welcome to emergency chaos where we provide tips and tricks to make you a better ER nurse today we are going over key ACLS medications these are going to be the medications that we are going to cover today and if you want to continue learning to master the essentials of the ER such as vasopressors emergency conditions and obtaining a rapid history and physical and much more consider checking out our book on Amazon the link is in a pin comment now let's start off with epinephrine it's going to be used during Cardiac Arrest it can be used in postcardiac arrest to maintain profusion and in symptomatic bre cardia we know that epinephrine is an alpha beta 1 and beta 2 Agonist so it increases the heart rate the strength of contraction increases blood pressure and helps open up the airway for these reasons we administer epinephrine in cardiac aress to help improve coronary and cerebral profusion giving the patient the best chance for a successful resuscitation the dose during cardiac arrest for adultes 1 milligram every 3 to5 minutes via IV or IO epinephrine can also be used during postcardiac arest to maintain profusion a map above 65 as maintaining profusion is key to avoid further damage to vital organs although infusion rates vary from facility to facility a common infusion range is 0.1 to 1 microgram per kilogram per minute with a maximum Fusion rate of 2 microG per kilog per minute please however follow your own facilities protocols for start rates titrations and Max doses a key point is that there are other vasil pressors and a different vasil pressor such as norepinephrine may be chosen by the provider for pressure support after cardiac arrest instead of epinephrine so just be mindful of it it doesn't always have to be epinephrine there's other pressures and epinephrine can also be used for symptomatic bre cardia and and epinephrine infusion may be administered while more permanent treatments or prepared like an intravenous Pacer per ACS the infusion dozing range in symptomatic Beric cardia is going to be 2 to 10 micrograms per minute now let's talk about amone it's going to be used in Cardiac Arrest with ventricular fibrillation or with pulses ventricular tachicardia it's in it's an anti- arhythmic that prolongs the action potential and refractory period of cardiac cells we hope that this essentially calms cardiac cells down making them less excitable less prone to ventricular fibrillation or postless ventricular tachic cardia the dose in Cardiac Arrest with v fib and pulses vtac is 300 migr IV or IO and if a second dose is needed it is 150 migr if Ros is a chief after the administration during the code and infusion should be started to maintain stable cardiac cells another use for it is going to be ventricular t cardia with a pulse the dose will be 150 Mig over 10 minutes followed by 1 MGR for one minute every minute over 6 hours which comes out to typically 360 milligram and then this is followed after the 6 hours by an infusion of 0.5 mg per minute over 18 hours now keep in mind that when administering the infusion in the acute setting carefully monitor for its side effects including bre cardia hypotension and QT elongation especially in that post Ross monitor for hypotension I've had that happen to uh my patients in the past now let's get to atropine atropine is used in symptomatic bready cardia as it blocks parasympathetic stimulation of the heart it blocks the vagus nerve and as a result it helps increase the heart rate the dose is 1 milligram every 3 to 5 minutes up to a Max of 3 milligrams the key thing with atropine it is is that it that it will most likely not be effective in third degree blocks it may still be ordered by your provider but it should not delay other more effective treatments like pacing another key with atropine is that you should be cautious when using it in ACS patient as the increase in heart rate will place further Demand on the heart therefore in further worsening the esia going on now let's discuss sodium bicar it's given to help treat the associated metabolic acidosis from prolonged cardiac aress as a result of the hypoxia and Poe profusion that starts to happen it's also used when hyperkalemia is suspected and with certain overdoses such as tricyclic anti-depressants although bicarb is very useful your initial attention in cardiac rest should be focused on high quality CPR oxygenating the patient epinephrine delivering def fibrillation as indicated then when when addressing the H's and T's then is sodium bicarb considered an administered now the typical dose for the sodium bicarb during cardiac aress in a dose is going to be one full amp or in other words 50 meq and 50 MLS next is going to be lidan it's another anti- arhythmic it's also going to be used for ventricular fibrillation and pulses ventricular techic cardia it blocks sodium channels and cardiac cells which help slow down conduction and ultimately stabilize cardiac cell membranes the adult dose is 1 to 1.5 mg per kilog I and if a repeat dose is needed it's going to be between 0.5 to 0.75 mg per kilogram it can also be used in ventricular techic cardia with the pulse as an infusion as like we did with amone but Lakin has its own dosing for that now magnesium is also used in Cardiac Arrest with polymorphic ventricular teic cardia or in other words torsades magnesium is essential in regulating some membrane ion channels therefore by replenishing we help stab iiz cardiac cells the dose is 2 G IV if magnesium assisted in achieving rasque and infusion of magnesium may be ordered by the provider and if so monitor magnesium levels closely and monitor for the side effects of hypotension and braady cardium and although magnesium magnesium is important keep in mind that t should be defibrillated as well now calcium chloride is given when hyperkalemia or calcium chocolate uh calcium channel blocker overdoses expected it's also thought to help the heart contract a little better now generally it's given when the H's and T's are addressed during the cardiac harest but many providers do routinely administer calcium chloride early on in the arrest as well the dose is going to be 1 G and now please know the difference between calcium chloride and calcium gluconate calcium chloride is very concentrated in comparison to to calcium gluc and it's only going to be used during Cardiac Arrest calcium gluconate is on the other hand is less concentrated and it's used for most patients now with hypoglycemia and dextrose so we know that hypoglycemia is a reversible cause of cardiac arrest and a point of care glucose's level is commonly checked early on in the arrest if the glucose level is low and amp of dexol is given IV an amp typically has 25 G in 50 in in a 50 ml syringe ensure to recheck the glucose level after Administration after the administration of dextrose to verify that it actually worked as well as rechecking it to make sure that you're training the level so that it is not dropping and if it is you catch it and you can give additional dextral amps or start the patient on an infusion of a D5 or d10 drip now adenine is used for SBT as it interrupts the Rhythm by blocking conduction through the AV node allowing the heart to go back to normal sinus rhythm when giving a Denine it is essential that the patient also be connected onto the defibrillator and that the crash C be at bedside to ensure you are prepared for anything that may come may come up the dose of adenosine should be uh the the dose of adenosine should be given in a large for IV ideally in the AC immediately followed by lifting the arm and giving a rapid flush of 20 MLS of normal sailing so that it reaches the heart as a Denine has a short halflife of 10 seconds the initial dose is six milligrams and if a repeat dose is needed it is 12 milligrams some providers may choose to start with a 12 milligram dose initially now let's get into some nursing tips the main tip is that you need to memorize these medications in the treatment typically perform with ACLS there are countless things I understand that there are countless things that you need to know as a new ER nurse but ACLS including the medications the treatments how to defate cardi over pace and everything associated with with ACLS is extremely important when an emergency comes up you want to you want to be sure that you understand the treatments and you want to make sure that you understand the treatments right um You have to either quiz yourself you need to ask your preceptor to quiz yourself or get together with the other New Year nurses in your cohort and review with each other but you must memorize and understand the ACLS protocols as an ER nurse and as always Teamwork Makes the DreamWork and here at emergency chaos we are proactive not reactive