ACLS question

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Sharktooth

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I was discussing a call with a co worker about a call he ran . He stated he had a pt in V-fib . He shocked the pt administered 1 epi and after 2 min of CPR had a rhythm change to asystole . He administered 2 more epi's then had a rhythm change to PEA . After a fluid challenge and bicarb he had ROSC .

The pt had iv access and was intubated . He transported the pt and delivered the pt to the ER with pulses and a good blood pressure .

My question is , per ACLS , should an amiodarone infusion been administered after ROSC since his initial rhythm was V-fib?

Thanks!
 
He never had an antidysrhythmic however the fact that he was in v-fib would indicate the need for one. The problem is that any common antidysrhythmic still demands a bolus to get the blood levels up to theraputic.

With a long enough transport time you could have done the amioderone rapid infusion (150mg in 50ml over 10 mins)to load and then hung the maint drip... or you could have gone the lidocaine route and then hung that.

You could have also called your OLMC (or the recieving facility depending on your system) and gotten an "expert consultation"

ACLS has plenty of protocols to follow but is not always geared to the realities of patient care. Remeber they are guidelines not hard and fast rules.
 
If you have a good pulse and BP, just let them be. Initiate hypothermia if you haven't already and if it's in your protocols, and transport.

Per ACLS, I still don't think you would. You were working out of the asystole algorithm, and you never gave an anti arrhythmic bolus to need a maintenance drip.
 
PoeticInjustice said:
If you have a good pulse and BP, just let them be. Initiate hypothermia if you haven't already and if it's in your protocols, and transport.

Per ACLS, I still don't think you would. You were working out of the asystole algorithm, and you never gave an anti arrhythmic bolus to need a maintenance drip.
Click to expand...

I agree. According to ACLS, you give the meds for the rhythm you are in at the time.
 
He never gave amiodarone during the arrest, therfore he doesn't do a maintenence drip.
 
Pavehawk said:
He never had an antidysrhythmic however the fact that he was in v-fib would indicate the need for one. The problem is that any common antidysrhythmic still demands a bolus to get the blood levels up to theraputic.

With a long enough transport time you could have done the amioderone rapid infusion (150mg in 50ml over 10 mins)to load and then hung the maint drip... or you could have gone the lidocaine route and then hung that.

You could have also called your OLMC (or the recieving facility depending on your system) and gotten an "expert consultation"

ACLS has plenty of protocols to follow but is not always geared to the realities of patient care. Remeber they are guidelines not hard and fast rules.
Click to expand...

I was also under this impression. If he started in fib you would want to give an anti arrhythmic to prevent him from going back into that initial rhythm.
 
I'd begin the 150mg amiodarone bolus. Some say not to, but as far as I know it is a judgement call (ie. not much evidence one way or the other).
 
Sharktooth said:
I was discussing a call with a co worker about a call he ran . He stated he had a pt in V-fib . He shocked the pt administered 1 epi and after 2 min of CPR had a rhythm change to asystole . He administered 2 more epi's then had a rhythm change to PEA . After a fluid challenge and bicarb he had ROSC .

The pt had iv access and was intubated . He transported the pt and delivered the pt to the ER with pulses and a good blood pressure .

My question is , per ACLS , should an amiodarone infusion been administered after ROSC since his initial rhythm was V-fib?

Thanks!
Click to expand...

No. Amiodarone is indicated for refractory vfib/vtach. If the person converted before a bolus was needed, then there is no need for a maintenance drip.

Just monitor them, start hypothermia protocols if you have them and transport.
 
An amiodarone infusion post-arrest has been withdrawn here but I do not know why.
 
Sharktooth said:
I was discussing a call with a co worker about a call he ran . He stated he had a pt in V-fib . He shocked the pt administered 1 epi and after 2 min of CPR had a rhythm change to asystole . He administered 2 more epi's then had a rhythm change to PEA . After a fluid challenge and bicarb he had ROSC .

The pt had iv access and was intubated . He transported the pt and delivered the pt to the ER with pulses and a good blood pressure .

My question is , per ACLS , should an amiodarone infusion been administered after ROSC since his initial rhythm was V-fib?

Thanks!
Click to expand...

What is the patient's blood pressure? I say leave it! Here's hoping that the AHA gets rid of all antiarrythmics in 2015 unless the Hs and Ts indicate a specific antidote!
 
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