ACLS DRUG 2000

Asystole

Primary Survey

Secondary Survey: Confirm rhythm (check monitor, power, different lead)

Treatment
o Consider bicarb, pacing early
o Police officer Hank having just found a body: "Again (asystole)! Boy, This 'Ere's Awful!"
o Bicarb (NaHCO3). Consider for indications below:

Class 1: hyperkalemia

Class 2a: bicarbonate-responsive acidosis, tricyclic OD, to alkinalize urine for aspirin OD

Class 2b: prolonged arrest

Not for hypercarbia-related (respiratory) acidosis, nor for routine use in cardiac arrest

o Transcutaneous Pacing (TCP)

Not shown to improve survival

If tried, try EARLY

o Epinephrine

1 mg IV q3-5 min

o Atropine

1 mg IV q3-5 min

Max 0.04 mg/kg

Consider possible causes (Officer Hank reporting in:"Agent (asystole) Hank Here ... He's Dead,
Marshall")
o Hypoxia
o Hyperkalemia
o Hypothermia

o Drug overdose (e.g., tricyclics)

o Myocardial Infarction

Consider termination. If patient had >10min with adequate resucitative effort and no treatable causes
present, consider cessation - it is, after all, the final rhythm.

Bradycardia

Primary Survey

Secondary Survey
o assess need for airway, oxygen, IV, monitor, fluids, vitals, pulse ox
o 12-lead ECG, Hx, P/E. Consider DDx
o If AV block:

2nd degree (type 2) or 3rd degree: standby TCP, prepare for transvenous pacing

slow wide complex escape rhythm: Do NOT give lidocaine.

If serious signs or symptoms, treat even though "Bub (bradycardia), All People Die Eventually"
o Atropine

0.5-1.0 mg IV push q 3-5 min

max 0.04 mg/kg

o Pacing

Use transcutaneous pacing (TCP) immediately if sx severe

o Dopamine

5-20 g/kg/min

o Epinephrine
2-10 g/min
Tachycardias

Primary Survey, Secondary Survey: Is patient stable or unstable?

o stable: determine rhythm, treat accordingly

o unstable

=chest pain, dyspnea, decreased level of conciousness, low BP, CHF, Acute MI

If HR is cause of symptom (almost always HR>150): cardiovert

Specific Rhythms
o Atrial fib/flutter
o Narrow-Complex (Supraventricular) Tachycardia
o Wide-Complex Tachycardia, Unknown Type
o Stable Ventricular Tachycardia

Atrial fibrillation/flutter

If unstable: proceed more urgently

Management: Control rate, consider rhythm cardioversion, and anticoagulate as shown below, according
to Category: 1, 2 or 3

Category 1. Normal EF

Rate control: Ca-blocker or beta-blocker.

Cardiovert:
o If onset < 48 hours, consider DC cardioversion OR with one of the following agents:
amiodarone, ibutilide, procainamide, (flecainide, propafenone), sotalol.
o If onset > 48 hours: avoid drugs that may cardiovert (e.g. amiodarone). Either:

Delayed Cardioversion: anticoagulate adequately x 3 weeks, then cardioversion, then

anticoagulate x 4 weeks

Early Cardioversion: iv heparin, then TEE, then cardioversion within 24 hours, then
anticoagulate x 4 weeks

Anticoagulate if not contraindicated, if A fib > 48 hrs

Category 2. EF< 40% or CHF

Rate control:
o digoxin, diltizaem, amiodarone (avoid if onset of AF > 48 hours).

o avoid verapamil, beta-blockers, ibutilide, procainamide (and propafenone/flecainide)

Cardiovert: same as Category 1, except the only conversion agent allowed is amiodarone.

Anticoagulate, if A fib > 48 hr.

