Adult ACLS Medications

Question 1

Cardiac Arrest: VF/VT Arrest - What Antiarrhythmics are used?

Answer 1

1. Amiodarone
2. Lidocaine

Question 2

Cardiac VF/VT Arrest: Amiodarone dosing?

Answer 2

1st Dose: 300mg IV/IO push (after 3rd shock)

2nd Dose: 150mg IV/IO (5-10min later)

• Caution use in TCA or Sodium Channel Blocker overdose-related cardiac arrest (think Mag Sulph use = BCEHS CPG)

Question 3

Cardiac VF/VT Arrest: Lidocaine dosing?

Answer 3

1st Dose: 1-1.5mg/kg IV/IO push (after 3rd shock)

2nd Dose: 0.5-0.75mg/kg IV/IO (5-10 min later) (1/2 the initial dose)

Question 4

Adult Bradycardia: What are the medication/intervention priorities?

Answer 4

1. Atropine
2. Transcutaneous Pacing
3. Dopamine Infusion
4. Epi Infusion
   5 Expert consultation (if above refractory)
5. Transvenous Pacing

Question 5

Symptomatic Bradycardia: Atropine Dosing?

Answer 5

1st Dose: 1mg bolus, repeat Q3-5 min (max 3 mg)

• If underdose or give it slow = causes reflex bradycardia

MOA:

Question 6

Symptomatic Bradycardia: Transcutaneous Pacing?

Answer 6

• It time allows = PSA (ketamine) = pain mgmt
• Set demand rate = 80/min
  *Set mA current = until feel mechanical capture at femoral & see pacing capture spikes prior to each QRS (QRS will widen)

Indications:
- unstable Brady <50/min with S/s CHADS (CP, hypotension, Acute P edema, ALOC, S/s shock)
Brady in presence of MI (SAN/AVN dysfunction, 2* type 2 HB, 3* HB, new LBBB or RBBB or alternating BBB or bifasicular block)
- VEB in Brady rate

Contraindications:
- Agonal rhythms or cardiac arrest

Question 7

Symptomatic Bradycardia: Dopamine Infusion Dosing?

Answer 7

5-20 mcg/min
(Titrate to desired response/taper slow)

• Also used for hypotension in shock
• Must correct hypopvolemia with volume replacement prior to dopamine use
  caution in cardiogenic shock with CHF
  Can cause tachyarrhythmias or excessive vasoconstriction
  DO NOT MIX WITH BICARB
• Not for use in paediatrics

Question 8

Symptomatic Bradycardia: EPI Infusion Dosing?

Answer 8

2-10mcg/min infusion
(titrate to response)

Question 9

Pulse: NCT medications & interventions?

Answer 9

Stable:
1. Vagal maneuver (if regular rhythm)
2. Adenosine (if regular rhythm)
- 1st Dose: 6mg IV followed by 20cc flush
- 2nd Dose: 12mg IV PRN
3. BB or CCB
4. Expert consultation

Unstable:
1. Synchronized Cardioversion (consider sedation)
or
2. Adenosine - if narrow/regular (same dosing)

Question 10

Pulse: WCT medications & Interventions (STABLE)

Answer 10

Stable & Wide: Consider any of these

1. Adenosine (only if reg/monomorphic)
   
   • 1st Dose: 6mg IV followed by 20cc flush
   • 2nd Dose: 12mg IV PRN
2. Procainamide Infusion:
   
   • 20-50mg/min (until arrhythmia stops or hypotension, or ECG shortens width by 50%
   • max dose: 17mg/kg
   • Maintenance infusion: 1-4mg/min
   • Avoid if long QTI or CHF
3. Amiodarone Infusion:
   
   • 1st dose: 150mg in 10min
   • Repeat as needed if VT recurs
   • Maintenance infusion: 1mg/min for 1st 6hr
4. Expert Consultation

Question 11

Pulse: WCT medications & Interventions (UNSTABLE)

Answer 11

Unstable:
- CHADS, monomorphic/reg or polymorphic/irreg = all electrical interventions
* typically HR +150/min = immediate cardioversion (< 150 = Rx might be approp).

1. Consider sedation
2. Narrow/reg/monomorphic = synchronized cardioversion
3. narrow/irreg = synchronized cardioversion
4. wide/reg/mono = synchronized cardioversion
5. wide/poly/irreg = defibrillation (200j)