MEDICATIONS IN ACLS

ACLS protocols rely on critical medications to manage cardiac arrest, arrhythmias, and hemodynamic instability. These drugs help restore circulation, stabilize heart rhythms, and improve perfusion during life-threatening emergencies.

Why It’s Important:
ACLS medications support high-quality CPR and defibrillation.
Proper administration improves survival in cardiac arrest and critical arrhythmias.
Understanding drug mechanisms, dosages, and indications is crucial for effective resuscitation.

 

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KEY ACLS MEDICATIONS & THEIR USES

1. Epinephrine (First-Line Cardiac Arrest Drug)

Class: Sympathomimetic (Adrenergic Agonist)
Indication:
Cardiac Arrest (VF, Pulseless VT, Asystole, PEA)
Bradycardia (if unresponsive to atropine & pacing)
Anaphylaxis & Severe Hypotension

Dose:

• Cardiac Arrest: 1 mg IV/IO every 3-5 min (No Max Dose).
• Bradycardia/Hypotension: 2-10 mcg/min IV infusion (Titrate to BP).

Effects:
Increases heart rate (chronotropic effect).
Strengthens cardiac contractions (inotropic effect).
Vasoconstricts to improve coronary and cerebral perfusion.

Key Takeaway: Epinephrine is essential for ALL cardiac arrest rhythms! Administer ASAP.

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2. Amiodarone (First-Line Antiarrhythmic for VF/pVT)

Class: Class III Antiarrhythmic
Indication:
Shock-refractory VF/pulseless VT (after defibrillation & epinephrine).
Stable Wide-Complex Tachycardia (VT with pulse).

Dose:

• Cardiac Arrest (VF/pVT): 300 mg IV bolus → 150 mg IV if needed.
• VT with Pulse: 150 mg IV over 10 min, then 1 mg/min infusion.

Effects:
Suppresses ventricular arrhythmias.
Prolongs the QT interval (slows repolarization).
Reduces ectopic electrical activity.

Key Takeaway: Amiodarone is the preferred antiarrhythmic for shock-resistant VF/pVT.

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3. Lidocaine (Alternative to Amiodarone)

Class: Class 1B Antiarrhythmic
Indication:
Alternative for VF/pVT if Amiodarone is unavailable.
Stable Wide-Complex Tachycardia (VT).

Dose:

• Cardiac Arrest (VF/pVT): 1-1.5 mg/kg IV bolus → Repeat 0.5-0.75 mg/kg every 5-10 min (Max: 3 mg/kg).
• VT with Pulse: 1-1.5 mg/kg IV, then infusion 1-4 mg/min.

Effects:
Suppresses ventricular ectopy and reentry rhythms.
Reduces automaticity of ectopic pacemakers.

Key Takeaway: Use Lidocaine ONLY if Amiodarone is unavailable or contraindicated.

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4. Atropine (First-Line for Symptomatic Bradycardia)

Class: Anticholinergic
Indication:
Symptomatic Bradycardia (HR <50 bpm + symptoms).

Dose:

• Bradycardia: 0.5 mg IV every 3-5 min (Max: 3 mg).

Effects:
Blocks vagal stimulation (increases HR).
Improves cardiac output by raising HR.

Key Takeaway: Atropine is NOT effective for high-degree AV blocks (Use pacing instead).

 

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OTHER ACLS MEDICATIONS FOR SPECIFIC SCENARIOS

5. Adenosine (First-Line for SVT)

Class: Antiarrhythmic (Purine Nucleotide)
Indication:
Supraventricular Tachycardia (SVT).

Dose:

• Initial: 6 mg IV rapid push → If ineffective, 12 mg IV.
• Follow each dose with a 20 mL saline flush.

Effects:
Temporarily stops AV nodal conduction (brief asystole may occur).
Resets supraventricular tachycardia.

Key Takeaway: Adenosine works FAST—warn the patient about a brief “impending doom” feeling!

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6. Magnesium Sulfate (For Torsades de Pointes & Hypomagnesemia)

Class: Electrolyte Replacement
Indication:
Torsades de Pointes (Polymorphic VT with Prolonged QT).

Dose:

• Torsades: 1-2 g IV diluted over 15 min.

Effects:
Stabilizes cardiac membranes and prevents arrhythmias.

Key Takeaway: Magnesium is critical in managing Torsades de Pointes!

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7. Sodium Bicarbonate (For Severe Metabolic Acidosis & Toxin Overdose)

Class: Alkalinizing Agent
Indication:
Severe metabolic acidosis (e.g., DKA, cardiac arrest with acidosis).
Tricyclic antidepressant overdose.

Dose:

• 1 mEq/kg IV bolus, repeat if needed.

Effects:
Buffers metabolic acidosis.

Key Takeaway: Routine use in cardiac arrest is NOT recommended—use ONLY if acidosis is confirmed.

 

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ROUTES OF ADMINISTRATION

Preferred Routes:

IV (Intravenous) – First choice for ACLS drugs.
IO (Intraosseous) – Second choice if IV access is unavailable.

Alternative Route (If IV/IO Not Available):

Endotracheal (ET) – Use NAVEL Drugs:

• Naloxone
• Atropine
• Vasopressin (removed from 2020 guidelines)
• Epinephrine
• Lidocaine

Key Takeaway: Use IO if IV access is delayed. ET administration is a last resort!

 

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COMMON MEDICATION ERRORS & HOW TO AVOID THEM

Key Takeaway: Correct dosing and timing of ACLS medications are critical to survival!

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SUMMARY: MASTERING ACLS MEDICATIONS

Epinephrine (1 mg IV every 3-5 min) is the cornerstone of cardiac arrest treatment.
Amiodarone (300 mg IV, then 150 mg) is preferred for shock-resistant VF/pVT.
Atropine (0.5 mg IV) is first-line for symptomatic bradycardia.
Adenosine (6 mg IV push) is used for SVT—administer rapidly!
Magnesium sulfate is essential for Torsades de Pointes.
Sodium Bicarbonate should NOT be used routinely in cardiac arrest.
IV is the preferred route; IO is the backup; ET is a last resort.

Takeaway: Understanding ACLS medications, their indications, and proper administration improves survival rates and ensures effective resuscitation!