Epinephrine (Cardiac Arrest Protocol)
Epinephrine is the drug of choice for all “dead guy” protocols. No drug has proven superior for increasing cerebral and coronary blood flow
Epinephrine is used as a 1:10000 prefill in cardiac arrest (1 mg / 10 cc).
Indications: all cardiac arrest rhythms, atropine-resistant bradycardia (infusion)
Route: IV, IO or ETT. ETT administration is discouraged
Dose for cardiac arrest: 1 mg q 3-5 minutes IV or IO.

Amiodarone (Cardiac Arrest Protocol)
This is an antidysrhythmic with many properties and complex drug interactions (caution for patients with shellfish allergies):
Indications: refractory shockable cardiac arrest
Dose: 300 mg IVP X1, repeat once @ 150 mg IVP p 5 minutes
Route: IV or IO

Lidocaine (Cardiac Arrest Protocol)
Indications: refractory shockable cardiac arrest
Dose: 1.0 - 1.5 mg/Kg initial dose followed by half doses every 3-5 minutes up to 3.0 mg/Kg
Route: IV or IO

Atropine (Bradycardia Protocol)
Indications: symptomatic bradycardia
Dose: 1.0 mg IVP, may be repeated as needed to a max of 3.0 mg
Route: IV,IO or ETT. ETT administration is discouraged
Always administer full therapeutic doses with a rapid push (give with conviction!)
Atropine should be used with caution for patients with suspected AMI

Dopamine infusion (Bradycardia Protocol)
Indications: second-line drug for symptomatic bradycardias; hypotension with signs of shock
5-20 mcg/kg/min for bradycardia; titrate to patient response

Epinephrine infusion (Bradycardia Protocol)
Indications: second-line drug for symptomatic bradycardias; hypotension with signs of shock
2-10 mcg/min for bradycardia; titrate to patient response

Adenosine (Tachycardia Protocol)
Indication: stable narrow complex SVT if vagal maneuvers are unsuccessful; unstable narrow complex SVT while preparing for cardioversion; stable, regular and monomorphic wide complex tachycardias that may possibly be SVT
Dose: 6 mg, followed by 12 mg if needed 1-2 minutes later, rapid IVP, in a proximal vein, followed by 20 cc flush
Route: IV or IO, must be sped into central circulation due to rapid metabolism
Expect to see significant but transient post-administration dysrhythmias and symptoms

Aspirin (Acute Coronary Syndrome Protocol)
The routine use of ASA is strongly recommended (Class I) in all patients with AMI or ACS
Give aspirin EARLY!
Dose 162-325 mg PO, chewed

Oxygen
Gauge delivery and percentage to patient presentation; AHA recommends titrating O2 delivery to SaO2 94-98% for hypoxic patients
Use caution when defibrillating

Oxygen (Acute Coronary Syndrome Protocol)
Gauge delivery and percentage to patient presentation; AHA recommends titrating O2 delivery to SaO2 ≥ 90% for ACS patients

Nitroglycerine SL  (acute coronary syndrome protocol)
Indications: ischemic CP, angina, AMI, CHF, pulmonary edema
Dose: 0.3-0.4 mg tablet or spray SL q 5 minutes
Route: SL
Contraindications: Viagra, Cialis, Levitra, SBP < 90, heart rate <50 or > 100, use with caution in MI with RV involvement

Morphine (acute coronary syndrome protocol)
Indications: AMI, myocardial chest pain, CHF, pulmonary edema
Dose: 2-10 mg slow IVP prn
Route: IV
Cautions: BP, respiratory drive, keep naloxone handy