ACLS Guidelines

“ During cardiac arrest drug

intervention is secondary only
to other interventions”
 Intravenous Access

Central Line: Peripheral Line:

-Subclavian Vein -Antecubital Vein
- Internal Jugular Vein - External Jugular Vein
-Needs interruption -NO interruption
-Increase peak conc -Slow conc peaks
-Complications -Less complications
 Peripheral IV Site

Administer drugs by Bolus

20 cc of saline or distilled water

Elevate the extremity for 10 to

20 seconds
 Tracheal Drug Administration

-Epinephrine, lidocaine and atropine

(Diluted in 10ml NSS or Distilled H2O)

- Administer 2 – 2.5x the recommended

IV dose
 Pharmacology

Agents used to Agents used

optimize to treat
cardiac Output Arrhythmias
and Blood
Pressure
Agents used to Optimize Cardiac Output and Blood pressure

3 Dimensions of the Cardiovascular

System
- Peripheral Vascular tone
- Inotrophic state of the heart
- Chronotrophic state of the heart
Agents used to Optimize Cardiac Output and Blood pressure

•Acute Ischemic
heart disease
Clinically used in: •Acute & Chronic
Heart Failure
•Shock
•Cardiac Arrest
 EPINEPHRINE
(Adrenalin); Adrenergic Agonist

INDICATION:
-respiratory distress due to bronchospasm, to provide
rapid relief of hypersensitivity reactions to drugs and other
allergens, and to prolong the action of infiltration
anesthetics. Its cardiac effects may be of use in restoring
cardiac rhythm in cardiac arrest.

DOSAGE:
Cardiac Arrest: 1 mg IV of 1:10,000 solution q 3-5 min
(double dose if via ET)
Anaphylaxis: 0.1-1 mg SQ or IM of 1:10,ooo solution
 NOREPINEPHRINE
 - Naturally occurring potent vasoconstrictor
and inotrophic agent
 Usually induces renal and splancnic
vasoconstrictor

INDICATION:
-Severe hypotension ( SBP <70mmHg)
-Low total peripheral resistance

DOSAGE: 0.5 -1.0mcg/min

 DOBUTAMINE

(Dobutrex); Inotropic

INDICATION:
-short term treatment of cardiac
decompensation in organic heart disease,
long term treatment of congestive heart
failure
 DOBUTAMINE
DOSAGE:
• diluted in an IV container to at least a 50 mL solution
using one of the following intravenous solutions as a
diluent: D5W, D5LR, .45% NaCL, 0.9% Sodium Chloride,
10% Dextrose Injection, PLR, D5LR

•Intravenous solutions should be used within 24 hours.

•Infusion of dobutamine should be started at a low rate (0.5

to 1.0 mcg/kg/min) and titrated at intervals of a few
minutes, guided by systemic blood pressure, urine flow,
frequency of ectopic activity, heart rate and measurements
of cardiac output.
 DOPAMINE
(Dopamine Hydrochloride); Vasopressor, Inotropic

INDICATION:
-correction of hemodynamic imbalances present in the
cardiogenic shock syndrome due to myocardial infarctions,
trauma, endotoxic septicemia, open heart surgery, renal
failure, and chronic cardiac decompensation as in
congestive failure.

DOSAGE:
diluted in an IV container to at least a 250 mL or 500ml
solution using one of the following intravenous solutions as
a diluent: D5W, D5LR, .45% NaCL, 0.9%
 DOPAMINE
DOSAGE:
-Begin administration of diluted solution at doses
of 2-5 mcg/kg/minute Dopamine in patients who
are likely to respond to modest increments of
heart force and renal perfusion.

-Seriously ill patients, begin at diluted solution at

doses of 5 mcg/kg/minute Dopamine
- increase gradually, using 5 to 10 mcg/kg/minute
increments, up to 20 to 50 mcg/kg/minute as
needed.
 Antiarrhythmic Drugs
Amiodarone

INDICATION:
-Treatment in Atrial & Ventricular arrhythmias
-Ventricular rate control in Rapid atrail arrhthmias
-After defibrillaion and Epinephrine in CA w/
persistent VT/VF
-Adjunct in electrical cardioversion in refractory
PSVT’s, AT & pharmacologic cardioversion of AF

Side Effects: Hypotension and Bradycardia

 Amiodarone

DOSAGE:
150mg IV over 10mins followed
by 1mg/kg/min infusion for 6H
and then 0.5mg/kg/min
 DIGOXIN

(Lanoxin); Cardiac Glycoside, Inotropic,

Antidysrhythmic

INDICATION:
-V-fib, V-flutter, CHF, pulmonary edema,
alternative treatment for PSVT

DOSAGE:
-Loading dose of 10-15 ug/kg
 ATROPINE
Anticholinergic

INDICATION:
- sinus bradycardia, asystole,
organophosphate and neurotoxin (nerve gas)
exposure, antidote to cholinergic drug
toxicity, mushroom poisoning
 ATROPINE
DOSAGE:
Bradycardia: 0.5-1 mg IV (ET tube at double dose)
q 3-5 min (max: 0.04mg/kg)

Cardiac Arrest: 1 mg q 3-5 min (max: 0.04mg/kg)

A total dose of 3mg (0.04mg/kg) results infull
vagal blockade in human

Nerve Gas/Organophosphate Exposure: 2-6 mg IV

or IM depending on severity, may repeat in 2 mg
increments q 3 min titrated to relief of symptoms.
 DEXTROSE 50%

(D50W); Caloric Agent

INDICATION:
-Documented hypoglycemia
-Seizures of unknown etiology
-Cerebral/meningeal edema related to eclampsia

DOSAGE:
Preparation: 25 g/50 ml preload (D50W)
Adult: 12.5 - 25 gm D50W slow IV, repeat PRN
 DIAZEPAM
Benzodiazepine; Anti-anxiety Agent

INDICATION:
- status epilepticus
-severe recurrent convulsive seizures;
-symptomatic relief of acute agitation, tremor,
-impending or acute delirium tremens and hallucinosis;
-skeletal muscle spasm due to reflex spasm to local pathology;
-treat pain resulting from muscle spasms caused by various
dystonias;
-tetanus
 DIAZEPAM

DOSAGE:
• Dosage should be individualized for
maximum beneficial effect.

• The usual recommended dose in older

children and adults ranges from 2 mg to 20 mg
I.M. or I.V., depending on the indication and its
severity.