Advanced Cardiac Life Support (ACLS) Course
ACLS Introduction
The Initial Assessment
ACLS Basic Life Support
Advanced Cardiac Life Support
Principles of Early Defibrillation
Systems of Care
ACLS Cases
ACLS Essentials
ACLS Skills Training
ACLS Exam

Pharmacological Tools

Use of any of the ACLS medication in Table 1 should be done within your scope of practice and after a thorough study of the actions and side effects. This table only provides a brief reminder for those who are already knowledgeable in the use of these medications. Moreover, the tablet contains only adult doses, indications, and routes of administration for the most common ACLS drugs.

Table 1: Doses, Routes, and Uses of Common Drugs

DRUGMAIN ACLS USEDOSE/ROUTENOTES
Adenosine
  • Narrow PSVT/SVT
  • Wide QRS tachycardia, avoid adenosine in irregular wide QRS
  • 6 mg IV bolus, may repeat with 12 mg in 1 to 2 min.
  • Rapid IV push close to the hub, followed by a saline bolusC
  • ontinuous cardiac monitoring during administration
  • Causes flushing and chest heaviness
  • Ideally, use a 3mL syringe, 3-way stopcock,
    and a 10mL flush to administer the adenosine
    efficiently
Amiodarone
  • VF/pulseless VT
  • VT with pulse
  • Tachycardia, rate control
  • Conscious VT/VF: 150mg over 10 minutes,
    followed by a drip
  • Unconscious VF/VT: 300mg, add 150 mg if not
    effective
  • Max dose: 450mg
  • Anticipate hypotension, bradycardia, and gastrointestinal toxicity
  • Continuous cardiac monitoring
  • Very long half-life (up to 40 days)
  • Do not use in 2nd or
    3rd-degree heart block
  • Do not administer via the ET tube route
Atropine
  • Symptomatic Bradycardia
  • 1 mg IV/IO
  • Max Dose: 3 mg
  • Cardiac and BP monitoring
  • Do not use in glaucoma or tachyarrhythmias
  • Minimum dose 0.5 mg
  • Specific Toxins/overdose (e.g. organophosphates)
  • 2 to 4 mg IV/IO may be needed
Dopamine
  • Shock/CHF
  • 5 to 20 mcg/kg/min
  • Titrate to desired blood pressure and/or
    desired heart rate
  • Max dose: 20mg
  • Fluid resuscitation first
  • Cardiac and BP monitoring
Epinephrine
  • Cardiac Arrest
  • 1.0 mg (1:10,000) IV/IO or 1 ampule (1:1,000) in
    10ml of normal saline
  • Maintain: 0.1 to 0.5 mcg/kg/min Titrate to
    desired blood pressure
  • Continuous cardiac monitoringe
  • NOTE: Distinguish between 1:1,000 and 1:10,000 concentrations
  • Give via central line when possible
  • Anaphylaxis
  • 0.3-0.5 mg IM
  • Repeat every 5 mins as needed
  • Symptomatic bradycardia/Shock
  • 2 to 10 mcg/min infusion
  • Titrate to response
Lidocaine
(Lidocaine is recommended when Amiodarone is not available)
  • Cardiac Arrest (VF/VT)
  • Initial: 1 to 1.5 mg/kg IV loading
  • Second: Half of first dose in 5 to 10 min
  • Maintain: 1 to 4 mg/min
  • Cardiac and BP monitoring
  • Rapid bolus can cause hypotension
    and bradycardia
  • Use with caution in renal failure
  • Wide Complex Tachycardia with Pulse
  • Initial: 0.5 to 1.5 mg/kg IV
  • Second: Half of first dose in 5 to 10 min
  • Maintain: 1 to 4 mg/min
Magnesium Sulfate
  • Cardiac Arrest/pulseless Torsades
  • Cardiac Arrest: 1 to 2 gm diluted in 10 mL D5W IVP
  • Cardiac and BP monitoring
  • Rapid bolus can cause hypotension and bradycardia
  • Use with caution in renal failure
  • Calcium chloride can reverse hypermagnesemia
  • Torsades de Pointes with pulse
  • If not Cardiac Arrest: 1 to 2 gm IV over
    5 to 60 min
  • Maintain: 0.5 to 1 gm/hr IV
Procainamide
  • Wide QRS Tachycardia
  • Preferred for VT with pulse (stable)
  • 20 to 50 mg/min IV until rhythm improves, hypotension occurs, QRS widens by 50%, or MAX dose is given
  • MAX dose: 17 mg/kg
  • Drip = 1 to 2 gm in 250 to 500 mL at 1 to 4 mg/min
  • Cardiac and BP monitoring
  • Caution with acute MI
  • May reduce dose with renal failure
  • Do not give with amiodarone
  • Do not use in prolonged QT or CHF
Sotalol
  • Tachyarrhythmia
  • Monomorphic VT
  • 3rd line anti-arrhythmic
  • 100 mg (1.5 mg/kg) IV over 5 min
  • Do not use in prolonged QT

⟵ Previous Lesson
Next Lesson ⟶