Adrenaline

Indication: Cardiac arrest—give immediately if bradyasystolic rhythm or after the second shock if VF/pVT
Cautions: Ensure reliable IV access; do not use cardiac arrest dose in a patient with a pulse.
Comments: Can be given via intraosseous route if IV access not available.
Dose: Available in 1 mg ampoules or rapid-access syringes (1:1000 (equivalent 1 mg/mL) and 1:10,000 ampoules (equivalent 0.1 mg/mL) concentrations)
- Adult:
  - IV, intraosseous: 1 mg rapid IV (using 1 mL of 1:1000 solution or 10 mL of 1:10,000 solution) This is repeated every 3–5 min followed by a 20 mL normal saline flush to ensure central delivery of the drug (if using a peripheral vein)
  - IV infusion: 1-4mcg/min; seek specialist advice
- Child:
  - IV, intraosseous: 10mcg/kg (max: 1mg as single dose) repeat every 3-5 min

Amiodarone

Also see: Antiarrhythmics
Indication: Cardiac arrest—give following 3rd shock in refractory VF/pVT
Adverse effects: may worsen bradyarrhythmias
Cautions: Thrombophlebitis when injected into a peripheral vein. Not compatible with normal saline give with glucose 5%
Comments: Can be given via intraosseous route if IV access not available - It is oily; shaking will cause bubbles and make it hard to draw up
Dose: Available in 150 mg ampoules.
- Give amiodarone 300 mg (6mL) IV or IO diluted in 5% dextrose up to 20 mL over 1-2 mins after the third shock
  - Flush with 5% dextrose or 0.9% sodium chloride, minimum of 20mLs
- Repeat 150 mg dose in 3–5 min if VF/pVT persists
- An infusion may be ordered after bolus dose(s) e.g. 15mg/kg over 24 hours

Indication: Cardiac arrest associated with hyperkalaemia (not due to digoxin toxicity), hypocalcaemia, calcium-channel blocker toxicity
Cautions: Thrombophlebitis when injected into a peripheral vein. Not compatible with sodium bicarbonate → Do not give calcium solutions and sodium bicarbonate simultaneously by the same route
Comments: Can be given via intraosseous route if IV access not available; flush well after use
Dose: Available as 10% calcium chloride (6.8 mmol in 10 mL) and 10% calcium gluconate (2.2 mmol in 10 mL) ampoules
- Cardiac arrest: 10 mL of Ca chloride or 30 mL of Ca gluconate as rapid IV bolus. Repeat in 3–5 min if no response

Indication: Cardiac arrest → give following 3rd shock in refractory VF/pVT if amiodarone unavailable
Actions: Membrane-stabilising antiarrhythmic
Adverse effects: Proarrhythmic → may worsen bradyarrhythmias
Comments: Can be given via intraosseous route if IV access not available
Dose: Available 100mg ampoules or rapid access syringes
- Cardiac arrest: 100mg rapid IV bolus. Repeat in 3-5 min if no response

Indication: Cardiac arrest associated with hypomagnesaemia, torsades de points or digoxin toxicity; third line agent in refractory VF/pVT
Comments: Can be given intraosseous route if IV access not available
Dose: Available as 0% magnesium sulfate ampoules (2.g/10mmol in 5mL)
- Cardiac arrest: 10mmol rapid IV bolus. Repeat in 3-5 minutes if no response

Indication: Cardiac arrest associated with hyperkalaemia, sodium channel blocker activity toxicity (TCA overdose) or severe metabolic acidosis, protracted arrest (>15 minutes)
Cautions: Not compatible with calcium or adrenaline → Do not give simultaneously by the same route
Comments: Can be given via intraosseous route if IV access not available
Dose: Available in 100mL of 8.4% (100mmol) ampoules or 50mL of 8.4% (50mmol) rapid-access syringes
- Cardiac arrest: 50mmol rapid IV bolus. Repeat in 3-5 min if no response