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nitrates AND phosphodiesterase inhibitors

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American Heart Association ACLS suspected acute coronary syndrome nitroglycerin contraindication phosphodiesterase inhibitor 24 hours

Use of a phosphodiesterase inhibitor within the previous 24 hours is the contraindication.
Examples include sildenafil and vardenafil. Combining them with nitrates can cause profound, potentially life-threatening hypotension. This combination is described as an absolute contraindication in Fuster and Hurst’s The Heart, Anti-Ischemic Therapy.
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cardiac arrest intravenous intraosseous access

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AHA adult cardiac arrest algorithm asystole establish IV IO access epinephrine

Establish IV or IO access.
For asystole, continue high-quality CPR, obtain IV/IO access, and give epinephrine as soon as feasible. Do not interrupt CPR for intubation or an extra pulse check.
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amiodarone ventricular fibrillation cardiac arrest

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site:cpr.heart.org adult cardiac arrest algorithm amiodarone 300 mg refractory VF pulseless VT

Amiodarone 300 mg IV/IO bolus.
For refractory pulseless VT/VF after shocks and epinephrine, prepare amiodarone 300 mg. The current AHA cardiac-arrest algorithm lists this as the first antiarrhythmic dose.
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atropine symptomatic bradycardia

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site:cpr.heart.org 2025 adult bradycardia algorithm atropine 1 mg initial dose

1 mg atropine IV bolus.
For symptomatic bradycardia with hypotension, repeat every 3 to 5 minutes as needed, up to a maximum total dose of 3 mg.
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adenosine supraventricular tachycardia

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site:cpr.heart.org 2025 adult tachycardia algorithm regular narrow complex adenosine 6 mg

Adenosine 6 mg rapid IV push, followed immediately by a normal-saline flush.
This is stable, regular narrow-complex tachycardia that did not respond to vagal maneuvers. If needed, the next dose is 12 mg.
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symptomatic bradycardia dopamine atropine

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site:cpr.heart.org 2025 adult bradycardia atropine ineffective dopamine 5 to 20 mcg/kg/min

Initiate dopamine infusion at 5 mcg/kg/min IV.
The patient has unstable symptomatic bradycardia with severe hypotension and altered mental status, unresponsive to two atropine doses. Dopamine infusion is appropriate and can be titrated to response.

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asystole epinephrine cardiac arrest

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site:cpr.heart.org 2025 adult cardiac arrest algorithm asystole epinephrine 1 mg 3-5 minutes

Epinephrine.
For asystole, continue high-quality CPR, establish IV/IO access, and give epinephrine 1 mg every 3 to 5 minutes while treating reversible causes. Defibrillation, atropine, and transcutaneous pacing are not indicated for asystole.
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aspirin acute myocardial infarction

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site:heart.org acute coronary syndrome aspirin 162 325 mg chew contraindication gastritis

Give aspirin 162 to 325 mg to chew.
A remote history of treated gastritis is not a contraindication to aspirin in STEMI. Chewed, non-enteric-coated aspirin provides rapid antiplatelet effect.
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ventricular fibrillation cardiac arrest epinephrine

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site:cpr.heart.org 2025 adult cardiac arrest ventricular fibrillation after second shock epinephrine 1 mg IV IO

Epinephrine 1 mg IV/IO.
After the second shock for ventricular fibrillation/pulseless VT, resume CPR and administer epinephrine 1 mg IV/IO, repeated every 3 to 5 minutes. Antiarrhythmic therapy is considered after the next shock if the rhythm remains refractory.
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asystole epinephrine cardiac arrest

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site:cpr.heart.org 2025 adult cardiac arrest algorithm asystole epinephrine 1 mg IV IO

Epinephrine 1 mg IV.
For asystole, continue high-quality CPR and administer epinephrine 1 mg IV/IO every 3 to 5 minutes. Atropine is not recommended for asystolic cardiac arrest.
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cardiac arrest intravenous intraosseous access

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site:cpr.heart.org adult cardiac arrest preferred medication administration IV IO 2025

