# Amiodarone in a CORE



## Audrey Lynn (Mar 8, 2012)

Since I did not find any recent or pertinent information about this on the threads, I thought I would ask. 

This past weekend we had a CORE and was unable to use Amiodarone during this because of the dish soap looking way it drew up, even in a slow manner. The medic tried to draw it with NS as well, but no luck. I was told this could cause an embolism, and I see why. 

So, my question is this: Have you had a situation similar and what did you do? Is there anything else that could have been done or another med to use? I know local protocols come into play, but with yours in mind, how would this play out? 

The reason I ask is that I am a Basic for the time being, until I start the paramedic program this August, and I am not familiar with the drug yet. Thanks in advance. 

Audrey


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## bigbaldguy (Mar 8, 2012)

Would you please roughly define CORE for those of us (me) who aren't familiar with that acronym. I googled it but I'm still not clear.


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## Veneficus (Mar 8, 2012)

bigbaldguy said:


> Would you please roughly define CORE for those of us (me) who aren't familiar with that acronym. I googled it but I'm still not clear.


I had no idea either, I gave up answering threads where the local lingo wasn't defined in an intelligible way.


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## Audrey Lynn (Mar 8, 2012)

Cardiac Or Respiratory Event (At least that's what I have been told). This was a cardiac arrest.


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## DrankTheKoolaid (Mar 8, 2012)

There are various reasons for a medication to do this.  Contamination, Temperature and age of medication would be the main 3.  Also mixing with the wrong solution will do this also.  Amiodarone is known to do this if it gets to cold


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## Veneficus (Mar 8, 2012)

Audrey Lynn said:


> Cardiac Or Respiratory Event (At least that's what I have been told). This was a cardiac arrest.



That sounds like a dispatch code that offers absolutely no useful information.

But moving on to the point...

In my experience, once the amio foams, you can either wait for it to settle and get another vial in the  meanwhile or you can go with any other antiarrhythmic of your favorite flavor. (lido, mag, procainamide, etc.)


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## fast65 (Mar 8, 2012)

Never heard of that acronym being used, cardiac arrest would have been easier. 

Terminology aside, as others have said, there are various factors that could have caused the amiodarone to foam like that. Depending upon what you carry on your rig, there are other antiarrhythmics you can use, around here we would have gone for the lidocaine.


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## m0nster986 (Mar 8, 2012)

Did he check the integrity, clarity, and expiration date of the drug prior to the shift?


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## TatuICU (Mar 8, 2012)

Amiodarone is detergent based and usually does foam, particularly if drawn from a glass ampule for some reason.  If he/she did the little "inject air into the vial and allow the pressure to pull the med into the syringe for me" trick then it would've definitely foamed like a mofo.  Nothing too odd about that and I'm unsure of why that would prevent it from being used.


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## MedicBrew (Mar 8, 2012)

Audrey Lynn said:


> So, my question is this: Have you had a situation similar and what did you do? Is there anything else that could have been done or another med to use? I know local protocols come into play, but with yours in mind, how would this play out?



When Amino made its debut here, there was some concern regarding the foaming issues that we also experienced.  We contacted several cardiologists and the consensus was to not be too concerned with the milky appearance; however that care should be taken not to inject the “bubbles”. To avoid this, elevate the syringe at a high angle when giving it RIVP stopping when you reach the large bubbles. Eventually, we went to pre-fills and have not had such an issue with it since. 

You should not administer Amino without the use of an in-line filter. We use a syringe filter, or filter needle for bolus and in-line 0.22 micro filter for infusions.


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## TatuICU (Mar 9, 2012)

MedicBrew said:


> Eventually, we went to pre-fills and have not had such an issue with it since.



This.

I'm telling you, that glass ampule stuff sucked.....bad.  It would take you 5 minutes to pull up a 150mg vial.


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## triemal04 (Mar 9, 2012)

MedicBrew said:


> Eventually, we went to pre-fills and have not had such an issue with it since.


Are you talking about the new mix that doesn't contain polysorbate or is there another prefill out there?

If it's the new mix I've got a couple questions if you don't mind.


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## Another German (Mar 12, 2012)

The "amiodarone foam" is sometimes really causing a problem. Here in Germany the manufacterer/distributor of amiodarone says, that amiodarone has to be mixed up with a bit of Glucose 5%. Don know, wether this is present and/or available in the US. 

Greetings


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## Medic Tim (Mar 12, 2012)

The first time a drew it up it foamed. After that I have taken my time and haven't really had an issue. Though it can take a while to draw up.


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## Moshi (Mar 17, 2012)

Another German said:


> The "amiodarone foam" is sometimes really causing a problem. Here in Germany the manufacterer/distributor of amiodarone says, that amiodarone has to be mixed up with a bit of Glucose 5%. Don know, wether this is present and/or available in the US.
> 
> Greetings



We also get that rule in Slovenia aswell. 5% Glucose only! No NaCl! Which seems a bit odd to me reading you guys dilute it with NS. Also is it better to dilute it at all?!


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## RESQGUY (Mar 18, 2012)

> m0nster986	 Did he check the integrity, clarity, and expiration date of the drug prior to the shift?



I have a feeling neither of them did.


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