Amidarone ?

[Srt4ever]

When dealing with an arrest patient with either VT or Vfib if you administer one dose of amidarone an they come out of it do you then hang the drip of 150 into a 50 ? If you administer both doses of amidarone do you still hang the drip ?

 

[STXmedic]

If you one 300mg dose and they convert, then you run the 150mg infusion. If you give both the 300 and 150 doses as blouses, then no infusion. 450mg is the max total dose.

 

[Srt4ever]

If you one 300mg dose and they convert, then you run the 150mg infusion. If you give both the 300 and 150 doses as blouses, then no infusion. 450mg is the max total dose.

Ok just wanted to make sure I was still on the same page. Anywhere we can get the new 2015 ACLS guidelines at ?

 

[akflightmedic]

Anywhere we can get the new 2015 ACLS guidelines at ?

http://lmgtfy.com/?q=ACLS+Guidelines+2015

 

[FiremanMike]

Our protocol says to only give it during the arrest or after the arrest, not both. We can do 300/150 during the arrest, but if we convert a ventricular rhythm before we've given amio, then we should hang the infusion during the post resuscitation phase.

 

[jcroteau]

May be a silly question, but if we give 300mg of amiodarone and they convert why would we then hang a 150mg drip? They're no longer in the arrhythmia which amiodarone is indicated for?


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[chaz90]

May be a silly question, but if we give 300mg of amiodarone and they convert why would we then hang a 150mg drip? They're no longer in the arrhythmia which amiodarone is indicated for?


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Amiodarone is used for termination of harmful arrhythmias and maintenance of a stable heart rhythm. Patients take prescribed oral antiarrhythmics all the time even when they are currently in a stable rhythm. As with many drugs, amiodarone needs both a loading dose and a maintenance dose to achieve a consistent therapeutic dose and have the desired affect. You may notice that when we administer amiodarone in the field the ED almost always hangs a maintenance infusion to follow it up. We are typically only starting the process of getting these patients regulated to appropriate levels.

 

[Ethan]

Is it common to dilute you standard dose in d5w or due you just draw it up and push the dose IV

 

[DesertMedic66]

For full arrests we just push it IV. If we are hanging a drip we just use a 50cc NS bag.

 

[usalsfyre]

450 is not the "max" dose of amiodarone, the patient will end up getting a gram over 24 hours at various rates. Your local protocol is going to dictate heavily if they get the post-ROSC infusion or not.

 

[Tigger]

Is it common to dilute you standard dose in d5w or due you just draw it up and push the dose IV

We are supposed to dilute the 300mg dose in 20cc, I would be remiss to say that that ever happens.

 

[ParamedicStudent]

1) In a full arrest, per PALS, the amiodarone does is 5mg/kg, with max 15mg/kg. Does that mean there's going to be 3 doses of Amio? Because for adults it's only two does, with 300mg then 150mg, but for PALS its going to be 3 doses of the same dose? Just clarifying.

I know Amio is an antiarrhythmic, so does that mean we can use amio for a-fib and/or PVC?

 

[STXmedic]

1) In a full arrest, per PALS, the amiodarone does is 5mg/kg, with max 15mg/kg. Does that mean there's going to be 3 doses of Amio? Because for adults it's only two does, with 300mg then 150mg, but for PALS its going to be 3 doses of the same dose? Just clarifying.

I know Amio is an antiarrhythmic, so does that mean we can use amio for a-fib and/or PVC?

Correct. As per PALS, you can re-dose amio twice for pediatrics (for a total of three doses). The bright side is you will likely never see pediatric in VF.

That's going to be heavily based on your protocol. Yes, amio can be used to treat frequent PVCs. However in the prehospital setting we typically don't treat PVCs. Amio is fairly common as a second line agent behind diltiazem for treating AF with RVR, though.

 

[NPO]

Our protocols allow us to hang 150mg in 100ml for a perfusing ventricular rhythm, or as a bolus for cardiac arrest. The only time we hang a maintenance drip post cardiac arrest is if Lidocaine was used to convert.

Correct. As per PALS, you can re-dose amio twice for pediatrics (for a total of three doses). The bright side is you will likely never see pediatric in VF.

That's going to be heavily based on your protocol. Yes, amio can be used to treat frequent PVCs. However in the prehospital setting we typically don't treat PVCs. Amio is fairly common as a second line agent behind diltiazem for treating AF with RVR, though.

We used to have a PVC protocol that talked about treatment of PVCs, but our new medical director decided it was redundant, because even under that protocol we didn't treat anything less than a PVC triplet, and anything more than that was a run of VTACH and we already had a protocol for that.

 

[Alan L Serve]

Are you using Amiodarone for anything other than hemodynamically stable polymorphic VTach with wide-QRS? In the case of someone someone who is hemodynamically unstable your first choice is synchronized cardioversion either monophasic or biphasic, except for unstable Vtach with wide-QRS and an irregular rate which requires regular defibrillation.

 

[Handsome Robb]

Are you using Amiodarone for anything other than hemodynamically stable polymorphic VTach with wide-QRS? In the case of someone someone who is hemodynamically unstable your first choice is synchronized cardioversion either monophasic or biphasic, except for unstable Vtach with wide-QRS and an irregular rate which requires regular defibrillation.

We can use it for AF with RVR if diltiazem is contraindicated but we're technically supposed to call if we want to go that route.


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[Tigger]

We can use it for AF with RVR if diltiazem is contraindicated but we're technically supposed to call if we want to go that route.


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It's not in our protocols yet, but our medical director seems to think we could get orders for it. Seems to be used in the ED fairly frequently.

 

[Alan L Serve]

We can use it for AF with RVR if diltiazem is contraindicated but we're technically supposed to call if we want to go that route.


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Why aren't you using a beta-blocker for rapid AF, like Metoprolol?

 

[Carlos Danger]

Why aren't you using a beta-blocker for rapid AF, like Metoprolol?

Many people feel diltiazem works better.

 

[Alan L Serve]

Many people feel diltiazem works better.

The 2014 AHA/ACC/HRS guidelines say that either Beta blockers of Non-DI CCBs are first-line but they don't say which is better.
http://emedicine.medscape.com/article/2500030-overview#a4