The administration of resuscitation medications and observations regarding their effects and side effects often lead to different guidelines for the types, doses, and uses of medication.
For instance, vasopressin was removed from the ACLS algorithm in 2015. Therefore, it is vital that emergency medical responders remain up to date on the procedures for treating victims with medication during resuscitation.
Furthermore, each member of the resuscitation team needs to be familiar with the drugs that are most used for emergencies, which are listed in Table 8. The uses and doses are in accordance with the AHA recommendations.
“These medications should only be administered by licensed and experienced medical professionals.”
| Drug | Section | Details |
|---|---|---|
| Adenosine | Type of Drug | Antiarrhythmic agent |
| Uses | Supraventricular tachycardia (SVT)AV reentrant tachycardia (AVRT) AV nodal reentrant tachycardia (AVNRT) arrhythmias Atrial tachycardia | |
| Recommended Dosage | 1st dose – Administer 6 mg IV/IO rapidly over 1-3 seconds followed by 20 ml of NS through rapid IV/IO 2nd dose – If the victim still demonstrates an SVT rhythm after 1-2 minutes administer 12 mg IV/IO rapidly over 1-3 seconds followed by 20 ml of NS through rapid IV/IO A lower dose of 3mg may be administered to victims that take dipyridamole, carbamazepine, or have a history of a heart transplant | |
| Side Effects | Chest pain, headache, shortness of breath, dizziness, worsening dysrhythmia, hypotension, diaphoresis, nausea, metallic taste in the mouth, sweating, facial flushing | |
| Other Notes | Cardiac monitoring should be performed during the administration Administer intravenously (IV) or through intraosseous (IO) infusion. Doses should be followed by a rapid flush as fast as possible. Do not use if there is a 2nd or 3rd degree heart block | |
| Amiodarone | Type of Drug | Antiarrhythmic Class 3 drug |
| Uses | Cardiac arrest resulting from ventricular fibrillation (VF) Ventricular tachycardia (VT) with pulse VT without pulse and the victim is unresponsive to shock Stable supraventricular tachycardia Atrial Fibrillation | |
| Recommended Dosage | For VF and VT without a pulse: Administer a 300 mg IV/IO push; If the arrhythmia returns or persists, administer one additional bolus of 150 mg IV/IO 3-5 minutes after giving the initial dose. After treating the arrhythmia, an infusion of amiodarone can be administered at a rate of 1mg/min over 6 hours followed by a 0.5mg/min infusion over 18 hours. For Stable supraventricular tachycardia with a pulse: Administer 150 mg IV over 10 minutes; If the arrhythmia returns or persists, repeat the bolus. This should be followed by a maintenance infusion of 1mg/min over 6 hours with a maximum dose of 2.2 g being given during a 24-hour period. | |
| Side Effects | Hypotension, interstitial lung disease (pulmonary fibrosis), hypothyroidism (Wolff-Chaikoff effect), hyperthyroidism (Jod-Basedow effect), corneal micro-deposits, optic neuropathy, bilateral optic disc swelling, reversible visual field defects, Headache, dizziness, tremors, ataxia; syncope, significant hypotension, bradycardia, torsades de pointes, nausea, vomiting, diarrhea, rash, skin discoloration, hair loss, flushing, coagulation abnormalities, liver enzyme changes, jaundice, hepatomegaly, hepatitis, cirrhosis, skin sensitivity to light, peripheral neuropathy, epididymitis, gynecomastia, increased risk of cancer | |
| Other Notes | Monitor ECG and BP Use with caution in patients with a perfusing rhythm or hepatic failure Do not use if there is a 2nd or 3rd degree heart block | |
| Atropine | Type of Drug | Antimuscarinic (anticholinergic) medication |
| Uses | Pulseless electrical activity (PEA) Cardiac arrest Asystole Bradycardia (HR< 60bpm) Toxic poisonings and overdoses | |
| Recommended Dosage | For bradycardia: Administer 0.5 mg IV/IO every 3-5 minutes with a maximum dose of 3 mg (6 doses) For toxin poisoning or overdose: Administer 2-4 mg as needed until the symptoms reverse | |
| Side 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 | |
| Other Notes | Monitor ECG, oxygen, and BP; Administer before intubation if bradycardia is present; Contraindicated in glaucoma and tachyarrhythmias Doses lower than 0.5 mg should not be administered as it may worsen bradycardia | |
| Dopamine | Type of Drug | Catecholamine vasopressor, inotrope |
| Uses | For symptomatic bradycardia: Can be administered for bradycardia after atropine For severe hypotension: can be administered for Systolic BP | |
| Recommended Dosage | Administer 5 to 20 mcg/kg/ per minute IV/IO with the infusion titrated to the victim’s response | |
