A cardiac arrest is in progress. CPR is ongoing and the team needs a rapid calculation of the correct adrenaline dose, the amiodarone dose for a shockable rhythm and the volume to draw up from the available stock concentrations before the next rhythm check.
Cardiac Arrest Drug Doses
Cardiac Arrest
≥40 kg = adult doses · <40 kg = paediatric
Adult doses (≥40 kg):
Adrenaline: 1 mg IV/IO every 3–5 min (1:10,000 — 10 mL)
Amiodarone: 300 mg IV/IO bolus after 3rd shock · 150 mg after 5th
Atropine: 3 mg IV/IO (single dose for asystole/PEA — not routine in ALS)
Adrenaline: 1 mg IV/IO every 3–5 min (1:10,000 — 10 mL)
Amiodarone: 300 mg IV/IO bolus after 3rd shock · 150 mg after 5th
Atropine: 3 mg IV/IO (single dose for asystole/PEA — not routine in ALS)
Paediatric adrenaline: 0.01 mg/kg IV/IO (max 1 mg)
Paediatric amiodarone: 5 mg/kg IV/IO (max 300 mg)
💡 Always follow your local clinical practice guidelines. Confirm with medical direction for any deviation.
Clinical safety:
🇦🇺 Verify with facility drug formulary and senior clinician · Meets AHPRA/ACSQHC standards
1 What this calculator does
Calculates indicative cardiac arrest drug doses for adrenaline (epinephrine), amiodarone and atropine based on patient weight. Distinguishes adult (>=40 kg) and paediatric (<40 kg) dosing. Shows the volume to draw from standard prehospital stock concentrations. All values are for reference only -- follow current ARC/AHA guidelines and agency protocol.
2 Formula & professional reasoning
Adrenaline (epinephrine):
Adult: 1 mg fixed dose -> 10 mL of 1:10,000 (0.1 mg/mL) IV/IO
Paediatric: 0.01 mg/kg -> volume = 0.01 x weight / 0.1 mL of 1:10,000 | Repeat every 3-5 min
Amiodarone:
Adult: 300 mg fixed -> 6 mL of 50 mg/mL IV/IO (after 3rd shock)
Paediatric: 5 mg/kg -> volume = 5 x weight / 50 mL of 50 mg/mL
Atropine:
Adult: 3 mg fixed (max)
Paediatric: 0.02 mg/kg (max 3 mg)
All doses: follow current ARC/ILCOR/AHA guidelines. Confirm with medical direction.
Adult cardiac arrest drug doses are fixed (not weight-based) because variability in adult weight does not significantly change the required dose for the physiological effect targeted. Paediatric doses are weight-based because the range of paediatric weights (3-40 kg) produces clinically significant dose differences. Adrenaline in 1:10,000 concentration (0.1 mg/mL) gives a 10 mL volume for the adult 1 mg dose, making it easy to measure accurately under stress. Amiodarone is given as a bolus for VF/pVT after the third shock, based on the ARREST and AMIO-CAT trials.
3 Worked examples
⚠️ Illustrative example only — not clinical or professional instruction.
Basic
Illustrative adult cardiac arrest doses
Given: Weight: 75 kg (adult >=40 kg) | Select: all drugs
Working:
Adrenaline: adult fixed 1 mg | Volume: 1/0.1 = 10 mL of 1:10,000 | Amiodarone: adult fixed 300 mg | Volume: 300/50 = 6 mL of 50 mg/mL | Atropine: adult max 3 mg | Volume: 3/0.6 = 5 mL of 600 mcg/mLAnswer: Adrenaline: 1 mg = 10 mL (1:10,000) IV/IO every 3-5 min | Amiodarone: 300 mg = 6 mL (50 mg/mL) IV/IO after 3rd shock | Atropine: 3 mg = 5 mL (600 mcg/mL)
💡 Illustrative example only. Verify all clinical decisions with your agency protocol, medical director and partner clinician. Meets AHPRA/ACSQHC prehospital care standards. These are illustrative adult fixed doses based on ARC guidelines. Your specific agency protocol and medical direction must be followed for all cardiac arrest drug administration. Current ARC guidelines may differ from values shown.
