ALS Medications

adrenaline als alsmedications amiodarone safety Apr 04, 2024
 
ALS drugs save lives by reversing the causes of cardiac arrest. πŸ«€πŸ’Š
 
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:
 
1️⃣ Adrenaline (1 ampoule per dose)
πŸ‘‰πŸ½ A potent adrenergic agonist
πŸ‘‰πŸ½ Causes vasoconstriction, directing available cardiac output to myocardium and brain.
πŸ‘‰πŸ½ The recommended dose in cardiac arrest is 1mg EVERY 4 MINUTES.
πŸ‘‰πŸ½ The timing of the first dose depends on the rhythm:
  πŸ”ΊShockable rhythm - first dose after 2nd shock
  πŸ”ΊNon-shockable rhythm - first dose immediately after first rhythm check
 
2️⃣ Amiodarone (300mg once)
πŸ‘‰πŸ½ Amiodarone 300mg is only recommended in SHOCKABLE rhythms and only after the THIRD SHOCK.
πŸ‘‰πŸ½ It has weak evidence for out-of-hospital arrest in improving survival to admission
πŸ‘‰πŸ½ It prolongs cardiac action potential and delays refractory period, which may be responsible for its ability to terminate ventricular and supraventricular arrhythmias
πŸ‘‰πŸ½ A bolus of amiodarone will cause profound hypotension, so should only be given AFTER administration of adrenaline.
 
Other drugs used in ALS, when indicated:
 
Lignocaine
πŸ‘‰πŸ½ No longer included in ALS algorithm due lack of supporting evidence
Theoretically may be an alternative to amiodarone as an antiarrhythmic agent
πŸ‘‰πŸ½ If guided to give lignocaine by the team leader, a bolus dose of 100mg is appropriate (5ml of 2%).
 
Calcium
πŸ‘‰πŸ½ Indications:
  πŸ”ΊHyperkalaemia.
  πŸ”ΊHypocalcaemia.
  πŸ”ΊCalcium channel blocker overdose.
πŸ‘‰πŸ½ Bolus dose 5-10mL of 10% calcium chloride
 
Magnesium
πŸ‘‰πŸ½ Magnesium is recommended for torsades de pointes
πŸ‘‰πŸ½ 5-10mmol bolus
πŸ‘‰πŸ½ Not recommended for VT/VF in the setting of normal QT intervals
 
Potassium
πŸ‘‰πŸ½ Indicated for hypokalaemia
πŸ‘‰πŸ½ Bolus dose of 10mmol potassium chloride
 
Sodium Bicarbonate
πŸ‘‰πŸ½ Indications:
  πŸ”Ί Hyperkalaemia.
  πŸ”Ί Metabolic acidosis.
  πŸ”Ί Tricyclic antidepressant overdose.
πŸ‘‰πŸ½ 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
 
 

 

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