There are about five code drugs that you need to know as a health professional. If you work in the hospital, procedure area, or a member of an emergency response team, these are the drugs that you have to have readily available and know when to use, how much to give, and how to give.
Epinephrine: is usually considered the first line medication in cardiac arrest. Epinephrine (adrenalin) is a hormone-neurotransmitter, that caused stimulation and increase in heart rate and vasoconstriction. It is readily available in the code cart in a 1 mg – 10ml syringe. The dose of Epinephrine is 1 mg. every 3-5 minutes, with no maximum dose. It is used in cardiac arrest as an IV push medication. It can also be used as an infusion in an unstable patient that needs their heart rate and blood pressure increased.
Vasopressin: also known as antidiuretic hormone (ADH), which given at a higher dose, causes vasoconstriction. It has a longer half-life than epinephrine. It is recommended to give once at the dose of 40 units IVP either replacing the first or second epinephrine given during cardiac arrest. It is recommended to give it as a one-time dose.
Amiodarone: this is a popular antiarrhythmic medication. During cardiac arrest after the epinephrine (or vasopressin) it is first line antiarrhythmic recommended. The dose during cardiac arrest is 300mg. IVP. This can be repeated one at 150mg. IVP. When the patient has a fast atrial or ventricular tachycardia, with a pulse, amiodarone is given slowly, over 10 minutes, due to the hypotensive side effects. The dose is 150mg. in 100ml, over 10 minutes.
Atropine: is not considered a code drug anymore. It is used for symptomatic and unstable bradycardia patients when the heart rate is below 50. The dose of atropine is 0.5mg IVP every 3-5 minutes with a maximum does of 3mg. It is available in 1mg prefilled (10ml) syringes in the code cart (use 5ml at a time). In the heart blocks (2nd degree, type II and 3rd degree) atropine may be ineffective. Dopamine infusion and transcutaneous pacemaker are the next recommended treatments for unstable bradycardia.
Adenosine: is a fast acting drug used for supraventricular tachycardia and Wolff-Parkinson-White Syndrome. It causes dramatic side effects, when given IVP. Administer in the IV line as close to the heart as possible, and be sure to flush it in quickly with 10-20ml of normal saline. Expect to see flat line on the cardiac monitor when this medication works. It then causes temporary ischemic chest pain, and other related symptoms. The half-life and symptoms last only 6 seconds long. The initial dose of adenosine is 6mg., and then repeat, with a second dose of 12mg. IVP. This drug is used in SVT after the vagal maneuvers were unsuccessful. Synchronized cardioversion and amiodarone are given if initial treatment does not work to slow the heart rate down.