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ACLSDrugs
byMarkJaimison

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ACLSprotocolutilizesthehighestqualitypharmaceuticalsinthefieldofemergencymedicine.Inorderto
preventfurtherinjury,ACLStrainedprofessionalsinitiateIVaccessorintubationincertainsituations
whereimmediateinterventionisneeded,suchasseriouscardiaceventsandstroke.Inprehospital
settings,thesepharmaceuticalsarevitaltokeepthepersonaliveandstableduringtransporttoa
medicalfacility.
ThepharmacologyusedbyACLSprovidersisthesameusedinhospitalsbyphysiciansworkingwiththe
samekindofmedicalemergencies.ACLScertificationcoursesprovideavastamountofinformation
aboutthesedrugs,andtraineeslearntodeterminewhichdrugtouseinanygivenclinicalsituation
throughthedifferentACLSalgorithms.
HerearesomeofthemostcommonlyuseddrugsforvariouscardiovasculareventsutilizedinACLS
protocol:
VentricularFibrillation/VentricularTachycardia
Vasopressin:Usedinthepulselessarrestalgorithmtoraisebloodpressureandinducemoderate
vasoconstriction.Hasbeenshowntobemoreeffectivethanepinephrineduringasystoliccardiac
arrest.
Epinephrine:Adrugwithpowerfulvasoconstrictiveeffects,usedtoincreasecardiacoutput.Canbe
giventhroughIV/IOandendotrachealtube.
Amiodarone:Antiarrhythmicagentusedforvarioustachyarrythmias,administeredthroughIV/IO.
Lidocaine:UsedasanalternativeinVT/VFcardiacarrestwhenamiodaroneisineffective.
Bradycardia
Epinephrine:Increasesheartrate,heartcontractility,andconductivitythroughtheAVnode.

Atropine:IncreasesactivityintheSAnodebyblockingthevagasnerveandincreasingheartrate.
Mostcommonlyuseddrugforbradycardia.
Dopamine
Tachycardia
Adenosine:Themaindrugusedtotreatsupraventriculartachycardia(stablenarrowcomplex).It
interruptsreentrythroughtheAVnodeandrestoresnormalsinusrhythm.Itisquicklyabsorbed
byredbloodcellsbeforebeingmetabolizedbythebody.
Betablockers:Neutralizestheeffectsofstresshormonesandepinephrine(adrenaline),whichcan
triggerorexacerbatetachyarrhythmias.
Dilitiazem
Digoxin
Amiodarone
Asystole/PEA
Vasopressin
Epinephrine
AcuteCoronarySyndomes
Aspirin
Oxygen
Morphine
Nitroglycerin
AcuteStroke
tPAtissue:Breaksdownbloodclotsinthetreatmentofembolicorthromboticstroke.
Glucose(D50)
PlasminogenActivator
Allofthesedrugshavespecificconditionsanddosagesforuse.Thesedrugsareverypowerful,andalso
comewithsomeserioussideeffects,soACLSprovidersmustexercisecautionandaccuratelydetermine
thecorrectdruganddosagestouse.ACLStrainingfeaturescomprehensivealgorithmswhich
professionalsfollowstepbysteptoensurethatoptimalpharmaceuticalcareisprovided.
OurACLSPharmaceuticalsReview&Tips:
Aspreviouslynoted,ACLSisaseriesofmedicalproceduresputintoactionusingstepbystepmethods,
inordertosaveapatientsufferingfromcardiacarrestorcertainothersimilarmedicalemergencies.In
additiontoproceduresandtechniques,drugsandmedicationsarealsousedtohelpmanageapatient
andbringhimbacktolife.
Thereareseveralsetsofmedicationsthatareadministeredthroughoutthealgorithmstokeepthe
patientrecovering,stepbystep.Furthermore,certainmedicationsaretobeadministeredimmediatelyor
inprehospitalsettingswhileothersetsofmedicationsaretobeadministeredintheemergencyroom