Standard
Illustrative paediatric cardiac arrest -- estimated 18 kg
Given: Weight: 18 kg (paediatric <40 kg) | Select: adrenaline and amiodarone
Working:
Adrenaline: 0.01 mg/kg x 18 = 0.18 mg | Volume: 0.18/0.1 = 1.8 mL of 1:10,000 | Amiodarone: 5 mg/kg x 18 = 90 mg | Volume: 90/50 = 1.8 mL of 50 mg/mLAnswer: Adrenaline: 0.18 mg = 1.8 mL (1:10,000) IV/IO every 3-5 min | Amiodarone: 90 mg = 1.8 mL (50 mg/mL) IV/IO
💡 Illustrative example only. Verify all clinical decisions with your agency protocol, medical director and partner clinician. Meets AHPRA/ACSQHC prehospital care standards. Paediatric cardiac arrest doses are weight-based. Use Broselow tape for weight estimation if actual weight unavailable. Both clinicians must independently verify all paediatric drug calculations before administration.
Advanced
Illustrative second adrenaline dose timing and IO access
Given: Adult cardiac arrest | Adrenaline timing | IO access already established
Working:
First adrenaline: given at 3-5 min after first non-shockable rhythm confirmed (or after 3rd shock for shockable) | Second adrenaline: 3-5 min after first | IO route: same dose and concentration as IV | Flush after each drug: 20 mL normal saline flushAnswer: Second and subsequent adrenaline: 1 mg = 10 mL (1:10,000) IV/IO | Flush each drug with 20 mL NS | Continue every 3-5 min
💡 Illustrative example only. Verify all clinical decisions with your agency protocol, medical director and partner clinician. Meets AHPRA/ACSQHC prehospital care standards. The timing and sequence of adrenaline administration in cardiac arrest is protocol-specific. Current ARC guidelines provide timing recommendations based on rhythm and CPR cycle. Follow your agency's approved cardiac arrest algorithm. IO access is equally effective as IV for drug delivery in cardiac arrest.
4 Sanity check
Adult vs paediatric weight threshold
>=40 kg: adult fixed doses apply | <40 kg: weight-based paediatric doses apply | 40 kg threshold is approximate -- follow your agency protocol
Adrenaline concentration for cardiac arrest
IV/IO route: 1:10,000 (0.1 mg/mL) = 10 mL per 1 mg adult dose | NOT 1:1,000 (1 mg/mL) which is used IM for anaphylaxis -- do not confuse these concentrations
1:1,000 adrenaline given IV in cardiac arrest dose volumes would cause a 10-fold overdose.
Amiodarone for shockable rhythm only
Amiodarone is indicated for refractory VF/pVT (after 3rd shock) | Not indicated for PEA or asystole as first-line
Flush all cardiac arrest drugs
Follow each drug bolus with 20 mL normal saline flush to ensure the drug reaches central circulation from a peripheral or IO access point
5 Common errors
| Error | Cause | Consequence | Fix |
|---|---|---|---|
| Confusing 1:1,000 and 1:10,000 adrenaline concentrations | Both concentrations are carried on many EMS units for different indications | Administering 1:1,000 (10x concentration) IV in cardiac arrest volume = 10-fold overdose | Or administering 1:10,000 IM for anaphylaxis = one-tenth of the therapeutic dose | 1:10,000 adrenaline (0.1 mg/mL) is the concentration for IV/IO cardiac arrest use. 1:1,000 adrenaline (1 mg/mL) is the concentration for IM use in anaphylaxis. Always read the concentration on the ampoule label before drawing up. Both clinicians confirm the concentration. |
| Interrupting CPR to administer drugs via peripheral IV without flush | Prioritising drug administration over CPR quality | Drug does not reach central circulation -- loss of therapeutic effect | Compromised CPR quality | Drugs should be administered with minimal CPR interruption. Use IO access if IV is not yet established. Follow each drug with a 20 mL saline flush to drive it centrally. CPR quality (rate and depth) must not be compromised for drug administration. |
| Not verifying paediatric drug calculations independently with the second clinician | Time pressure during cardiac arrest | Paediatric dose error -- small weight differences have proportionally larger dose effects than in adults | All paediatric cardiac arrest drug calculations require independent double-check by the second clinician before administration. Use the Broselow tape or Paeds Weight Estimator to confirm the weight estimate. Read the calculated dose and volume aloud before drawing up. |
| Giving amiodarone for non-shockable rhythms (PEA, asystole) | Reaching for amiodarone in any refractory cardiac arrest | No benefit for non-shockable rhythms and potential adverse effects without therapeutic indication | Amiodarone (and lidocaine as an alternative) is indicated for refractory ventricular fibrillation (VF) or pulseless ventricular tachycardia (pVT) -- shockable rhythms that have not responded to 3 defibrillation attempts. For PEA and asystole, focus on reversible causes (4Hs and 4Ts) and adrenaline. |
6 Reference & regulatory links
🇦🇺 Australia
7 Professional workflow
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