Category 3. WPW A fib

Suggested by: delta wave on resting EKG, very young patient, HR>300

Avoid adenosine, beta-blocker, Ca-blocker, or Digoxin

If < 48 hour:
o If EF normal: one of the following for both rate control and cardioversion: amiodarone,
procainamide, propafenone, sotalol, flecainide
o If EF abnormal or CHF: amiodarone or cardioversion

If > 48 hour
o Medication listed above may be associated with risk of emboli
o Anticoagulate and DC cardioversion as in Category 1.

Note: new ALCS does not allow mixing antiarrhythmics for A fib/flutter.
Narrow-Complex SVT

If unstable, cardiovert

No cardioversion for stable SVT with low EF.

Management
1. 12-lead ECG, clinical exam
2. Vagal stimulation, adenosine. Consider esophageal lead
3. Treat according to specific rhythm:

PSVT
EF normal

PSVT

MAT

Junctional

Ca-blocker> beta-blocker> digoxin> DC Cardioversion.

Consider procainamide, sotalol, amiodarone.

If unstable proceed to cardioversion

EF < 40%, CHF

No Cardioversion. Digoxin or amiodarone or diltiazem.

If unstable proceed to cardioversion.

MAT

EF normal: Ca-blocker, beta-blocker, amiodarone

EF < 40%, CHF: amiodarone, diltiazem

Note: no cardioversion

Junctional

EF normal: amiodarone, beta-blocker, Ca-blocker

EF < 40%, CHF: amiodarone

Notes
o rare, most commonly misdiagnosed PSVT.
o likely digoxin or theophylline OD, catecholamine state
o no cardioversion

Wide-Complex Tachycardia, Unknown Type

If unstable, cardiovert

Attempt to establish specific diagnosis

o 12 leads, esophageal lead, Clinical info
o Note: the use of adenosine to differentiate SVT vs VT is now de-emphasized.

If unable to make Dx, treat according to EF:

o EF normal: DC cardioversion or procainamide or amiodarone

o EF < 40%, CHF: DC cardioversion or amiodarone

o Note: no lidocaine and bretylium in protocol
Stable VT

May proceed directly to cardioversion

If not, treat according to morphology:

o Monomorphic VT

EF normal: one of the following:

procainamide (2a), sotalol (2a) OR

amiodarone (2b), lidocaine (2b)

EF poor

amiodarone 150 mg iv over 10 min OR lidocaine 0.5-0.75 mg/kg iv push

Synchromized cardioversion

o Polymorphic VT

Baseline QT Normal

Possible ischemia (treat) or electrolyte (esp. low K, Mg) abnormality (correct)

EF normal: betablocker, lidocaine, amiodarone, procainamide, or sotalol

EF poor
1. amiodarone 150 mg iv over 10 min OR lidocaine 0.5-0.75 mg/kg iv push
2. synchromized cardioversion

Prolonged QT baseline (torsade)

Correct electrolyte abnormalities.

Treatment options: magnesium, overdrive pacing, isoproterenol, phenytoin,

lidocaine

Cardioversion

For tachycardia with serious signs and symptoms. Generally not needed for HR<150.

If HR>150, prepare for immediate cardioversion. May give brief drug trial.

Steps:
o Prepare emergency equipment
o Medicate if possible
o Cardioversion

monomorphic VT with pulse, PSVT, A fib, A flutter: 100-200-300-360 J*

(Synchronized)

may try 50J first for PSVT or A flutter

may use equivalent biphasic (biphasic 70, 120, 150, and 170 J)

if machine unable to synchronize and patient critical, defibrillate

polymorphic VT: use VT/VF algorithm

PEA

The "PEA" mnemonic may be even better than "ABCD!"

If not, "Please Eat Apples"

Primary Survey, then Secondary Survey: rule out pseudo-PEA (handheld doppler: look for cardiac
mechanical activities. If present treat agressively).

Problem
o Search for the probable cause ...