afterwards.
ForACLSstudents,itisveryimportanttothoroughlyunderstandafewpointsregardingmedication
administration:
Itisveryimportanttoknowthenatureofthedrug/drugs
Itiscruciallyimportanttounderstandthepropertimeforadministeringmedications
Itisalsoveryimportanttounderstandthepropermethodofdrugadministration
Theaffectofmedicationisalsotobeunderstood,carefully.
ACLSmedicationsareadministeredforseveralpurposesi.e.tokeepapersonaliveandprotectingand
preparingtheheartforlaterinterventions.
TheAmericanHeartAssociationhasprovidedprotocolsforpropermedicationdistributionandregularly
updatestheseprotocolsfromtimetotime.Hence,itisveryimportantforallmedicalprofessionalsto
learntheACLSprotocolsandkeepupdatingthemselvesasneeded.Hereisashortoutlineofthe
medicationsadministeredthroughouttheAdvancedCardiacLifeSupportalgorithm.

PreHospitalMedications
AtthebeginningoftheLifeSupportprocedure,thereareseveraldrugsthatcanbeadministered.These
medicationsareaimedatinstantreliefandpreparingapatientforfurthertreatment.Thesemedications
maybeadministered:
Orally
ThroughIntravenousInjectionsalsoknownasIV
InjectedinBones/IO
ThroughETtube
OnlyParamedicsarecertifiedfordrugadministrationandEMTsarenotallowedtoadminister
medicationsinanambulance.However,undersomeconditionstheyareallowedtoadminister
nitroglycerinforrelievingchestpainandaspirin.
Thetypicalmedicationsthatareusedduringprehospitalsettingsorinanambulanceare:
Atropine
Diltiazem
Adenosine
Epinephrine
Lidocaine
Magnesium
Verapamil
Vasopressin
Therearecertainotherdrugsthatarecarriedbyambulancepersonnelforrelievingchestpainandother
symptomsarisingfromcardiacarrest,asidefromtheaforementionedpharmaceuticals.Afewofthem
are:

Aspirin
Dopamine
Sodiumbicarbonate
Morphine
Calcium

EmergencyRoomMedications
Afterthepatientreachestheemergencyroom,heistobeadministeredwithseveralothermedications
forpropertreatment.ThesedrugsmaybelongtotheprimaryorsecondarygroupsofAdvanceCardiac
LifeSupportdrugs.PrimaryACLSmedicationsarethosewhicharetobeadministeredtokeepthe
patientaliveandaregenerallyadministeredinprehospitalsettings.However,duetostorageorcost
issues,therearecertaindrugsthatcannotbecarriedintheambulanceandaregiventothepatientas
soonashearrivestotheemergencyroom.Ontheotherhand,secondarydrugsarethosewhichareto
beadministeredtoweedtherootcauseout.
Themedicationsthatarenormallyadministeredintheemergencyroomsettingsare:
DigoxinorAmiodaronefornormalizingabnormalheartrhythms
Drugsforflushingclotsoutofheart
DrugsfornormalizingBloodpressurei.e.BetablockersorACEinhibitors
Drugsforthinningbloodtopreventclotformationinsideheartorarteries.
Inadditiontothesedrugs,severalotherdrugsaredetailedintheACLSprotocolsissuedbytheAmerican
HeartAssociation.TheguidelinesforAdvancedCardiacLifeSupportprovidedetailedalgorithmsfor
treatingseveralcardiacconditionsthatmayendupinarrestandprocedurestofighttheseconditionsin
ordertosavelives.Whenproperclinicalguidelinesarecoupledwithproperorprescribeddrugs,the
recoveryofpatientsiseffectiveandfastidious.

VentricularFibrillation
Epinephrine
Vasopressin
Amiodarone
Lidocaine
Magnesium

Asystole/PEA
Epinephrine
Vasopressin

Bradycardia
Atropine
Epinephrine
Dopamine

Tachycardia
Adenosine
Diltiazem
Betablockers
Amiodarone
Digoxin
Verapamil
Magnesium

AcuteCoronarySyndrome
Oxygen
Aspirin
Nitroglycerine
Morphine
FibrolynicTherapy
Heparin
Betablockers

AcuteStrokeCare
tPA(tissueplasminogenactivator)
Glucose
Labetolo
Nitroprusside
Nicardipine
Aspirin

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