6 mg (rapid IV push), Repeat Dose: 12 mg (2)
Stable, Narrow, Complex PSVT
Adenosine Side Effects
Amiodarone Dose: Cardiac Arrest
300 mg, Repeat Dose: 150 mg (1)
Naturally occurring agent that can "chemically cardiovert" PSVT to NSR, Half-life of 10 secs, does not cause hypotension
Adenosine Brand Name and Class
Amiodarone Dose: Ventricular Arrhythmias
150 mg/10 min, put in 100 cc saline, if converts Maintenance Dose: 1mg/min
Amiodarone Brand Name and Class
Cordarone, Pacerone/ Antidysrhythmic
Antidysrhythmic that prolongs duration of AP and refractory period and relaxes smooth muscles, reducing peripheral vascular resistance and increasing coronary blood flow
Life threatening ventricular and supraventricular dysrythmias, frequently atrial fibrillation (V-Fib, Pulseless V-Tach, Hemodynamically unstable V-Tach)
Hypersensitivity, cardiogenic shock, severe sinus bradycardia, or advanced heart block
Hepatic impairment, pregnancy, nursing mothers, children
160-325 mg (PO)
Aspirin inhibits agents that cause the production of inflammation, pain, and fever. It relieves mild to moderate pain by acting on peripheral nervous system, lowers body temperature in fever, and powerfully inhibits platelet of an MI.
Aspirin Brand Names and Class
Acetylsalicylic Acid, Alka-Seltzer, Bayer, Empirin, St. Joseph Children's/ Analgesic, Antipyretic, Platelet Inhibitor, Antiinflammatory
Chest pain suggestive of an MI
Hypersensitivity to salicylates, active ulcer disease, asthma
Allergies to other NSAIDS, bleeding disorders, children or teenagers with varicella or influenza- like symptoms
Atropine Dose: Asystole/PEA
1 mg/3-5 min, Max Dose: 3 mg (every 3-5 mins)
Atropine Dose: Bradycardia
0.5 mg/3-5 min, Max Dose: 3 mg
Atropine Brand Name and Class
Atropine blocks the parasympathetic nervous system, specifically the vagal effects on heart rate. It does not increase contractility but may increase myocardial oxygen demand. Decreases airway secretions
Symptomatic Sinus Bradycardia, Asystole, Bradycardic PEA (HR < 60) (Book: Hemodynamically significant Bradycardia, bradyasystolic arrest, and organophosphate poisoning)
None in the emergency setting
Calcium Chloride Brand Name and Class
Calcium Chloride Description
Calcium Chloride increases myocardial contractile force and increases ventricular automaticity
Calcium Chloride Indications
Hyperkalemia, hypocalcemia, hypermagnesiemia, and calcium channel blocker toxicity.
Calcium Chloride Contraindications
Ventricular Fibrillation, hypercalcemia, and possible digitalis toxicity
Calcium Chloride Precautions
It may precipitate toxicity in pts taking digotxin. Ensure the IV line is in a large veinand flushed before using and after calcium.
Calcium Chloride Dose
500-1000 mg (Book: 2-4 mg/kg IV (10% solution)/10 min
Ditliazem Brand Name and Class
(Cardizem)/Calcium Channel Blocker
A slow calcium channel blocker similar to verapamil. It dilate coronary and peripheral arteries and arterioles, thus increasing circulation to the heart and reducing peripheral vascular resistance.
Supraventricular tachdysrhythmias (A-Fib, A-Flutter, and PSVT refractory to adenosine) and to increase coronary artery perfusion in angina
Hypersensitivity, sick sinus syndrome, 2nd or 3rd degree heart block, systolic BP < 90, diastolic BP < 60, wide-complex tachycardia and WPW
CHF (especially with Beta-blockers), conduction abnormalities, renal or hepatic impairment, the elderly, and nursing mothers
15-20 mg (0.25 mg/kg) over 2 min, 20-25 mg (0.35 mg/kg) over 2 min
Dobutamine Brand name and Class
A synthetic catecholamine and beta agent that increases the strength of cardiac contraction without appreciable increasing HR.
