Emergency Medicine Life-Saving Drugs

1. EPINEPHRINE (Adrenaline)

• Mechanism: α-adrenergic effects increase coronary perfusion pressure and cerebral perfusion pressure during CPR; β-adrenergic effects increase heart rate and contractility
• Dose in cardiac arrest: 1 mg IV/IO every 3-5 minutes until ROSC; 2.5 mg via endotracheal tube every 3-5 min if IV/IO not established (dilute in 5-10 mL NS)
• Dose in anaphylaxis: 0.3-0.5 mg IM via autoinjector; or IV infusion: mix 1 mg in 500 mL D5W, start at 0.5 mL/min and titrate
• Dose for bradycardia/septic shock: IV infusion 2-10 mcg/min; 0.05-2 mcg/kg/min respectively
• Rhythm indications: Prioritize EARLY administration for non-shockable rhythms (asystole, PEA) - associated with increased ROSC, survival, and neurologically intact survival; evidence insufficient for optimal timing in shockable rhythms (VF/pulseless VT)
• High-dose epinephrine: NOT recommended for routine use; exceptions include beta-blocker overdose and calcium channel blocker overdose

2. AMIODARONE

• Mechanism: Class III antiarrhythmic; blocks Na+, K+, Ca++ channels; also has alpha and beta-blocking properties
• Indication: VF or pulseless VT unresponsive to CPR, defibrillation, and vasopressor therapy
• Goal: Facilitates restoration and maintenance of a spontaneous perfusing rhythm in concert with defibrillation (does NOT directly convert VF)
• Note: Associated with increased rates of ROSC and hospital admission, but not yet proven to increase long-term survival or survival with good neurologic outcome

3. LIDOCAINE

• Indication: Shock-resistant VF in adults and children; alternative to amiodarone per 2020 AHA Guidelines
• Mechanism: Class IB antiarrhythmic - blocks fast Na+ channels, shortens action potential duration
• Note: IV lidocaine is frequently used; however, IV amiodarone appears to be more effective in increasing survival to discharge

4. ATROPINE

• Mechanism: Muscarinic acetylcholine receptor antagonist - blocks vagal tone
• Indication: Symptomatic bradycardia, organophosphate/nerve agent poisoning
• Must be available before anesthesia induction (alongside epinephrine, propofol, succinylcholine)

5. VASOPRESSORS FOR SHOCK

6. NALOXONE

• Mechanism: Pure opioid receptor antagonist - reverses respiratory depression, sedation, and analgesia
• Indications: Respiratory arrest or severe respiratory depression from opioid overdose (accidental, iatrogenic, or intentional)
• Routes: IV, IM, intranasal (2 mg/mL intranasal has efficacy similar to 2 mg IM)
• Key teaching: Naloxone is increasingly being made available to the public for reversal of opioid-induced apnea outside hospital settings

7. SUCCINYLCHOLINE

• Mechanism: Depolarizing neuromuscular blocker
• Key property: Ultra-rapid onset (~60 sec) and short duration (~10 min) - ideal for emergency airway management and RSI
• Must be available: Alongside epinephrine, atropine, and propofol before anesthesia in emergency settings

8. ADENOSINE

• Mechanism: Slows conduction through the AV node - terminates re-entrant SVT
• Dose: 6 mg rapid IV push; may repeat with 12 mg if no response
• Key note: Extremely short half-life (~10 seconds) - must be given as rapid IV push followed immediately by saline flush

9. DANTROLENE

• Mechanism: Blocks ryanodine receptors, preventing pathological calcium release from sarcoplasmic reticulum
• Indication: Malignant hyperthermia - a rare but potentially fatal hypermetabolic crisis triggered by volatile anesthetics or succinylcholine
• Requirement: At least 12 bottles must be immediately available wherever triggering agents are stocked

10. MAGNESIUM SULFATE

• Indications:
  • Torsades de Pointes (polymorphic VT with prolonged QT): 1-2 g IV over 5-20 min
  • Eclampsia/pre-eclampsia: seizure prevention and treatment
  • Severe asthma (refractory bronchospasm)
• Note: Routine use for standard VF/pulseless VT is NOT recommended in adult ACLS

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