ACLS TEACHING (DR. GRACE)
Drugs:
DRUG DOSE INDICATION CONTRAINDICATION
Adrenaline IV/IO 1mg (1ml ● Cardiac arrest
1:1000) every 3-5 min (CPR)
followed by 20mls
flush
IV infusion ● Unstable
2-10mcg/kg/min bradyarrhytmias
Noradrenaline IVI 0.05-1mcg/kg/min Hypotension post CPR
Cardiogenic shock
Dopamine IV infusion Inotropes: ● Hypertension
2-20mcg/kg/min ● Hypotension ● Increased HR
● Bradycardia
Dobutamine 2-20mcg/kg/min Inotropes: Tachydysrhytmias
● CHF
Adenosine 6mg (2mL) IV rapidly Antiarrhythmic: ● 2nd or 3rd AV
over 1-3s (Flush with ● PSVT block
20mL of NS bolus; ● VT
elevate IV arm). If no ● Sick sinus
effect in 1-2 min, give syndrome
12mg over 1-3s. May ● Asthma!
repeat 12mg bolus
one more time.
Atropine 0.5-1mg IVP every Vagolytic:
3-5 min ● Symptomatic
bradycardia
1-5mg IV/IO, IM OP Poisoning
Neb 0.4-2mg in 3mL Asthma
saline
Amiodarone 300mg IVP (diluted in Antiarrhythmic: ● Cardiogenic
20mls D5% solution). ● VT shock
May repeat 150mg ● VF ● Bradycardia
IVP every 3-5 min ● 2nd or 3rd
(max 2200mg/24 block
, hours)
Lytic Cocktail IV Calcium gluconate Electrolye: ● VF
10% 10cc in 10min: ● For cardiac ● Digitalis toxicity
membrane ● Hypercalcemia
stabilization
IV Dextrose 50% Nutrient: Intracerebral
50cc ● To prevent hemorrhage
hypoglycemia
IV Actrapid 10 unit
Lignocaine Initial dose: Cardiac arrest post
IV/IO 1-1.5mg/kg VT/VF
Additional dose Refractory VF
0.5-0.75mg/kg and
repeat 5-10min up to
3x (or max dose
3mg/kg)
MgSo4 2.47gm
Sodium IV 1mEq/kg bolus Known prexisting
Bicarbonate hyperkalemia
Known prexisting
bicarbonate responsive
acidosis; aspirin
overdose, DKA, TCA or
cocaine
5Hs, 5Ts:
● Hypoxia
● H+ (Acidosis)
● Hypothermia
● Hypovolemic
● Hypo/Hyperkalemia
● Tension Pneumothorax
● Toxins
● Tamponade (Cardiac Tamponade)
● Thrombosis, pulmonary
● Thrombosis, coronary
Algorithm:
, For unstable bradycardia, which you’d like to prefer, medical or electrical management?
● Both equally same
● Electrical is definitive treatment
● Medical is used to buy time
● If TCP is available on time, then we use TCP, while waiting for TVP
If pVT/VF, after we shocked x 3, considered refractory VT/VF
AED
How to function AED, dos donts
cardiac membrane stabilizatio
MEGACODE SCENARIO:
Scenario 1:
Drugs:
DRUG DOSE INDICATION CONTRAINDICATION
Adrenaline IV/IO 1mg (1ml ● Cardiac arrest
1:1000) every 3-5 min (CPR)
followed by 20mls
flush
IV infusion ● Unstable
2-10mcg/kg/min bradyarrhytmias
Noradrenaline IVI 0.05-1mcg/kg/min Hypotension post CPR
Cardiogenic shock
Dopamine IV infusion Inotropes: ● Hypertension
2-20mcg/kg/min ● Hypotension ● Increased HR
● Bradycardia
Dobutamine 2-20mcg/kg/min Inotropes: Tachydysrhytmias
● CHF
Adenosine 6mg (2mL) IV rapidly Antiarrhythmic: ● 2nd or 3rd AV
over 1-3s (Flush with ● PSVT block
20mL of NS bolus; ● VT
elevate IV arm). If no ● Sick sinus
effect in 1-2 min, give syndrome
12mg over 1-3s. May ● Asthma!
repeat 12mg bolus
one more time.
Atropine 0.5-1mg IVP every Vagolytic:
3-5 min ● Symptomatic
bradycardia
1-5mg IV/IO, IM OP Poisoning
Neb 0.4-2mg in 3mL Asthma
saline
Amiodarone 300mg IVP (diluted in Antiarrhythmic: ● Cardiogenic
20mls D5% solution). ● VT shock
May repeat 150mg ● VF ● Bradycardia
IVP every 3-5 min ● 2nd or 3rd
(max 2200mg/24 block
, hours)
Lytic Cocktail IV Calcium gluconate Electrolye: ● VF
10% 10cc in 10min: ● For cardiac ● Digitalis toxicity
membrane ● Hypercalcemia
stabilization
IV Dextrose 50% Nutrient: Intracerebral
50cc ● To prevent hemorrhage
hypoglycemia
IV Actrapid 10 unit
Lignocaine Initial dose: Cardiac arrest post
IV/IO 1-1.5mg/kg VT/VF
Additional dose Refractory VF
0.5-0.75mg/kg and
repeat 5-10min up to
3x (or max dose
3mg/kg)
MgSo4 2.47gm
Sodium IV 1mEq/kg bolus Known prexisting
Bicarbonate hyperkalemia
Known prexisting
bicarbonate responsive
acidosis; aspirin
overdose, DKA, TCA or
cocaine
5Hs, 5Ts:
● Hypoxia
● H+ (Acidosis)
● Hypothermia
● Hypovolemic
● Hypo/Hyperkalemia
● Tension Pneumothorax
● Toxins
● Tamponade (Cardiac Tamponade)
● Thrombosis, pulmonary
● Thrombosis, coronary
Algorithm:
, For unstable bradycardia, which you’d like to prefer, medical or electrical management?
● Both equally same
● Electrical is definitive treatment
● Medical is used to buy time
● If TCP is available on time, then we use TCP, while waiting for TVP
If pVT/VF, after we shocked x 3, considered refractory VT/VF
AED
How to function AED, dos donts
cardiac membrane stabilizatio
MEGACODE SCENARIO:
Scenario 1:
