ACLS

MEDICATIO
N
Routes of Administration

Medications should be given IV or IO

Avoid obtaining Central line access
ET Tube administration ONLY if unable to gain
IV or IO Access
Medications for
Cardiac Arrest
Cardiac Arrest

Cardiac arrest algorithm is used for two pathways :

A shockable rhythm : Ventricular Fibrillation (VF) or pulseless
Ventricular Tachycardia (VT)
A nonshockable rhythm : asystole, Pulseless Electrical Activity (PEA)
Two Types of Agents

Pressor Agents (increased blood flow)

Epinephrine and Vasopressin

Antidysrhythmics (suppression of dysrhythmia)

Amiodarone, Lidocaine, Magnesium Sulfate
EPINEPHRINE

Used during resuscitation primarily for its -

adrenergic effects
+ inotrope, + chronotrope, SVR, BP
automaticity
force of contraction
coronary and cerebral blood flow
Bronchial dilation
Dosage IV/IO:
Cardiac Arrest-1 mg q 3-5 min

7
AMIODARONE

Dosage:
VF/pulseless VT = 300mg IVP/IO
may repeat one time at 150mg IVP/IO
LIDOCAINE

Indication:
Consider using if amiodarone not available or
allergy to Amiodarone
LIDOCAINE

Dosage:

1-1.5 mg/kg/dose x 1
then 0.5 0.75 mg/kg q 5-10 min (max. 3
doses or 3mg/kg)
MAGNESIUM SULFATE

Indications: Torsades de pointes

(Hypomagnesaemia may lead to development
of Torsades)

Dosage:
Pulseless arrest w/ Torsades,
= 1 2 grams
Administration in Cardiac Arrest

Follow each medication with a 20 ml flush and

elevate arm 1-20 seconds
Anticipate the next medication and have it
ready to administer
If we administer medications at the beginning
of the cycle of CPR, we can circulate them for 2
minutes
Administer Medications at beginning of cycle
Medications for
Post Arrest Care
 Post Arrest Hypotension Not
Responsive to Fluid Bolus

Vasopressor Infusions:
Epinephrine 0.1-0.5 mcg/kg/min
Dopamine 5-10 mcg/kg/min
Norepinephrine 0.1-0.5 mcg/kg/min
BRADYCARDIA
Bradycardia
The drugs is given if bradyarrhythmia causing :

Hypotension
Acutely altered mental status
Signs of shock
Ischemic chest discomfort
Acute heart failure

First-line treatment
Atropine 0.5 mg IV may repeat to a total dose of 3 mg

Use atropine cautiously in the presence of acute coronary

ATROPINE ischemia or MI

Do not rely on atropine in Mobitz type II second or third

degree AV block or in patients with third degree AV block
with a new wide QRS complex
 If Atropine is ineffective, consider :

Transcutaneous
pacing

OR DOPAMINE
2 to 10 mcg/kg per minute
(chronotropic or heart rate dose)

OR EPINEPHRINE 2 to 10 mcg/min
TACHYCARDIA
 FOR
TACHYCARDIA
 Tachycardia

CARDIOVERSION
Unstable Tachycardia
Sign & symptoms :
Hypotension
Acutely altered mental Consider of giving
status adenosine, if
regular narrow
Signs of shock complex
Ischemic chest discomfort
First dose :
Acute heart failure 6 mg rapid IV push;
ADENOSINE follow with NS flush

Second dose :
12 mg if required
Tachycardia
Stable Tachycardia

If QRS 0.12 second (wide) If QRS is not wide

Consider : - Vagal maneuvers

- Adenosine only if regular &
monomorphic
First dose: 6 mg rapid IV push; follow
with NS flush
Second dose: 12 mg if required
- Adenosine (if regular)
- Blocker or calcium channel
blocker

- Consider antiarrhytmic infusion

First dose: 150 mg over 10 minutes
Repeat as needed if VT recurs.
Follow by maintenance infusion of
1 mg/min for first 6 hours
 Medications for
Acute Coronary Syndromes
MONA

Oxygen
Start at 4 LPM and Titrate to
maintain O2 saturation <94%
 MONA
Aspirin 160mg 325 mg (absorbed better if
chewed)
- Aspirin (non-enteric coated) should be administered
to ALL patients suspected of acute coronary
syndromes, unless there is a true aspirin allergy or
recent GI bleed.
MONA
Nitroglycerin
Dosage:

SL 0.4mg tab q5min x 3

Strong Cautions:
Right Ventricular infarct
Phosphodiestrace inhibitors in last 24-48 hours
MONA

Morphine
Chest pain unresponsive to nitrates
Dosage:
2-4 mg repeat PRN
-
Side Effects: respiratory depression BP
USE of PCI

PCI is treatment of choice when it can be

performed < 90 minutes door to balloon time
PCI is treatment of choice If facility not capable
of PCI, but transfer to PCI facility can still
accomplish door to balloon time of < 90
minutes
 Fibrinolytic Therapy

Breaks up the fibrin network that binds clots together

Indications: ST elevation >1 mm in 2 or more contiguous

leads or new LBBB or new BBB that obscures ST
Time of symptom onset must be <12 hours
Caution: fibrinolytics can cause death from brain
Adjunctive Treatments

IV Nitroglycerin
Heparin
Clopidogrel (Plavix)
Beta Blockers
ACE Inhibitors
Statin Therapies
Medications for
Stroke
 Fibrinolytic Therapy
Breaks up the fibrin network that binds clots together

Indications: Stroke symptoms > 1hour with normal CT

Scan
Time of symptom onset must be < 3 hours (now 4
)
Caution: fibrinolytics can cause death from brain
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