Vascular Access By Endotracheal Tube

A number of medications may be administered by endotracheal tube in the critical minutes of resuscitation before intravenous (IV) access is obtained. These include atropine, diazepam, epinephrine, isoproterenol, lidocaine, and naloxone but not sodium bicarbonate, calcium chloride, or bretylium. The American Heart Association Advanced Cardiac Life Support (ACLS) and Pediatric Advanced Life Support (PALS) guidelines recommend increasing IV dosages of resuscitation medications by a factor of 2 to 3 with dilution of 3 to 5 mL before administration via endotracheal tube. Epinephrine as a preparation of 1 mg/mL (1:1000) should be given in a dosage of 0.1 mg/kg (standard dosage). Drug administration is followed by several positive-pressure ventilations using a bag-to-tube device. 1

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