Adenosine (Dose)
6 mg IV bolus, may repeat with 12 mg in 1 to 2 min.
Adenosine (Use)
Narrow PSVT/SVT
Wide QRS tachycardia, avoid adenosine in irregular wide QRS
Adenosine (Special Considerations)
RAPID IV push close to the hub, followed by a saline bolus
Continuous cardiac monitoring during administration
Causes flushing and chest heaviness
Amiodarone (Use)
VF/pulseless VT
VT with pulse
Tachycardia rate control
Amiodarone (Dose, VF/pulseless VT)
300mg dilute in 20 to 30ml., may repeat 150mg every 3 to 5 minutes
Amiodarone (Dose, Stable VT with a pulse)
150mg bolus followed by amiodarone drip (300 mg should only be used in a code situation)
Amiodarone (Special Considerations)
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 (Use)
Symptomatic bradycardia
Specific Toxins/overdose (e.g. organophosphates)
Atropine (Dose, Symptomatic bradycardia)
0.5 mg IV/IO every 3 to 5 minutes
MAX DOSE: 3 mg
Atropine (Dose, Specific toxins/OD)
2 to 4 mg IV/IO may be needed
Atropine (Special Considerations)
Cardiac and BP monitoring
Do not use in glaucoma or tachyarrhythmias
Minimum dose 0.5 mg
Dopamine (Use)
Shock/CHF
Dopamine (Dose)
2 to 20 mcg/kg/min
Titrate to desired blood pressure
Dopamine (Special Considerations)
Fluid resuscitation first
Cardiac and BP monitoring
Epinephrine (Use)
Cardiac arrest
Anaphylaxis
Symptomatic bradycardia/shock
Epinephrine (Dose, Cardiac Arrest)
Initial: 1.0 mg (1:10000) IV or 2 to 2.5 mg (1:1000)
Maintain: 0.1 to 0.5 mcg/kg/min Titrate to desire blood pressure
Epinephrine (Dose, Anaphylaxis)
0.3-0.5 mg IM
Repeat every 5 mins as needed
Epinephrine (Dose, Symptomatic bradycardia/shock)
2 to 10 mcg/min infusion
Titrate to response
Epinephrine (Special Considerations)
Continuous cardiac monitoring
NOTE: Distinguish between 1:1000 and 1:10000 concentrations
Give via central line when possible
Lidocaine (Use)
Cardiac Arrest (VF/VT)
Wide Complex Tachycardia with Pulse
Recommended when Amiodarone is not available
Lidocaine (Dose, Cardiac arrest)
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
Lidocaine (Dose, Wide complex tachy 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
Lidocaine (Special Considerations)
Cardiac and BP monitoring
Rapid bolus can cause hypotension and bradycardia
Use with caution in renal failure
Magnesium sulfate (Use)
Cardiac Arrest/pulseless Torsades
Torsades de Pointes with pulse
Magnesium sulfate (Dose, cardiac arrest/pulseless Torsades)
Cardiac Arrest: 1 to 2 gm diluted in 10 mL D5W IVP
Magnesium sulfate (Dose, 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
Magnesium sulfate (Special Considerations)
Cardiac and BP monitoring
Rapid bolus can cause hypotension and bradycardia
Use with caution in renal failure
Calcium chloride can reverse hypermagnesemia
Procainamide (Use)
Wide QRS Tachycardia
Preferred for VT with pulse (stable)
Procainamide (Dose)
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
Procainamide (Special Considerations)
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 (Use)
Tachyarrhythmia
Monomorphic VT
3rd line anti-arrhythmic
Sotalol (Dose)
100 mg (1.5 mg/kg) IV over 5 min
Sotalol (Special Considerations)
Do not use in prolonged QT