ACLS Algorithms Medications
Adenosine
Algorithm(s)
Ventricular tachycardia with a pulse
Dosing in ACLS
First dose: 6 mg IV push followed by saline bolus
Second dose: 12 mg IV push followed by saline bolus
Adverse effects
Headache, dizziness, metallic taste, dyspnea, hypotension, bradycardia or palpitations, nausea, flushing, sweating
Contraindications
Do not use in patients with second or third degree heart block
Clinical Pearls
Warn patients that they may feel strange when the medication is administered
It is best to place the patient in Trendelenburg position (head lowered respective to body/feet)
Administer only when the patient is on a cardiac monitor
Provide via a central line, if possible
The bolus should be given as rapidly as possible
Amiodarone
Algorithm(s)
Ventricular fibrillation (VF)/pulseless ventricular tachycardia (pVT)
Ventricular tachycardia with a pulse
Dosing in ACLS
First dose: 300 mg bolus IV
Second dose: 150 mg bolus IV
Maximum: 2.2 grams over 24 hours
Adverse effects
Headache, dizziness, tremors, ataxia; syncope, significant hypotension, bradycardia, CHF, Torsades de pointes, nausea, vomiting, diarrhea, rash, skin discoloration, hair loss, flushing, coagulation abnormalities
Contraindications
Do not use in patients with second or third degree heart block
Amiodarone interacts with many different drugs
When possible, do not give with other drugs that can prolong the QT interval
Clinical Pearls
Give as a bolus in cardiac arrest, but if drug is administered too rapidly, it can cause hypotension
Atropine
Algorithm(s)
Bradycardia
Dosing in ACLS
0.5 mg IV every 3-5 minutes
Maximum: 3 mg
Adverse effects
Headache, dizziness, confusion, anxiety, flushing, blurred vision, photophobia, pupil dilation, dry mouth, tachycardia, hypotension, hypertension, nausea, vomiting, constipation, urinary retention, painful urination, rash, dry skin
Contraindications
If bradycardia is due to hypothermia, do not give atropine
If you suspect cardiac ischemia, use atropine with caution, if at all
Clinical Pearls
Do not give dose less than 0.5 mg because it could paradoxically slow the heart rate
May give atropine more frequently than every three minutes in dire circumstances
Dopamine
Algorithm(s)
Bradycardia
Dosing in ACLS
IV infusion of 2 to 20 mcg/kg/minute titrated to response
Adverse effects
Headache, dyspnea, palpitations, PVCs, SVT, VT, nausea/ vomiting, acute renal failure
Contraindications
Use with caution in cardiogenic shock with congestive heart failure
Clinical Pearls
Do not mix in alkaline solutions or with sodium bicarbonate
May need to also give fluids if patient is hypovolemic
Should be on cardiac monitor with blood pressure and pulse oximetry
Epinephrine
Algorithm(s)
Asystole/Pulseless electrical activity (PEA)
Ventricular fibrillation (VF)/pulseless ventricular tachycardia (pVT)
Bradycardia
Dosing in ACLS
Cardiac arrest: 1 mg IV every 3 to 5 minutes, follow with 20 ml saline flush
Bradycardia: IV infusion of 2 to 10 mcg/minute titrated to response
Adverse effects
May worsen or cause cardiac ischemia
Tremors, anxiety, headaches, dizziness, confusion, SVT, VT, hallucinations, dyspnea, palpitations, chest pain, hypertension, nausea, vomiting, hyperglycemia, hypokalemia, vasoconstriction
Avoid VT caused by cocaine
Contraindications
There are no absolute contraindications to the use of injectable epinephrine when used properly during ACLS
Clinical Pearls
Can be given through endotracheal tube
Central line administration is preferred, it can cause local skin necrosis at injection site
Generally comes in two concentrations (1:10,000 and 1:1,000) so it is essential to know the proper volume to achieve desired dosage.
Should be on cardiac monitor with blood pressure and pulse oximetry
Lidocaine
Algorithm(s)
Ventricular fibrillation (VF)/pulseless ventricular tachycardia (pVT)
Ventricular tachycardia with a pulse
Dosing in ACLS
VF/pVT: 1 to 1.5 mg/kg IV bolus; may repeat X 2 every 5-10 minutes (half starting dose); maximum of 3 mg/kg; follow with 1 to 4 mg per minute infusion
Wide complex tachycardia with pulse: 0.5 to 0.75 mg/kg IV (up to 1.5 mg/kg); may repeat X 2 every 5-10 minutes (half starting dose); maximum of 3 mg/kg; follow with 1 to 4 mg per minute infusion
Adverse effects
Seizures, heart block, bradycardia, dyspnea, respiratory depression, nausea, vomiting, headache, dizziness, tremor, drowsiness, tinnitus, blurred vision, hypotension, rash
Contraindications
Do not use in wide complex bradycardia
Do not use prophylactically in acute myocardial infarction
Clinical Pearls
Should be on cardiac monitor with blood pressure and pulse oximetry
May cause seizures