IV or IO.
Use intravenous access first when feasible. Intraosseous access is appropriate if IV access cannot be quickly obtained.
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acute myocardial infarction hypotension fluid bolus

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site:heart.org STEMI hypotension nitroglycerin contraindicated fluid bolus acute coronary syndrome

IV fluid bolus.
The patient has severe hypotension (BP 78/50 mm Hg). Oxygen is unnecessary with SpO₂ 97%, and both morphine and nitroglycerin can worsen hypotension.
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adenosine supraventricular tachycardia

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site:cpr.heart.org 2025 adult tachycardia algorithm second adenosine 12 mg regular narrow complex

Administer adenosine 12 mg IV push.
The patient is stable with regular narrow-complex tachycardia, and the initial 6 mg adenosine dose failed. Give 12 mg rapidly, followed by a saline flush.

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symptomatic bradycardia hypotension

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site:cpr.heart.org 2025 adult bradycardia algorithm hypotension cardiopulmonary compromise

Hypotension.
Treat bradycardia when it causes cardiopulmonary compromise, such as hypotension, altered mental status, signs of shock, ischemic chest discomfort, or acute heart failure.
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amiodarone ventricular fibrillation cardiac arrest

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site:cpr.heart.org 2025 cardiac arrest amiodarone second dose 150 mg IV IO

150 mg IV push.
For refractory VF/pulseless VT, after the initial 300 mg amiodarone dose, the recommended second dose is 150 mg IV/IO bolus.
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Epinephrine 1 mg IV/IO.
Continue CPR and give epinephrine every 3 to 5 minutes. The next antiarrhythmic dose is not due yet.
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atrioventricular block transcutaneous pacing atropine

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site:cpr.heart.org 2025 adult bradycardia algorithm atropine ineffective transcutaneous pacing

Initiate transcutaneous pacing.
This is unstable symptomatic bradycardia from Mobitz type II AV block with hypotension and altered mental status, unresponsive to atropine.
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post cardiac arrest hypotension vasopressor

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site:cpr.heart.org 2025 post cardiac arrest care hypotension dopamine infusion fluids

Begin a dopamine infusion.
The patient remains hypotensive after adequate fluid boluses following ROSC. Start a vasopressor infusion to support perfusion and raise MAP to at least 65 mm Hg.
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site:cpr.heart.org 2025 adult tachycardia unstable wide complex synchronized cardioversion

Perform synchronized cardioversion.
This is unstable wide-complex tachycardia with hypotension, diaphoresis, and chest discomfort. Do not delay treatment for IV access, a 12-lead ECG, or consultation.
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magnesium torsades de pointes cardiac arrest

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site:cpr.heart.org 2025 magnesium torsades de pointes cardiac arrest pulseless ventricular tachycardia

Pulseless ventricular tachycardia associated with torsades de pointes.
Magnesium is indicated for torsades de pointes, which is polymorphic VT associated with a prolonged QT interval.
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cardiopulmonary resuscitation chest compression interruptions

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site:cpr.heart.org chest compression interruptions less than 10 seconds adult CPR

10 seconds.
Pause chest compressions for no longer than 10 seconds.
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pulseless electrical activity cardiopulmonary resuscitation

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site:cpr.heart.org adult cardiac arrest uncertain pulse start high quality CPR PEA

Start high-quality CPR.
If a pulse is not definitely felt within 10 seconds in an unresponsive patient, treat as pulseless and immediately begin CPR.
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atropine symptomatic bradycardia

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site:cpr.heart.org 2025 adult bradycardia algorithm atropine 1 mg hypotension

Atropine 1 mg IV bolus.
The patient has symptomatic bradycardia with hypotension, pallor, and diaphoresis. Repeat every 3 to 5 minutes if needed, maximum total dose 3 mg.
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site:cpr.heart.org 2025 regular narrow complex tachycardia stable vagal maneuvers first

Vagal maneuvers.
The rhythm is a stable, regular narrow-complex tachycardia. First-line treatment is vagal maneuvers; if unsuccessful, give adenosine 6 mg rapid IV push.
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