Emergency Chaos: Key ACLS Medications Lecture

Introduction

• Focus on improving ER nurse skills through ACLS medication knowledge.
• Encouragement to read further on ER essentials like vasopressors and emergency conditions.

Medications Covered

1. Epinephrine

   • Uses: Cardiac arrest, post-cardiac arrest, symptomatic bradycardia.
   • Action: Alpha, Beta-1, Beta-2 agonist increases heart rate, contraction strength, BP, and airway dilation.
   • Dosage:
     • Cardiac Arrest: 1 mg every 3-5 min (IV/IO).
     • Post-cardiac arrest infusion: 0.1 to 1 mcg/kg/min, max 2 mcg/kg/min.
     • Symptomatic Bradycardia: Infusion 2-10 mcg/min.
   • Notes: Epinephrine isn't the only vasopressor option; norepinephrine may be used.

2. Amiodarone

   • Uses: Cardiac arrest with VFib or pulseless VTach.
   • Action: Antiarrhythmic; prolongs action potential and refractory period.
   • Dosage:
     • Initial: 300 mg IV/IO, second dose: 150 mg.
     • VTach with pulse: 150 mg over 10 min; followed by 1 mg/min for 6 hrs, then 0.5 mg/min for 18 hrs.
   • Monitoring: Side effects include bradycardia, hypotension, QT elongation.

3. Atropine

   • Uses: Symptomatic bradycardia.
   • Action: Blocks parasympathetic stimulation, increases heart rate.
   • Dosage: 1 mg every 3-5 min, up to 3 mg max.
   • Notes: Ineffective in 3rd degree blocks; caution in ACS patients.

4. Sodium Bicarbonate

   • Uses: Metabolic acidosis during prolonged cardiac arrest, hyperkalemia, TCA overdose.
   • Dosage: 50 mEq or 50 mL during cardiac arrest.
   • Priority: Focus on CPR, oxygenation, epinephrine, defibrillation first.

5. Lidocaine

   • Uses: VFib, pulseless VTach.
   • Action: Sodium channel blocker, stabilizes cardiac membranes.
   • Dosage: 1-1.5 mg/kg, repeat dose 0.5-0.75 mg/kg.

6. Magnesium

   • Uses: Polymorphic VTach (Torsades de Pointes).
   • Dosage: 2 g IV.
   • Notes: Monitor magnesium levels, watch for hypotension, bradycardia.

7. Calcium Chloride

   • Uses: Hyperkalemia, calcium channel blocker overdose.
   • Dosage: 1 g when addressing H's & T's in cardiac arrest.
   • Note: Differentiate from calcium gluconate.

8. Dextrose

   • Uses: Hypoglycemia, reversible cardiac arrest cause.
   • Dosage: 25 g in 50 mL if hypoglycemia detected.

9. Adenosine

   • Uses: SVT.
   • Action: Interrupts AV node conduction.
   • Dosage: 6 mg initial dose, followed by 12 mg if needed.
   • Procedure: Administer via large bore IV with rapid saline flush.

Nursing Tips

• Memorize ACLS medications and treatments.
• Practice quizzing with peers or preceptors.
• Emphasize teamwork and preparedness in emergency scenarios.

• Conclusion: Understanding ACLS is vital for effective ER nursing; proactive team collaboration is key.