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More Code Drugs Drug Indication Adult Dosage Adenosine Narrow Complex Paroxysmal Supraventricular Tachycardia (PSVT) With patient in reverse Trendelenburg position: Initial bolus of 6mg rapidly over 1-3 seconds, followed by 20ml normal saline, then elevate the extremity Repeat dose of 12mg in 1-2 minutes if needed A third dose of 12mg may be given in 1-2 minutes if needed Calcium Chloride Known or suspected hypercalcemia; hypocalcemia; antidote for calcium channel blocker or B-adrenergic blocker overdose; Prophylactically before IV calcium channel blockers to prevent hypotension Hyperkalemia, calcium channel blocker overdose, or IV prophylaxis before calcium channel blocker: Slow IV push of 500-1000 mg/kg (5-10ml of a 10% solution). Dopamine Symptomatic Bradycardia (after atropine) Hypotension(SBP<70-100 mmHg)with s/s shock See IV Drips section below Levophed Hypotension SBP <70 with S/S shock See IV Drips section below Lidocaine Ventricular Fibrillation (VF) Pulseless electrical Activity (PEA) Stable Ventricular Tachycardia (VT) Cardiac Arrest from VF/VT: Initial dose:1-1.5mg/kg IV. For refractory VF may give additional 0.5- 0.75mg/kg IV, repeat in 5-10 minutes (max dose of 3mg/kg). Single dose of 1.5mg/kg IV ETT: 2-4mg/kg (Also see IV Drips) Magnesium Sulfate For use in cardiac arrest only if Torsades De Pointes or suspected hypomagnesemia is present Cardiac arrest for torsades de pointes or hypomagnesemia: 1-2g (2-4ml of 50% solution) diluted in 10ml of D5W IV over 5 – 20 min. Non-cardiac arrest with Torsade de pointes:Loading dose of 1-2g mixed in 50-100ml of D5W over 5-60 minutes. Follow with 0.5-1g/h IV (titrate to control the torsades) Nitroglycerin Suspected ischemic pain or MI IV infusion: 10-20mcg/min. Increase by 5 – 10 mcg/min every 5 – 10 minutes until desired response. Onset of actions 1-2 minutes Sublingual: 1 tablet (0.3-0.4mg) x3 at 5 minute intervals(Also see IV Drips) Oxygen Suspected ischemic chest pain 4 lpm per nc for uncomplicated MI; 100% oxygen during resuscitation. Drug Indication Adult Dosage Procainamide VF, Pulseless VT, may use for treatment of PSVT uncontrolled by adenosine/vagal maneuvers if BP is stable, stable wide complex tachycardia of unknown origin, atrial fibrillation with rapid rate in WPW syndrome Recurrent VF/VT: 20mg/min IV infusion (max total dose: 17mg/kg). Also see IV Drips section Vasopressin VF, pulseless VT 40 units IV single dose. May be used as an alternative pressor to epinephrine for the 1st or 2nd dose. Epinephrine may be administer 10 minutes after vasopressin Verapamil Alternative drug (after adenosine) to terminate Paroxysmal Supraventricular Tachycardia (PSVT) May control ventricular response in patients with atrial fib, atrial flutter, and multipfocal atrial tachycardia. IV infusion: Initial: 2.5-5mg IV bolus over 2 minutes Second dose: 5-10mg if needed in 15-30 minutes. Max dose:20 mg ACLS Medication IV Drips Drug Concentration/Indication Adult Dosage Dopamine (Intropin) Mix as: 800mg dopamine in 250cc D5W Concentration: 3200mcg/ml Indications: Hypotension that occurs with symptomatic bradycardia Hypotension that occurs after return of spontaneous circulation Cardiogenic shock. May be used in bradycardia to increase HR. 2 – 20 mcg/kg/min and titrate to patients response. Lidocaine (Xylocaine) Mix as: 2 grams of Lidocaine in 500 cc D5W Concentration: 4mg/ml Indications: Significant ventricular ectopy (runs of VT, R on T, frequent or multiform PVc’s) seen in the setting of AMI or ischemia VT/VF that persists after defibrillation and administration of epinephrine VT with pulse Wide complex tachycardia of uncertain origin Maintenance infusion: 1-4mg/min (20-50mcg/kg per minute) Infusion rates: 15cc/hr=60mg/hr=1mg/min 30cc/hr=120mg/hr=2mg/min 45cc/hr=180mg/hr=3mg/min 60cc/hr=240mg/hr=4mg/min Norepinephrine (Levophed) Mix as: 8 mg Norepinephrine in 250cc D5W Concentration: 32mcg/ml Indications: Treatment of profound hypotension unresponsive to volume loading & dopamine IV Infusion only: 0.5-1mcg/min titrated to improve BP up to 30mcg/mi . Procainamide Mix as: 1 gram Procainamide in 250cc D5W Or 2 grams Procainamide in 500 cc D5W Concentration: 4mg/ml Indications: Treatment of ventricular arrythmias Recurrent VF/VT: 20mg/min IV infusion (max total dose of 17mg/kg). Administer at 20mg/min until one of the following occurs: Arrhythmia suppression Hypotension QRS widens by >50% Total dose of 17mg/kg is given Maintenance Infusion: 1-4mg/min Renal or cardiac dysfunction: Max total dose: 12 mg/kg. Infusion Rates: 15cc/hr=60mg/hr=1mg/min Tracheal Administration of Resuscitation Medications Certain medications can be administered via the tracheal tube if unable to obtain intravenous access. Tracheal doses of medications should be 2 to 4 times higher than the intravenous route. Resuscitation medications that can be given via tracheal tube are the “ALE” drugs. Medication Tracheal Administration Atropine 2 to 3 mg diluted in 10 ml normal saline Lidocaine 2 to 4 mg/kg Epinephrine 2 to 2.5 mg diluted in 10ml normal saline Recommended Technique for Tracheal Drug Administration Prepare medication according to tracheal administration guidelines Stop chest compressions and inject the medication via the ETT Flush the ETT with 10 ml of normal saline when indicated Immediately attach the ventilation bag to the tracheal tube and ventilate forcefully 3 to 4 times to circulate the drug.