Wide QRS: suggests massive myocardial injury, hyperkalemia, hypoxia, hypothermia

Wide QRS+Slow: consider drug OD (tricyclics, beta-blockers, Ca-blockers, digoxin)

Narrow complex: suggests intact heart; consider hypovolemia, infection, PE, tamponade

o ... and treat as needed

Consider fluid challenge empirically

Consider bicarbonate

hyperkalemia K (Class 1)

bicarbonate responsive acidosis, tricyclic OD, to alkinalize urine for aspirin OD

(Class2a)

prolonged arrest (Class 2b)

not for hypercarbic acidosis

Epinephrine: 1 mg IV q3-5 min

Atropine
o If bradycardia, 1 mg IV q3-5 min
o max 0.04 mg/kg

Underlying Causes

5H's, 5T's

Or, if you prefer talking to fighting: He Hid His Huge Hammer, Then Thought To Try Talking

Or, if you like food: Poor (PEA) Hungry Hanna (or Hank) Hurried Herself Here, Then Tasted My Ohso-good Pie ( P=PE, M=MI, O=Overdose ... if you'd like a more lurid mnemonic, this one can easily be
changed, as in "Heavenly Hanna ..." [use your imagination])

If you prefer a mechanistic approach (and are used to thinking about MAP, CO, SVR, etc.) think of
things that affect forward flow...
o Decreased Preload: Hypovolemia, Tamponade, Tension Pneumothorax
o Increased Afterload: Pulmonary Embolus
o Decreased Contractility: Hypoxia, Hypothermia, Acidosis, Myocardial Ischemia
o Altered Rate/Rhythm: Hyperkalemia, Drug Overdose

Hypovolemia
o Assess: Collapsed vasculature
o Tx: Fluids

Hypoxia
o Assess: Airway, cyanosis, ABGs
o Tx: Oxygen, ventilation

Hydrogen ion (acidosis)

o Assess: Diabetic patient, ABGs

o Tx: Bicarb 1 mEq/kg, hyperventilation

Hyperkalemia (preexisting)
o Assess: Renal patient, EKG, serum K level
o Tx: Bicarb, CaCl, albuterol neb, insulin/glucose, dialysis, diuresis, kayexalate

Hypothermia
o Assess: Core temperature
o Tx: Hypothermia Algorithm

Tablets/toxins overdose
o Assess: Hx of medications, drug use
o Tx: Treat accordingly

Tamponade, cardiac
o Assess: No pulse w/ CPR, JVD, narrow pulse pressure prior to arrest
o Tx: Pericardiocentesis

Tension pneumothorax
o Assess: No pulse w/ CPR, JVD, tracheal deviation
o Tx: Needle thoracostomy

Thrombosis, coronary
o Assess: History, EKG
o Tx: Acute Coronary Syndrome algorithm

Thrombosis, pulmonary embolism

o Assess: No pulse w/ CPR, JVD
o Tx: Thrombolytics, surgery

Unstable VT/VF

Remember: initial stacked shocks are part of the primary survey

Implement the secondary survey after your stacked shocks.

Meds: drug-shock-drug-shock pattern. Continue CPR while giving meds, and shock (360J or 150J if
biphasic) within 30-60 seconds. Evaluate rhythm and check for pulse immediately after shocking.

Epi or vasopressin big drugs (may give either one as first choice).
o If VF/PVT persists, may move on to antiarrhythmics and sodium bicarb
o max out one antiarrhythmic before proceeding to the next in order to limit pro-arrhythmic drugdrug interactions.

"Think Shock Shock Shock, EVerybody Shocks: Anna (nicole smith) Shocks, Lydia (possner) Shocks,
Madeleine (cox) Shocks, Pamela (anderson) Shocks, Bridget (hall) Shocks" ... this one needs some
work. I couldn't think of enough names, so did a quick search for "models" and found a list - I
recognized only a few names; choose your own favorites (this page happens to have only females, I
think)

Precordial Thump
o May be performed immediately after determining pulselessness in a witnessed arrest with no
defibrillator immediately available.
o Check pulse after thump.

