Common ACLS Drugs & Electrical Therapy - 2018

Common medications and electrical therapy interventions based on AHA ACLS Recommendations Including 2018 Update.


Treatment for suspected SVT. Can be used for regular and monomorphic wide complex tachycardia if suspected SVT.

  • First dose: 6 mg rapid push followed by rapid flush.

  • Second dose: 12 mg 1 to 2 minutes after, if needed.


Used in the treatment of refractory VF/pVT or recurrent VT with a pulse. May be used for other atrial and ventricular rhythms.

  • Refractory VF/pVT Cardiac Arrest

    • First dose: 300 mg IV/IO push.

    • Second dose (if needed): 150 mg IV/IO push.

  • Life Threatening Arrhythmia

    • Rapid Infusion: 150 mg IV over 10 minutes. May repeat every 10 minutes as needed.

    • Maintenance Dose: 540 mg IV over 18 hours (0.5 mg/min)

  • Max Cumulative: 2.2 g IV over 24 hours.


For patients with ACS or ischemic chest pain to prevent further clotting.

  • Dose: Chew 160 to 325 mg tablets ASAP

Atropine Sulfate

Care of symptomatic bradycardia.

  • Dose: 0.5 mg IV push every 3 to 5 minutes as needed. Max cumulative dose 3 mg.


  • Biphasic Dose: Initial amount at manufacturer recommendation of 120-200 J. Additional doses should be equivalent or higher per manufacturer recommendation.


Treatment of a-fib and a-flutter. Consider for refractory narrow complex tachycardia's not remedied with adenosine.

  • Dose: 15 - 20 mg (0.25 mg/kg) IV over 2 minutes. May repeat after 15 minutes at 20 - 25 mg (0.35 mg/kg).


Used in treatment of symptomatic bradycardia or hypotension in patients with signs of shock.

  • Typical dose: 2-20 mcg/kg/min. Titrate to effect.

  • Taper slowly.


Used in care of cardiac arrest, symptomatic bradycardia, severe hypotension & anaphylaxis.

  • Cardiac arrest

    • Dose: 1 mg (1:10,000) every 3 to 5 minutes followed by flush.

  • Profound Bradycardia or Hypotension

    • Dose: 2-10 mcg/min. Titrate to effect.


Used in the treatment of refractory VF/pVT.

  • Cardiac arrest dose: 1-1.5 mg/kg IV/IO.

    • For refractory VF may repeat 0.5 - 0.75 mg/kg and may repeat in 5-10 mins for a max 3 doses or total of 3 mg/kg.

    • Maintenance Infusion: 1-4 mg per min (30-50 mcg/kg per minute).

Magnesium Sulfate

Used in cardiac arrest only if torsades de pointes or hypomagnesemia.

  • Cardiac arrest dose: 1-2 g diluted in 10 ml IV/IO


Initial treatment for anginal ischemic pain. Also used in hypertensive emergency with ACS.

  • Sublingual Dose: 0.4 mg spray or tablet. Repeat at 5 minute intervals for total of 3 doses.


B-blocker for treatment of SVT.

  • Dose: 0.5-1 mg over 1 minute. Repeated as needed up to total dose of 0.1 mg/kg.


Used in treatment of wide variety of arrhythmias including monomorphic VT, wide-complex tachycardia and SVT.

  • Dose: 20 mg/min IV until arrhythmia suppression, hypotension, QRS widens by >50% or total dose of 17 mg/kg.

  • Maintenance dose: 1-4 mg/min. Reduce dose if renal or hepatic insufficiency noted.


Used in treatment of supraventricular and ventricular arrhythmias without structural heart disease.

  • Dose: 1-1.5 mg/kg slow infusion (see insert).

Synchronized Cardioversion

Used in the treatment of unstable tachycardia rhythms with a pulse.

  • Premedicate whenever possible.

  • Increase subsequent shocks in a stepwise fashion per manufacturer's recommendation.

  • Initial biphasic cardioversion doses:

    • Narrow Regular - 50-100 J

    • Narrow Irregular - 120-200 J

    • Wide Regular: 100 J

    • Wide Irregular: Defibrillation dose

Transcutaneous Pacing

Used in the emergency treatment of symptomatic bradycardia

  • Premedicate whenever possible.

  • Set demand rate to approximately 80/min

  • Increase current (mA) from minimum setting until “capture” achieved.

  • Check for Mechanical Capture

Josh Halstead