ALS drugs save lives by reversing the causes of cardiac arrest. π«π
Adrenaline and amiodarone are the two key drugs recommended within the ALS algorithm, however, several others are useful depending on the clinical situation.
Here’s what you need to know:
1οΈβ£ Adrenaline (1 ampoule per dose)
ππ½ A potent adrenergic agonist
ππ½ Causes vasoconstriction, directing available cardiac output to myocardium and brain.
ππ½ The recommended dose in cardiac arrest is 1mg EVERY 4 MINUTES.
ππ½ The timing of the first dose depends on the rhythm:
πΊShockable rhythm - first dose after 2nd shock
πΊNon-shockable rhythm - first dose immediately after first rhythm check
2οΈβ£ Amiodarone (300mg once)
ππ½ Amiodarone 300mg is only recommended in SHOCKABLE rhythms and only after the THIRD SHOCK.
ππ½ It has weak evidence for out-of-hospital arrest in improving survival to admission
ππ½ It prolongs cardiac action potential and delays refractory period, which may be responsible for its ability to terminate ventricular and supraventricular arrhythmias
ππ½ A bolus of amiodarone will cause profound hypotension, so should only be given AFTER administration of adrenaline.
Other drugs used in ALS, when indicated:
ππ½ No longer included in ALS algorithm due lack of supporting evidence
Theoretically may be an alternative to amiodarone as an antiarrhythmic agent
ππ½ If guided to give lignocaine by the team leader, a bolus dose of 100mg is appropriate (5ml of 2%).
πΊCalcium channel blocker overdose.
ππ½ Bolus dose 5-10mL of 10% calcium chloride
ππ½ Magnesium is recommended for torsades de pointes
ππ½ Not recommended for VT/VF in the setting of normal QT intervals
ππ½ Indicated for hypokalaemia
ππ½ Bolus dose of 10mmol potassium chloride
πΊ Tricyclic antidepressant overdose.
ππ½ Dosage 20-50ml over 2-3 minutes, then guided by blood gas.
Note! When mixed with adrenaline or calcium, they can precipitate and block the line!
Ref: https://www.anzcor.org/assets/anzcor-guidelines/guideline-11-5-medications-in-adult-cardiac-arrest-246.pdf