Shock 200J*
o If VF or VT is shown on monitor: shock immediately.
o Do not lift paddles from chest after shocking - simultaneously charge at next energy level and
evaluate rhythm.

Shock 200-300J*
o If VF or VT persists on monitor, shock immediately.
o Do not check pulse, do not continue CPR, do not lift paddles from chest.
o After shocking, simultaneously charge at next energy level and evaluate rhythm.

Shock 360J*
o If VF or VT persists, shock immediately.

Epinephrine
o 1 mg IV q3-5 min.
o High dose epinephrine is no longer recommended

Vasopressin
o 40 U IV
o one time dose (wait 5-10 minutes before starting epi).
o Preferred first drug?

Shock 360J*

Amiodarone (Class 2b)

o 300mg IV push.
o May repeat once at 150mg in 3-5 min
o max cumulative dose = 2.2g IV/24hrs

Shock 360J*

Lidocaine (Class Inderterminate)

o 1.0-1.5 mg/kg IV q 3-5 min
o max 3 mg/kg

Shock 360J*

Magnesium Sulfate (Class 2b)

o 1-2 g IV (over 2 min) for suspected hypomagnesemia or torsades de pointes (polymorphic VT)

Shock 360J*

Procainamide "Acceptable but not recommended" in refractory VF (Class 2b)

o 30 mg/min or 100 mg boluses q 5 min, up to 17 mg/kg.
o Besides having a pro-arrhythmic drug-drug interaction with amiodarone, procainamide is of
limited value in an arrest situation due to lengthy administration time.
o Note: bretylium acceptable but no longer recommended in ACLS

Shock 360J*

Bicarbonate
o 1 mEq/kg IV for reasons below:

Class 1: hyperkalemia

Class 2a: bicarbonate-responsive acidosis, tricyclic OD, to alkinalize urine for aspirin OD

Class 2b: prolonged arrest

o Not for hypercarbia-related acidosis, nor for routine use in cardiac arrest

Shock 360J*

* Or equivalent biphasic shocks (150J-150J-150J). Biphasic refers to pattern of energy wave, which is first
positive then negative, i.e. in opposite direction (vs. only positive in traditional monophasic shocks). It requires
less energy to achieve equivalent results. Lower energy requirements = smaller, lighter, cheaper, longer-lasting
defibrillators. All new ICDs, for example, are biphasic. Newer defibrillators also monitor impedence, and
compensate for changes. Success rates may be higher with impedence-compensated biphasic defibrillation.
See this AHA site for details.
ACLS Drugs
adenosine: 6-12 mg iv push with saline flush q 5 min
amiodarone:
Non-cardiac arrest
o load 15 mg/min over 10 min (150 mg) (mix 150 mg in 100cc D5W in PVC or Glass, infuse over
10 min)
o then 1 mg/min x 6 hrs (mix 900 mg in 500 cc D5W)
o then 0.5 mg/min x 18 hrs and beyond;
o supplemental bolus: 15 mg/min x 10 min

Cardiac arrest
o 300 mg iv push (diluted in 20 cc D5W)
o can consider repeat 150 mg iv x 1

Max dose: 2.2 gm in 24hrs

atropine: 0.5-1 mg, up to 0.04 mg/kg

epinephrine: 1 mg q3-5 min iv
diltiazem:

load 0.25mg/kg iv over 2 min, then 0.35mg/kg over 2 min in 15 min

infuse 5-15 mg/hour

ibutilde:

>60 kg 1 mg

<60 kg 0.01 mg/kg over 10 min

may repeat x 1

make sure K>4.0 and Mg normal.

not recommended for low EF

lidocaine:

1 mg/kg bolus

additional 0.5 mg/kg q8-10 min, up to total 3 mg/kg.

