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Advanced Cardiac Life Support drug dosing and protocol reference for cardiac arrest and emergency situations
ACLS protocols are for trained healthcare providers. This calculator is for reference only and does not replace clinical judgment or current AHA guidelines.
| Drug | Dose | Route | Indication |
|---|---|---|---|
| Epinephrine | 1 mg q3-5 minutes | IV/IO | All cardiac arrest rhythms |
| Amiodarone | 300 mg, then 150 mg | IV/IO | VF/pVT refractory to defibrillation |
| Lidocaine | 70.0-105.0 mg (1-1.5 mg/kg) | IV/IO | VF/pVT (alternative to amiodarone) |
| Atropine | 1 mg q3-5 minutes (max 3 mg) | IV/IO | Symptomatic bradycardia |
| Adenosine | 6 mg, then 12 mg | IV (rapid push) | Regular narrow-complex SVT |
| Magnesium Sulfate | 2 g over 15 min | IV/IO | Torsades de Pointes |
| Calcium Chloride | 1 g (10 mL of 10%) | IV/IO | Hyperkalemia, Ca²⁺ blocker toxicity |
| Sodium Bicarb | 70 mEq (1 mEq/kg) | IV/IO | Hyperkalemia, TCA overdose |
120-200 J (manufacturer recommendation)
Use same or higher energy for subsequent shocks
360 J for all shocks
Narrow regular: 50-100 J
Wide regular: 100 J
Irregular: 120-200 J biphasic
Shockable rhythms have the best prognosis. Early defibrillation is critical. After the first shock, resume CPR immediately for 2 minutes before checking rhythm. Give epinephrine after the second shock and every 3-5 minutes. Amiodarone or lidocaine should be given for refractory VF/VT.
Non-shockable rhythms require immediate CPR and identification of reversible causes. Give epinephrine as soon as possible and every 3-5 minutes. Focus on high-quality CPR and treating underlying causes (Hs and Ts). Consider early advanced airway and quantitative waveform capnography.
Optimize oxygenation (avoid hyperoxia), maintain adequate perfusion (MAP ≥65), and consider targeted temperature management. Treat hypotension with fluids and vasopressors. Emergency coronary angiography should be considered for suspected cardiac etiology. Avoid hyperthermia.
Effective resuscitation requires clear role assignment, closed-loop communication, and team leadership. Minimize interruptions in chest compressions. Use quantitative waveform capnography to monitor CPR quality (target ETCO2 >10 mmHg). Rotate compressors every 2 minutes.
For VF/pVT, give epinephrine after the second shock (after CPR). For PEA/asystole, give epinephrine as soon as possible. Continue every 3-5 minutes throughout the resuscitation. Epinephrine increases coronary and cerebral perfusion pressure.
Amiodarone is the first-line antiarrhythmic for VF/pVT that is refractory to CPR, defibrillation, and epinephrine. Give 300 mg IV/IO, followed by 150 mg if VF/pVT persists. It helps stabilize the cardiac membrane and may improve chances of successful defibrillation.
Torsades de Pointes (polymorphic VT with long QT) is treated with magnesium sulfate 2 g IV/IO over 15 minutes. Correct electrolyte abnormalities (especially low K+ and Mg++). Increase heart rate with pacing or isoproterenol. Avoid QT-prolonging drugs.
TTM involves maintaining body temperature between 32-36°C for 24 hours after cardiac arrest to improve neurologic outcomes. It should be considered for comatose adults after ROSC. Avoid hyperthermia (>37.5°C) in the first 72 hours. Strict temperature control is essential.
Consider stopping after 20-30 minutes of high-quality CPR if there is no ROSC, no shockable rhythm, and no reversible causes identified. However, continue longer for witnessed arrest, initial shockable rhythm, or reversible causes (hypothermia, drug overdose). Always consider the clinical context.
Defibrillation delivers unsynchronized shock for pulseless VF/VT (immediate shock). Cardioversion delivers synchronized shock timed with QRS complex for unstable tachycardias with a pulse. Synchronized cardioversion prevents shock during vulnerable period and reduces risk of inducing VF.
This ACLS drug calculator is for educational and reference purposes only. It is designed for use by healthcare professionals trained in Advanced Cardiac Life Support. This tool does not replace clinical judgment, current AHA guidelines, or institutional protocols. Always follow current ACLS algorithms and consult with experienced clinicians. Emergency situations require immediate action by qualified personnel.