To increases Cardiac Output in CHF/cardiogenic shock
Hypersensitivty to sympathomimetic amines, ventricular tachycardia, and hypovolemia without fluid resuscitation
Atrial Fibrillation or preexisting hypertension
Dopamine Brand Name and Class
A naturally occurring catecholamine that increases cardiac output without appreciably increasing myocardial oxygen consumption. It maintains renal and mesenteric blood flow while inducing vasoconstriction and increasing systolic BP.
Primary: cardiogenic shock and Secondary: Nonhypovolemic hypotension (70-100 mmHg)
Hypovolemic hypotension without aggresive fluid resuscitation, tachydysrhythmias, ventricular fibrillation, and pheochromocytoma
Occlussive vascular disease, cold injury, arterial emboloism. Ensure adequate fluid resuscitation of the hypovolemic pt.
Epinephrine Brand Name and Class
A naturally occurring catecholamine that increases HR, cardiac contractile force, myocardial electrical activity, systemic vascular resistance, and systolic BP and decreases overall airway resistance and automaticity. It also, through bronchial artery constriction, may reduce pulmonary congestion and increase tidal volume and vital capacity.
To restore rhythm in cardiac arrest and severe allergic reactions
Hypersensitivity to sympathomimetic amines, narrow angle glaucoma; hemorrhagic, traumatic, or cardiac shock; coronary insufficiency; dysrhythmias; organic brain or heart disease; or during labor
Elderly, debilitated pts, hypertension, diabetes, hyperthyroidism, Parkinson's disease, tuberculosis, asthma, emphysema, and in children < 6 years.
Epinephrine Dose: Cardiac Arrest
1 mg/3-5 min, Max Dose: None
Epinephrine Dose: Bradycardia/Hypotension
Epinephrine Dose: Allergic Reaction
0.3-0.5 mg/5-15 min
Flumazenil Brand Name and Class
A benzodiazepine antagonist used to reverse the sedative, recall, and psychomotor effects of diazepam, midazolam, and the other benzodiazepines.
Respiratory depression secondary to benzodiazepines
Hypersensitivity to flumazenil or benzodiazepines; those patients who take flumazenil for status epilepticus or seizures; seizure-prone patients during labor and delivery; tricyclic antidepressant overdose
Hepatic impairment, elderly, pregnancy, nursing mothers, head injury, alcohol and drug dependency and physical dependence on benzodiazepines
1st: 0.2 mg/15 sec, 2nd: 0.3 mg/30 sec, 3rd: 0.5 mg/30 sec, Max Dose: 3 mg
Furosemide Brand Name and Class
A rapid-acting, potent diuretic and antihypertensive that inhibits sodium reabsorption by the kidney. its vasodilating effects reduce venous return and cardiac workload.
Congestive heart failure and pulmonary edema (w/o Signs and Symptoms of Shock)
Hypersensitivity to drug or the sulfonamides, fluid and elctrolyte depletion states, heptic coma, pregnancy (except in life-threatening circumstances)
Infants, elderly, hepatic impairment, nephrotic syndrome, cardiogenic shock associated with acute MI, gout, or pts receiving digitalis or potassium-depleting steroids.
1st: 0.5-1 mg/kg/1-2 min, 2nd: 2 mg/kg/1-2min
Lidocaine Brand Name and Class
An antidysrhythmic that suppresses automaticity and raises stimulation threshold of the ventricles. Also causes sedation, anticonvulsant, and anaglgesic effects
Pulseless VT, V-Fib, VT (an alternative to Amiodarone)
Hypersensitivity to amide-type local anesthetics, supraventricular dysrhythmias, Stokes-Adam syndrome, 2nd and 3rd degree heart blocks, and bradycardias
Hepatic or renal impairment, CHF, hypoxia, respiratory depression, hypovolemia, myasthenia gravis, shock debilitated pts, elderly, family history of malignant hypothermia.
Lidocaine Dose: Cardiac Arrest
1-1.5 mg/kg/3-5 min, Repeat: 0.5-0.75 mg/kg, Max Dose: 3 mg/kg (Book: follow conversion with 2-4 mg/min drip.)
Lidocaine Dose: Perfusing Arrhythmia and Stable VT
0.5-0.75 mg/kg conversion with 1-4 mg/min
Lidocaine Side Effects:
Magnesium Sulfate Brand name and Class
Magnesium Sulfate Description
An electrolyte that acts as a calcium channel blocker, acting as a CNS depressant and anticonvulsant. It also depresses the function of smooth, skeletal, and cardiac muscles.
