ACLS Drugs

adenosine: 6-12 mg iv push with saline flush q 5 min

amiodarone:
Non-cardiac arrest
o load 15 mg/min over 10 min (150 mg) (mix 150 mg in 100cc D5W in PVC or
Glass, infuse over 10 min)
o then 1 mg/min x 6 hrs (mix 900 mg in 500 cc D5W)
o then 0.5 mg/min x 18 hrs and beyond;
o supplemental bolus: 15 mg/min x 10 min
Cardiac arrest
o 300 mg iv push (diluted in 20 cc D5W)
o can consider repeat 150 mg iv x 1
Max dose: 2.2 gm in 24hrs
atropine: 0.5-1 mg, up to 0.04 mg/kg
epinephrine: 1 mg q3-5 min iv
diltiazem:
load 0.25mg/kg iv over 2 min, then 0.35mg/kg over 2 min in 15 min
infuse 5-15 mg/hour
ibutilde:
>60 kg 1 mg
<60 kg 0.01 mg/kg over 10 min
may repeat x 1
make sure K>4.0 and Mg normal.
not recommended for low EF
lidocaine:
1 mg/kg bolus
additional 0.5 mg/kg q8-10 min, up to total 3 mg/kg.
Then infuse 1-4 mg/min
magnesium sulfate: 1-2g over 5-60 min
procainamide:
load 20 mg/min up to 17 mg/kg (1000 mg)
then infuse 1-4 mg/min
Side Effects: HTN, torsade
vasopressin: 40 IU x 1 dose only (for pulseless VT/VF)
verapamil: 2.5-5-10 mg bolus
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Class Definitions: I II III Indeterminant
Class I
Definitely recommended. Definitive, excellent evidence provides support.
Definition
Class I interventions are always acceptable, unquestionably safe, and definitely useful.
Proven in both efficacy and effectiveness.**
Must be used in the intended manner for proper clinical indications
Required Evidence
One or more Level 1 studies are present (with rare exceptions).
Study results are consistently positive and compelling.
Class IIa and IIb
Acceptable and useful
Definition
o Both Class IIa and IIb interventions are acceptable, safe, and considered
efficacious, but true clinical effectiveness is not yet confirmed definitively.
o Must be used in the intended manner for proper clinical indications.
Required Evidence
o Available evidence, in general, is positive.
o Level 1 studies are absent, inconsistent, or lack power.
o Classes IIa and IIb are distinguished by levels of available evidence and
consistency of results.
o No evidence of harm.
Class IIa
Acceptable and useful. Very good evidence provides support.
Definition
o Class IIa interventions are acceptable, safe, and useful in clinical practice.
o Considered interventions of choice.
Required Evidence
o Generally higher levels of evidence.
o Results are consistently positive.
Class IIb
Acceptable and useful. Fair-to-good evidence provides support
Definition
o Class IIb interventions are acceptable, safe, and useful in clinical practice.
o Considered optional or alternative interventions.
Required Evidence
o Generally lower or intermediate levels of evidence.
o Results are generally but not consistently positive.
Class III
Not acceptable, not useful, may be harmful
Definition
o Class III interventions are unacceptable, not useful in clinical practice, and may
be harmful.
Required Evidence
o Complete lack of positive data from higher levels of evidence.
o Some studies suggest or confirm harm.
Class Indeterminant
Definition
o A continuing area of research; no recommendation until further research is
available.
Required Evidence
o Higher-level evidence unavailable; studies in progress, inconsistent, or
contradictory.
o Lower-level studies, when available, are not compelling.
**Efficacy versus effectiveness. Evidence-based medicine draws sharp distinctions between
efficacy and effectiveness, terms that initially seem synonymous. Drugs and other interventions
may produce a significant level of benefit in tightly designed, closely controlled, and rigidly
executed laboratory or clinical trials. These trials are a measure of efficacy--under the rigorous
conditions of a controlled clinical study, the intervention "seems to work." When applied in
actual practice, however, the intervention does not perform nearly as well. Effectiveness is the
degree to which the intervention continues to produce positive benefits when used as intended in
clinical practice--in the "real world." To communicate clearly, the term useful clinically is used
to mean effectiveness.
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Much of the information on this site comes from these unofficial sites: acls2000 and acls.net.
Also, from the American Heart Association's site.
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