Then infuse 1-4 mg/min

magnesium sulfate: 1-2g over 5-60 min

procainamide:

load 20 mg/min up to 17 mg/kg (1000 mg)

then infuse 1-4 mg/min

Side Effects: HTN, torsade

vasopressin: 40 IU x 1 dose only (for pulseless VT/VF)

verapamil: 2.5-5-10 mg bolus
Class Definitions: I II III Indeterminant
Class I

Definitely recommended. Definitive, excellent evidence provides support.

Definition
Class I interventions are always acceptable, unquestionably safe, and definitely useful.
Proven in both efficacy and effectiveness.**
Must be used in the intended manner for proper clinical indications
Required Evidence
One or more Level 1 studies are present (with rare exceptions).
Study results are consistently positive and compelling.

Class IIa and IIb

Acceptable and useful

Definition
o Both Class IIa and IIb interventions are acceptable, safe, and considered efficacious, but true
clinical effectiveness is not yet confirmed definitively.

o Must be used in the intended manner for proper clinical indications.

Required Evidence
o Available evidence, in general, is positive.
o Level 1 studies are absent, inconsistent, or lack power.
o Classes IIa and IIb are distinguished by levels of available evidence and consistency of results.
o No evidence of harm.

Class IIa

Acceptable and useful. Very good evidence provides support.

Definition
o Class IIa interventions are acceptable, safe, and useful in clinical practice.
o Considered interventions of choice.

Required Evidence
o Generally higher levels of evidence.
o Results are consistently positive.

Class IIb

Acceptable and useful. Fair-to-good evidence provides support

Definition
o Class IIb interventions are acceptable, safe, and useful in clinical practice.
o Considered optional or alternative interventions.

Required Evidence
o Generally lower or intermediate levels of evidence.
o Results are generally but not consistently positive.

Class III

Not acceptable, not useful, may be harmful

Definition

o Class III interventions are unacceptable, not useful in clinical practice, and may be harmful.

Required Evidence
o Complete lack of positive data from higher levels of evidence.
o Some studies suggest or confirm harm.

Class Indeterminant

Definition
o A continuing area of research; no recommendation until further research is available.

Required Evidence
o Higher-level evidence unavailable; studies in progress, inconsistent, or contradictory.

ADENOSIN
Indikasi Obat utama pada takikardia dengan QRS sempit, PSVT (paroxymal Supraventrikular
Tachycardia).

Efektif untuk menghentikan proses masuk kembali yang terjadi pada nodus AV dan Nodus SA. Obat ini
tidak mempunyai efek untuk menghentikan fibrilasi atrial, flutter atrial atau takikardia ventrikel.
Efek samping dan perhatian khusus Flushing, periode asistol atau brakikardia, ventrikular ektopi
Kurang efektif pada pasien yang mengonsumsi teofilin, jangan berikan pada pasien yang mendapat
dipiridamole Jika diberikan pada takikardia dengan QRS lebar (VT) karena dapat menyebabkan
perburukan termasuk hipotensi Periode transien sinus brakikardia dan ventrikel ektopik bisa terjadi
setelah terminasi SVT Kontraindikasi Blok AV derajat 2 atau 3 Takikardia yang disebabkan karena
obat Dosis Letakkan pasien pada posisi trendelenberg sebelum pemberian obat Bolus 6 mg IV cepat
dalam waktu 1-3 detik diikuti bolus saline normal 20 ml, kemudian lengan diangkat Ulangi pemberian
12 ml IV dalam 1-2 menit jika diperlukan, dapat diulangi lagi Adenosin 12 mg IV dapat diberikan
dengan jarak 1-2 menit setelah pemberian dosis kedua
AMIODARON
Indikasi Digunakan secara luas untuk fibrilasi atrial dan takiaritmia ventrikular. Selain itu untuk
mengontrol kecepatan nadi pada aritmia atrial dan pada pasien dengan funsi ventrikel kiri yang menurun
jika pemberian digoksin sudah tidak efektif. Pemberian direkomendasikan pada keadaan berikut:
Pengobatan VF yang refrakter atau VT tanpa nadi Pengobatan VT yang polimorfik dan takikardi
dengan QRS lebar yang tidak jelas sumbernya Sebagai obat pndukung pada kardioversi elektrik kasus
SVT dan PVST Takikardi atrial multifokal dengan fungsi ventrikel kiri yang baik Mengontrol
kecepatan nadi fibrilasi atrial Efek samping dan perhatian khusus Vasodilatasi dan hipotensi Memiliki
efek inotropik negatif Memiliki efek memperpanjang interval QT Dosis Pada henti jantung 300 mg
IV cepat (dalam panduan AHA th 2000, dianjurkan untuk diencerkan dengan 20-30 ml dekstrose 5%).
Pertimbankan pemberian berikutnya sebanyak 150 mg IV dalam 3-5 menit. Dosis kumulatif maksimum
2,2 gram IV/24 jam. Pada kompleks QRS lebar yang stabil, maksimum pemberian 2,2 gramIV/24 jam.
Cara pemberian dengan bolus 150 mcg IV dalam 5-10 menit dapat diulang 150 mg IV setiap 10 menit
jika diperlukan. Dilanjutkan dosis 360 mg IV selama 6 jam (1mg/menit). Dosis pemeliharaan 540 mg IV
dalam 18 jam (0,5 mg/menit). Jangan diberikan secara bersamaan dengan procainamide.