Magnesium Sulfate Indications
Refractory ventricular fibrillation, and ulseless ventricular tachycardia (especially torsades de pointes), AMI, eclamptic seizures.
Magnesium Sulfate Contraindications
Heart block, myocardial damage, shock, persistent hypertensiion, and hypocalcemia.
Magnesium Sulfate Precautions
Renal impairment, digitalized patients, other CNS-depressants, or neuromuscular blocking agents
Magnesium Sulfate Dose
1-2 g/5-20 min, (book: V-Fib or tachycardia: 1-2 g IV over 2 min, Torsade de Pointes: 1-2 g IV followed by infusion of 0.5 to 1 g / hr IV, AMI: 1-2 g IV over 5-30 min, Eclampsia: 2-4 g IV/IM
Morphine Sulfate Brand Name and Class
Morphine Sulfate Description
A potent analgesic and sedative that causes some vasodilation, reducing venous return, and reduced myocardial oxygen demand
Morphine Sulfate Indications
Chest Pain with Acute Coronary Syndrome, unresponsive to nitrates, and Acute Cardiogenic Pulmonary Edema (Book: Moderate to severe pain and in MI and to reduce venous return in pulmonary edema.)
Morphine Sulfate Contraindications
Hypersensitivity to opiates, undiagnosed head or abdominal injury, hypotension, or volume depletion, acute bronchial asthma, COPD, severe respiratory depression, or pulmonary edema due to chemical inhalation.
Morphine Sulfate Precautions
Elderly, children, or debilitated patients. Naloxone should be readily available to counteract the effects of morphine.
Morphine Sulfate Dose
2-4 mg/5-30 min, Repeat Dose: 2-8 mg/5-15 min
Nitroglycerin Brand Name and Class
A rapid smooth muscle relaxant that reduces peripheral vascular resistance, blood pressure, venous return, and cardiac workload
Chest pain associated with angina and acute myocardial infarction, and acute pulmonary edema
Systolic BP <90 or 30 below baseline, Severe Bradycardia < 50, Tachycardia > 100, Right ventricular infarction, ED drugs. (Book: Hypersensitivity, tolerance to nitrates, severe anemia, head trauma, hypotension, increased ICP, patients taking Sildenafil, glaucoma, and shock)
May induce headache that is sometimes severe. Nitroglycerin is light sensitive and will lose potency when exposed to the air.
1 tablet (0.4 mg) SL. May be repeated/ 3-5 min up to 3 tablets, or 1/2 in topical ointment or 0.4 mg (one spray) SL up to 3 spray/25 min.
Sodium Bicarbonate Brand Name and Class
Sodium Bicarbonate Description
Provides vascular bicarbonate to assist the buffer system in reducing the effects of metabolic acidosis and in the treatment of some overdoses.
Sodium Bicarbonate Indications
Preexisting hyperkalemia, acidosis, prolonged resuscitation (>10-15 min), (book: TCA and barbiturate overdose, refractory acidosis)
Sodium Bicarbonate Contraindications
None when used in severe hypoxia or late cardiac arrest
Sodium Bicarbonate Precautions
May cause alkalosis if given in too large a quantity. It may also deactivate vasopressors and may precipitate with calcium chloride.
Sodium Bicarbonate Dose
1 mEq/kg IV, then 0.5 mEq/kg/10 min
Vasopressin Brand Name and Class
A hormone with strong vasopressive and antidiuretic properties but that may precipitate angina and/or AMI.
Alternative to Epinephrine for Shock refractory VF and Asystole/PEA. (Book: To increase peripheral vascular resistance in arrest (CPR) or th control bleeding from esophageal varices)
Chronic nephritis with nitrogen retention, ischemic heart disease, PVCs, advanced arteriosclerosis or first stage of labor
Epilepsy, migraine, heart failure, angina, vascular disease, hepatic impairment, elderly, and children
Cardiac Arrest: 40 units (1 time dose)
Esophageal varices: 0.2-0.4 units/min IV drip.
Contributing Factors: H's
Hypovolemia, Hypoxia, Hydrogen ions (acidosis), Hypo-/hyperkalemia, Hypoglycemia, Hypothermia
Contributing Factors: T's
Toxins, Tamponade cardiac, Tension pneumothorax, thrombosis (coronary or pulmonary), Trauma.