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Acls Drugs

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  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  Back to Top of Page  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. o   Lower-level studies, when available, are not compelling. **Efficacy versus effectiveness. Evidence-based medicine draws sharp distinctions between efficacy and effectiveness, terms that initially seem synonymous. Drugs and other interventions may produce a significant level of benefit in tightly designed, closely controlled, and rigidly executed laboratory or clinical trials. These trials are a measure of efficacy--under the rigorous conditions of a controlled clinical study, the intervention seems to work. When applied in actual practice, however, the intervention does not perform nearly as well. Effectiveness is the degree to which the intervention continues to produce positive benefits when used as intended in clinical practice--in the real world. To communicate clearly, the term useful clinically is used to mean effectiveness. Back to Top of Page Much of the information on this site comes from these unofficial sites: acls2000 and acls.net.  Also, from the American Heart Association's site. Back to Top of Page 
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