ACLS review

241.  Describe the technique for administering medications through the ET tube.

When giving drugs via the ET tube route the typical dose is increased by 2-2½ times and is diluted in 5-10ml of saline and injected directly into the trachea.

242.  What concentration of epinephrine should be administered via the ET tube?

Give epinephrine 1:1000 2-2½ mg diluted in 5-10ml of normal saline or sterile water.

243.  How often can epinephrine be repeated in the cardiac arrest victim?

Epinephrine may be repeated every 3-5 minutes in the cardiac arrest victim.

244.  What are the recommendations for administering vasopressin to a victim in pulseless arrest?

Vasopressin is no longer recommended.  Vasopressin is a nonadrenergic peripheral vasoconstrictor that also causes coronary and renal vasoconstriction.  A single RCT enrolling 336 patients compared multiple doses of standard-dose epinephrine with multiple doses of standard dose vasopressin (40 units IV) in the emergency department after OHCA. The trial had a number of limitations but showed no benefit with the use of vasopressin for ROSC or survival to discharge with or without good neurologic outcome. Vasopressin has been removed from the Adult Cardiac Arrest Algorithm

245.  Is it appropriate to give escalating doses of epinephrine?

No studies have found improved survival rate or improved neurological outcome when escalating doses of epinephrine were used.  Therefore, the routine use of high dose or escalating dose of epinephrine cannot be recommended.  


Reviewed 2/28/16