| Side Effects | Headache, dyspnea, palpitations, PVCs, SVT, VT, nausea/ vomiting, acute renal failure, doses above 10μg/kg per minute can cause systemic and splanchnic vasoconstriction, administer higher doses with caution as a decrease in splanchic perfusion may have detrimental effects | |
| Other Notes | Monitor ECG and BP If the victim is hypovolemic, administer fluid boluses first and avoid high infusion rates Do not mix with alkaline solutions or sodium bicarbonate | |
| Epinephrine | Type of Drug | Catecholamine vasopressor, Inotrope |
| Uses | Cardiac arrest (Asystole) Anaphylaxis Symptomatic bradycardia after atropine Shock when atropine and pacing are ineffective Pulseless Ventricular Tachycardia (pVT)Ventricular Fibrillation (VF) Pulseless Electrical Activity (PEA) | |
| Recommended Dosage | For cardiac arrest: Administer 1.0 mg (1:10000) IV or 2-2.5 mg (1:1000) per ET tube every 3-5 minutes; follow by a 0.1‑0.5 mcg/kg per minute infusion titrated to the victim’s response For pVT, VF, Asystole, and PEA: Administer 1 mg IV/IO every 3-5 minutes or administer 2 mg in 10 ml of NS by ETT For symptomatic bradycardia or shock: Start an infusion of 2-10 mcg/min IV/IO titrating it to the victim’s response | |
| Side Effects | Tremors, anxiety, headaches, dizziness, confusion, SVT, VT, hallucinations, dyspnea, palpitations, chest pain, hypertension, nausea, vomiting, hyperglycemia, hypokalemia, vasoconstriction, tachycardia | |
| Other Notes | It is important to aware of the concentration being used as epinephrine is available in 1:1000 and 1:10000 concentrations Monitor oxygen, BP, and ECG Administer through a central line if possible, in order to avoid the risk of tissue necrosis Do not administer for cocaine- induced VT | |
| Lidocaine | Type of Drug | Antiarrhythmic Class 1b drug |
| Uses | Refractory Ventricular fibrillation (VF) Pulseless ventricular tachycardia (pVT) Cardiac arrest from VF or VT Wide complex tachycardia Continuous infusion after return of spontaneous circulation (ROSC) from VF/pVT 2nd line agent if amiodarone is unavailable | |
| Recommended Dosage | Cardiac Arrest: 1‑1.5 mg/kg IV/IO bolus; may repeat twice at a half dose every 5-10 minutes to total of 3 mg/kg; followed by a continuous infusion of 1-4 mg per minute Continuous infusion should begin with the post-ROSC from VF/pVT: For wide complex tachycardia with pulse: Administer 0.5-1.5 mg/kg IV; may repeat treatment twice at half dose every 5-10 minutes for a total dose of 3 mg/kg; followed by a continuous infusion of 1‑4 mg per minute | |
| Side Effects | Seizures, heart block, bradycardia, dyspnea, respiratory depression, nausea, vomiting, headache, dizziness, tremor, drowsiness, tinnitus, blurred vision, hypotension, rash, muscle twitching, tingling, confusion | |
| Other Notes | Monitor ECG and BP May cause seizures in some persons Do not administer for wide complex bradycardia Do not administer prophylactically to a victim of acute MI | |
| Magnesium sulfate | Type of Drug | Antiarrhythmic agent Electrolyte Bronchodilator Vasodilator |
| Uses | Torsades de pointes Arrhythmias related to hypomagnesemia Digitalis toxicity | |
| Recommended Dosage | For cardiac arrest due to hypomagnesemia or torsades: Administer 1-2 grams IV/IO bolus over 5-20 minutes; magnesium should be diluted in 50 to 100 ml of D5W For torsades with a pulse: Administer 1-2 grams IV/IO over 5-60 minutes followed by a maintenance infusion of 0.5-1 gram per hour; magnesium should be diluted in 50 to 100 ml of D5W For victims with severe renal impairment, do not administer more than 20 grams in 48 hours. | |
| Side Effects | Confusion, sedation, weakness, respiratory depression/paralysis, hypotension, heart block, bradycardia, cardiac arrest, nausea, vomiting, muscle cramping, flushing, sweating, calcium deficiency, upset stomach, diarrhea, coma | |
| Other Notes | Monitor ECG, oxygen, and BP Rapid bolus may cause hypotension and bradycardia Should be used with caution in victims with a history of renal failure Calcium chloride or gluconate is the antidote for the reversal of hypermagnesemia | |
| Oxygen | Type of Drug | Elemental gas |
| Uses | Respiratory distress or failure Hypoxia Shock Trauma Cardiac arrest | |
| Recommended Dosage | For resuscitation, administer at 100% through a high flow system and titrate to victim’s response to maintain oxygen saturation >94% If the victim has a history of COPD administer oxygen if the pulse ox drops below 90% on room air | |
| Side Effects | Headache, dry nose and/or mouth, possible airway obstruction if secretions become dry | |
| Other Notes | Monitor oxygen saturation Insufficient flow rates may cause carbon dioxide retention |
Torsades de pointes: Magnesium sulphate 2g IV over 10 minutes