01
Vasopressor / Catecholamine
Epinephrine
Dose
1mg IV/IO q3–5min
Indication
Cardiac Arrest — V-Fib, PEA, Asystole
Alpha/Beta agonist. May cause post-ROSC hypertension. Use 1:10,000 for IV cardiac arrest. Push fast and flush.
02
Antiarrhythmic — Class III
Amiodarone
Arrest
300mg IVP → 150mg repeat
Stable
150mg IV over 10 min
Indication
V-Fib, V-Tach (with or without pulse)
Hypotension with rapid infusion. Dilute for stable VT. Incompatible with normal saline — use D5W.
03
Anticholinergic / Parasympatholytic
Atropine
Dose
0.5mg IV (max 3mg)
Indication
Symptomatic bradycardia, organophosphate poisoning
Doses <0.5mg may paradoxically worsen bradycardia. For organophosphate: titrate to drying secretions (no max dose).
04
Endogenous Nucleoside
Adenosine
1st
6mg rapid IVP + flush
2nd/3rd
12mg rapid IVP x2
Indication
SVT (Supraventricular Tachycardia)
Must push FAST at antecubital or proximal site. Transient asystole expected. Ineffective for A-Fib/Flutter. Warn patient — chest pressure/flushing common.
05
Antiarrhythmic — Class IB
Lidocaine
Dose
1–1.5mg/kg IV/IO
Indication
V-Tach, V-Fib — alternative to amiodarone
CNS toxicity at high doses (seizures, altered LOC). Max single dose 3mg/kg. Monitor for bradycardia and hypotension.
06
Electrolyte / Antiarrhythmic
Magnesium Sulfate
Dose
1–2g IV over 5–10 min
Indication
Torsades de Pointes, severe asthma (bronchospasm)
Rapid push causes hypotension and flushing. Monitor for respiratory depression. Have calcium gluconate ready as antidote.
07
Vasopressor / Catecholamine Drip
Dopamine
Dose
5–20 mcg/kg/min drip
Indication
Cardiogenic shock, symptomatic bradycardia (refractory)
Dose-dependent effects: 5–10 = beta (↑HR/contractility); 10–20 = alpha (↑BP/vasoconstriction). Tissue necrosis with extravasation.
08
Nitrate / Vasodilator
Nitroglycerin
Dose
0.4mg SL q5min × 3
Indication
Chest pain, ACS, pulmonary edema (hypertensive)
CONTRAINDICATED if SBP <90 mmHg, recent PDE-5 inhibitor use (Viagra/Cialis ≤24–48h), right ventricular infarct (inferior MI — get 12-lead first).
09
Antiplatelet / NSAID
Aspirin
Dose
324mg PO (chewed)
Indication
ACS / STEMI — suspected cardiac chest pain
Must be chewed (not swallowed whole) for rapid absorption. Contraindicated: active GI bleed, true ASA allergy, hemorrhagic stroke.
10
Buffer / Alkalinizing Agent
Sodium Bicarbonate
Dose
1 mEq/kg IV/IO bolus
Indication
TCA overdose, hyperkalemia, prolonged cardiac arrest
Not first-line in routine arrest. Inactivates epinephrine and dopamine — flush line between drugs. Causes CO₂ shift — ensure adequate ventilation.