SULFAS ATROPIN Indikasi Obat utama pada sinus brakikardia (kelas 1). Mungkin memiliki efek pada
AV blok pada level nodal (kelas 2A) atau pada asistol ventrikular. Tidak efektif pada tingkat blok infranodal
(mobitz tipe 2) (kelas 2 B) Obat pilihan kedua setelah epinefrin atau vasopressin untuk asistol , brakikardi,
dan Pulseless electrical activity (kelas 2 B) Efek samping dan perhatian khusus Hati hati pemberian pada
hipoksia dan iskemia karena iskemia dapat meningkatkan kebutuhan oksigen miokard Hindari pada
bradikardia hipotermi Tidak efektif untuk infra nodal AV blok ,dan AV blok tipe 3 dengan QRS kompleks
yang lebar Cera pemberian Pada asistol atau Pulseless electrical activity 1mg IV cepat, diulangi setiap 3-5
menit. Jika asistol menetap dapat diulangi dampai mencapai dosis maksimum 0,03-0,04 mg/kgBB Pada
brakikardia diberikan 0,5-1 mg IV setiap 3-5 menit sesuai kebutuhan tidak melebihi 0,04 mg/kg BB.
Penggunaan dengan interval jangka pendek (3 menit) dan dosis yang lebih tinggi (0,04mg/kg BB) deberikan
pada kondisi klinis yang berat. Pemberian melalui trakea dengan dosis 2-3 X dosis IV diencerkan dalam 10
ml saline normal. 4. VERAPAMIL Indikasi Obat pliha alternatif setelah adenosine untuk menghentikan
PSVT (paroxysmal supraventrikular tachycardia) dengan QRS sempit dan tekanan darah yang adekuat dan
fungsi ventrikel kiri yang baik Mengontrol respons ventrikel pada pasien dengan fibrilasi atrial, flutter
atrial atau multifokal atrial takikardia. Kontraindikasi dan efek samping Jangan digunakan pada takikardia
dengan QRS kompleks yang lebar yang tidak diketahui sumbernya Jangan diberikan pada WPW dan
fibrilasi atrial, sick sinus syndrome, atau AV blok dearjat 2 dan 3 Dapat menyebabkan vasodilatasi perifer
dan penurunan kontraktilitas miokard sehingga menyebabkan hipotensi Cara pemberian 2,,5 5 mg IV
bolus selama lebih dari 2 menit. Dosis berikutnya 5-10 mg IV jika diperlukan dengan interval waktu 15-30

