Hi guys. Marius here with the Resuscitation Coach. On this channel we do all things resuscitation, so please consider subscribing. I often get asked by new ACLS students what medications they should review for their ACLS practical stations. So let's jump straight in. Here we go. Epinephrine or Epi, also known in most parts of the world as Adrenaline, is probably the most widely known emergency medication. The ACLS course, indications for using epinephrine include cardiac arrest management, symptomatic bradycardia, and hypotension as part of your post cardiac arrest care. For adult cardiac arrest, we administer 1mg of the 0.1 mg per ml, or 1:10 000 concentration. We can repeat a dose every three to five minutes during resuscitation, but for educational efficiency, we can give it every four minutes as a mid range. Each dose should be followed with a 20ml flush and elevation of the extremity. For the Endotracheal route, which we don't use in the ACLS stations, we will use two to 2.5 milligrams diluted in 10 ml of normal saline. As the uptake of Epinephrine down the ET tube is not the most reliable. For symptomatic bradycardia, we can start an infusion at two to 10 mcg per minute and titrate against the effect. For a continuous infusion, the initial rate is 0.1- 0.5 mcg per kilogram per minute. Always titrate a dose against the effect. Amiodarone is also known in the ICU, the ER and EMS environment as amio. Some common names for Amio is Cordarone and Pacerone. I like to call it the Big A. The indications of Amiodarone include Ventricular Fibrillation and Pulseless Ventricular Tachycardia. Amiodarone can also be used when a patient has a stable wide QRS tachycardia. Amiodarone is used in the treatment of ventricular fibrillation or VF and pulseless ventricular tachycardia, unresponsive to high-quality CPR, defibrillation and a vasopressor. In cardiac arrest, the first dose is 300 milligrams IV or IO push, followed by a D5 water flush. The second dose if needed, is 150 milligrams IV or IO. The pattern followed by clinicians in VF or pulseless ventricular tachycardia arrest is usually high-quality CPR, defibrillate once, defibrillate for a second time, then we'll give our Epinephrine. Defibrillate for a third time that is then followed by the Amiodarone Defibrillate for a fourth time. We give Epinephrine and defibrillate for a fifth time and will give Amiodarone and defibrillate for a sixth time, Epinephrine again. I always remember that after the equal number of shocks, shock, 2, 4, 6, etc., the patient will receive an epi and after uneven number of shocks, shock three and five, the patient will receive Amiodarone, all assuming that the rhythm did not change from VF or pulseless VT to something else inbetween.. If this pattern is followed, your patient will receive one dose of epi every four minutes and one dose of Amiodarone every four minutes. Usual dose interval for both medications are three to five minutes, as per the AHA guidelines. It should be noted that Amiodarone doses could be replaced with Lidocaine as an alternative, but in most ACLS courses, students will use Amiodarone. As an infusion Amiodarone can be administered as follows. During your ACLS course, you will give a rapid infusion of 150 milligrams IV over 10 minutes, which is 15 milligram per minute. In clinical practice, we may repeat a rapid infusion and then start with slow and maintenance infusion. The slow infusion is 360 milligram IV over six hours, which is one milligram per minute, and your maintenance infusion is 540 milligrams IV over 18 hours, which works out to about 0.5 milligrams per minute. Keep in mind that a maximum cumulative dose of Amiodarone over 24 hours is 2.2 grams. Adeonsine is the first drug for most forms of stable, narrow, complex, superventricular tachycardia, or S V T, and is effective in terminating dose due to reentry involving AV node or sinus node. We may consider it for unstable, narrow, complex reentry tachycardias while preparing for cardioversion. It can also be used for regular and monomorphic wide complex tachycardia or to be of a previously defined to be a reentry S V T. Diagnostic maneuver for stable, narrow complex SVT. Keep in mind that adenosine does not convert AF and Atrial flutter or ventricular tachycardia unless it's a ventricular track outflow VT. Adenosine is given as a rapid push of six milligrams over one to three seconds, followed by a normal saline flush. A second dose of 12 milligrams can be given in one to two minutes if needed. Don't forget that the halflife of Adenosine is very short, about 10 seconds, so we need to be very quick in administering the Adenosine for it to be effective. Ensure to record a rhythm strip before, during and after the administration of Adenosine. Place the patient in a mild reverse trendellenburg position before administration of the drug. Please explain to your patient what is going to happen. Prior to Adenosine administration, think about it like this. Your heart rate is doing 180 in your chest, and you can feel the heart bouncing in your chest and suddenly Adenosine is given, and your heart rate goes from 180 to 0 in a split second. The first thing that your patient will be thinking is that my heart has just stopped and I'm going to die. So clearly communicate to your patient. The Adenosine dose in one syringe, an 20 more flush in another. Attach both syringes to the same port or an adjacent IV injection port, nearest to the patient with Adenosine closest to the patient. Clamp the IV tubing above the injection port, push the IV Adenosine as quickly as possible while maintaining pressure on the Adenosine plunger, push the Normal Sailine flush rapidly and elevate the arm. Atropine is the first drug for symptomatic Sinus Bradycardia, may be beneficial in the presence of AV nodal block, but likely not to be effective in second degree block type two or third degree block. Routine use during PEA or Asystole is unlikely to have a therapeutic benefit and is not part of the AHA recommendation anymore. The ACLS dosage of Atropine is one milligrams IV every three to five minutes as needed. Kindly note that a dose of Atropine has been increased from 0.5 to one milligram in the 2020 American Heart Association Guidelines. Do not exceed 0.04 milligrams per kilogram or a total dose of three milligrams. Dopamine is a second line drug for symptomatic bradycardia after Atropine, or where transcutaneous pacing is ineffective. It can be used for hypotension and the management of shock, unresponsive to fluid administration as part of the post cardiac arrest care. The AHA recommended infusion rate of Dopamine is five to 20 mcg per kg per minute. It's always important to titrate a dose against the effect required and ensure to taper slowly. The last medication that we all review is oxygen, and yes, oxygen is a medication. Oxygen is used during post cardiac arrest care to maintain an oxygen saturation of between 92 and 98% when a patient is hypoxemic and the saturation is equal or below to 94%. We hope you benefited from this video. Kindly like, subscribe and smash that notification bell. We'll also leave links in the description below for videos that we've made previously on the various medications. Have a fantastic day.