Which medication is specifically indicated for torsades de pointes during arrest, and what is the dose?

Which medication is specifically indicated for torsades de pointes during arrest, and what is the dose?

• A. Magnesium sulfate 1-2 g IV bolus; may repeat if torsades/persistent long QT.
• B. Amiodarone 150 mg IV bolus
• C. Calcium chloride 1 g IV
• D. Epinephrine 1 mg IV

Answer: (A)

Torsades de pointes during arrest is driven by a prolonged QT and early afterdepolarizations, which magnesium helps suppress. The medication of choice is magnesium sulfate given as an IV bolus of 1-2 grams, typically over 1-2 minutes. If the arrhythmia or QT prolongation persists, a second bolus can be given. Magnesium works even if the patient’s serum magnesium is normal and is the specific treatment that addresses the underlying electrophysiology of torsades, making it the best choice in this scenario. Other drugs like amiodarone are not the targeted treatment for torsades, and calcium or epinephrine serve different roles in arrest management rather than directly terminating torsades.

Torsades de pointes during arrest is driven by a prolonged QT and early afterdepolarizations, which magnesium helps suppress. The medication of choice is magnesium sulfate given as an IV bolus of 1-2 grams, typically over 1-2 minutes. If the arrhythmia or QT prolongation persists, a second bolus can be given. Magnesium works even if the patient’s serum magnesium is normal and is the specific treatment that addresses the underlying electrophysiology of torsades, making it the best choice in this scenario. Other drugs like amiodarone are not the targeted treatment for torsades, and calcium or epinephrine serve different roles in arrest management rather than directly terminating torsades.