menit dari pemberian dosis pertama. Dosis meksimum 20mg IV Alternatif : 5 mg bolus tiap 15 menit
dengan total dosis 30 mg. Pada usia lanjut obat diberikan selama lebih dari 3 menit. 5. DILTIAZEM Untuk
mengontrol kecepatan nadi pada fibrilasi atrial dan flutter atrial. Dapat menghentikan re-entrant arrhytmia
pada tingkat AV nodal. Digunakan setelah pemberian adenosin untuk mengibati PSVT pada pasien dengan
QRS kompleks yang sempit dan tekanan darah yang adekuat. Efek samping Jangan gunakan penghambat
kanal kalsium pada QRS kompleks lebar dengan sumber yang tidak jelas atau obat-obatan yang memicu
takikardia Cegah pemberian penghambat kanal kalsium pada pasien dengan sindrom wolf-parkinson-white
dengan fibrilasi atrial atau flutter atrial, sick sinus syndrome atau pasien dengan blok AV Perhatian bahwa
tekanan darah dapat menurun akibat vasodilatasi perifer Cara pemberian Untuk mengontrol denyut nadi,
berikan 15-20 (0,25 mg/kg) IV selama lebih dari 2 menit. Dapat diulangi 15 menit kemudian dengan dosis
20-25 mg(0,35 mg/kg) selama lebih dari 2 menit. Dosis pemeliharaan 5-15 mg/jam, dititrasi sesuai dengan
denyut nadi. Dapat deiencerkan dengan dekstrose 5% atau normal saline. 6. LIDOKAIN Indikasi Diberikan
pada henti jantung dengan irama VF/VT tanpa nadi. Bisa juga diberikan pada VT stabil, dengan kompleks
QRS lebar dengan tipe yang tidak jelas. Dapat diberikan melalui selang endotrakeal. Efek samping Jika
pemberian berlebihan dapat menimbulkan tanda- tanda toksisitas Dosis dikurangi pada pasien dengan
fungsi hati yang menurun, maupun fungsi ventrikel kiri yang menurun Pemberian pencegahan pada IMA
tidak dianjurkan Cara pemberian Dosis awal 1-15 mg/kg BB IV bolus Untuk VF refrakter :0,5 0,75
mg/kg IV diulangi 5-10 menit kemudian, dengan dosis maksimum 3 ml?kg BB Dosis tunggal 1,5 mg/kg
BB IV pada henti jantung Pemberian melalui trakea 2-4 mg/kg BB Pada aritmia VT stabil , QRS kompleks
lebar dengan tipe yang tidak jelas, ektopi yang signifikan, dosisnya adalah 0,5 0,075 mg/kg BB IV sampai
1-1,5 mg/kg BB IV diulangi setiap 5 10 menit dengan total dosis 3 mg/kg. Dosis pemeliharaan 1-4
mg/menit IV (30-50 ug/kg BB per menit) diencerkan dalam D5W D10W atau normal saline 7.
MAGNESIUM SULFAT Indikasi Dianjurkan pada henti jantung hanya jika terjadi Torsaides de Pointes
atau hipomagnesemia VF refrakter (setelah pemberian lidokain) Torsaides de Pointes dengan nadi
Mengobati ventrikel aritmia yang disebabkan intoksikasi digitalis Pemberian profilaksis pada IMA tidak
dianjurkan Kontraindikasi Seringkali terjadi penurunan TD pada waktu diberikan secara tepat Hati hati
pemberian pada orang yang terkena gagal jantung Dosis Pada henti jantung (jika terjadi hipomagnesemia)
atau Torsaides de pointes Torsaides de pointes (tanpa henti jantung) : bolus 1-2 g dicampur dalam 50-100
cc D5W selama lebih dari 5-60 menit IV. Lanjutkan dengan 0,5-1g perhari IV IMA jika ada indikasi :
bolus 1-2 g dicampur dalam 50-100 cc D5W selama lebih dari 5-60 menit IV. Lanjutkan dengan 0,5-1g
perhari IV