07/09/2026
💊 Let’s Talk ACLS Drugs! 💊
Knowing when, why, and how to administer ACLS medications is just as important as memorizing the algorithm.
🔴 Epinephrine
• Cardiac Arrest: 1 mg IV/IO every 3–5 minutes
⚠️ Reminder: In the adult VF/pulseless VT algorithm, do not give epinephrine after the first shock. Give it after the second shock.
💡 Instructor Tip: A practical way to stay within the 3–5 minute window is to give epinephrine every other CPR cycle:
✅ Give epinephrine one cycle
✅ Skip the next cycle
✅ Repeat as needed while monitoring timing
🟠 Amiodarone
• Refractory VF/Pulseless VT:
• First dose: 300 mg IV/IO push
• Second dose: 150 mg IV/IO push
⚠️ Important: Amiodarone is not compatible with normal saline. If normal saline is running through the same IV line, avoid administering amiodarone through that line. When a flush is required, use D5W or Ringer’s Lactate according to your organization’s protocol, or use a separate IV line if available.
🟡 Lidocaine
• Alternative to amiodarone for refractory VF/Pulseless VT:
• Initial dose: 1–1.5 mg/kg IV/IO
• Additional doses: 0.5–0.75 mg/kg every 5–10 minutes
🟢 Atropine
• Used for symptomatic bradycardia
• Dose: 1 mg IV every 3–5 minutes
• Maximum total dose is 3mg
✅ Atropine works best when the problem is at the AV node, such as first-degree AV block and many cases of Mobitz I (Wenckebach).
⚠️ Atropine is generally not effective for Mobitz II second-degree AV block or third-degree (complete) heart block because these are often below the AV node. Consider pacing and appropriate supportive therapies.
🔵 Adenosine
• Initial dose: 6 mg rapid IV push
• Second dose: 12 mg rapid IV push if needed
⚡ Adenosine has an extremely short half-life (less than 10 seconds).
💡 Administration Tip:
Give adenosine through a proximal IV site (preferably the AC), push it rapidly, immediately follow with a flush, and raise the arm to help delivery to the heart.
📈 Expect a brief pause on the monitor—this is an expected effect of the medication.
💬 If your patient is awake, explain beforehand that they may briefly feel chest pressure, flushing, shortness of breath, or a sensation of anxiety. Preparing the patient improves trust and reduces fear.
🎓 At Criticare Medical Institute, we don’t just teach medication doses—we teach the clinical reasoning behind every intervention so providers can respond with confidence when seconds matter.
If you are looking at booking your next ACLS Course visit us at www.criticaremedical.com
