EMS Field Case Management

EMS Field Drugs: Pharmacological Tools

Use of any ACLS medication should be within your scope of practice and after thorough study of actions and side effects. This table is a brief reminder for trained professionals.

Drug	Main ACLS Use	Dose / IV / IO	Notes
Sotalol	Tachycardia rate control, Wide QRS tachycardia	100 mg (1.5 mg/kg) IV over 5 min	Do not use in prolonged QT or CHF
Atropine	Symptomatic bradycardia, Specific toxins/overdose	1 mg IV/IO; Max 3 mg	Minimum dose 0.5 mg; avoid in glaucoma/tachyarrhythmias
Lidocaine	VT with pulse (stable), Wide complex tachycardia	Initial 1–1.5 mg/kg IV; Maintain 1–4 mg/min	Use when Amiodarone not available
Adenosine	Narrow PSVT/SVT, Wide QRS tachycardia	6 mg IV bolus; repeat 12 mg in 1–2 min	Rapid IV push; causes flushing, chest heaviness
Dopamine	Shock/CHF, Symptomatic bradycardia	5–20 mcg/kg/min infusion	Titrate to BP/HR; continuous monitoring
Epinephrine	Anaphylaxis, Cardiac Arrest, Shock	1 mg IV/IO (1:10,000); 0.3–0.5 mg IM	Distinguish 1:1,000 vs 1:10,000; monitor BP/HR
Amiodarone	VF/pulseless VT, Tachyarrhythmia	150 mg over 10 min (VT/VF); 300 mg IV (VF/VT)	Long half-life; avoid in 2nd/3rd-degree block
Procainamide	Wide QRS tachycardia, VT with pulse	20–50 mg/min IV until rhythm improves	Max dose 17 mg/kg; avoid with Amiodarone
Magnesium Sulfate	Torsades de Pointes, Pulseless VF/VT	1–2 gm IV over 5–60 min; Maintain 0.5–1 gm/hr	Calcium chloride can reverse hypermagnesemia