing the blood vessels so the • A-fib dose, 20 mg) direct IV over 2 bolus by administering 0.35
Diltiazem heart does not have to pump as minutes mg/kg actual body weight over
hard. It also increases the supply of 2 min (average adult dose, 25
blood and oxygen to the heart. mg) direct IV
Sympathomimetic Agents • PEA During a resuscitation IV bolus Recommended dose:
relaxing the muscles in the airways • Asystole effort: 1 mg During a 0.5-1.0 mg (5-10 mL)
and tightening the blood vessels. 1:10,000 dilution (9mL resuscitation effort: Through ET tube:
Epinephrine
PNSS + 1 mg/mL Epi) IV q5min 2 mg
If no IV access:
Through ET tube:
Antidysrhythmic • SVT 6 mg Rapid IV bolus + if no conversion within 1-2
blocks faulty circuitry in the heart, saline flush of minutes give 12 mg second
Adenosine which causes irregular heart rhythm 10/20 cc PNSS dose, 12 mg third dose
Extremity should
be elevated
 Anticholinergic, Antispasmodic • Sinus 0.5- 1 mg (5-10 ml of 0.1 IV injection or IM repeat dose can be
Agents bradycardia mg/ml) injection administered in 3 to 5 minutes
Atropine blocks the parasympathetic system, Through ET Tube:
speeding up the heart rate. 1.0 mg + NSS 10 cc for dilution
Max Dose: 3 mg
Class IB antiarrhythmic drug • V-tach 1.0 mg/kg after Amio drip IV bolus second dose of 0.5 mg/kg may
blocking sodium channels and thus • V-fib @ 25-50 mg/ min be administered 5 minutes after
decreasing the rate of contractions completion of the first injection.
of the heart. Max Dose: Not more than 200-
300 mg should be administered
during a one hour period
Lidocaine Through ET Tube:
2X IV dose
Maintenance dose:
A continuous infusion at a rate
of 1 to 4 mg/min is used to
maintain adequate serum levels
for 24 to 48 hours.