Arrythmias and drugs, please help!

[d_miracle36]

My protocols are vague concerning the treatment. We have adenosine, lidocaine, amiodorone, and metoprolol. Basically the only drug it says to give in a stable pt. is adenosine in narrow tachy rhythms. It prescribes no other treatment for those. For unstable is synch. cardioversion. Other drugs it says to consider only in cardiac arrest. Id like to know what circumstances you would give those drugs mentioned above. Give me some senarios and it would help me out alot. Thanks.

 

[Handsome Robb]

Amiodorone can be given to someone in wide complex v-tach with a pulse. 150 mg in 100 mL NS over 10 minutes or 300 mg in pulseless ventricular tach/fib arrest first dose of 300 mg followed by a second dose of 150 mg and thats all you can give.

Lidocaine has fallen out of favor last I checked. But it could be given in place of Amiodorone during a ventricular tach/vib arrest @ 1-1.5 mg/kg repeated to a max of 3 mg/kg followed by a maintenance infusion of 2-4 mg/minute.

You shouldn't be giving these medications if you don't know why or when to give them...and the protocol said so does not solve this problem.

 

[MrBrown]

My protocols are vague concerning the treatment.

The treatment of what?

We have adenosine, lidocaine, amiodorone, and metoprolol.

All of which have their uses ... but not all for the same thing

Basically the only drug it says to give in a stable pt. is adenosine in narrow tachy rhythms. It prescribes no other treatment for those.

In the prehospital environment you shouldn't really be touching stable rhythms in unsymptomatic patients

For unstable is synch. cardioversion.

Yes, for a patient who is significantly cardiovascuarly compromised from a tachyarrythmia syncronised cardioversion is indicated.

 

[usafmedic45]

Why the heck didn't you learn this stuff during your training? If you're pushing these drugs, you should already know about them.

 

[Trevor]

Why the heck didn't you learn this stuff during your training? If you're pushing these drugs, you should already know about them.

Agreed...

 

[d_miracle36]

Why the heck didn't you learn this stuff during your training? If you're pushing these drugs, you should already know about them.

I havent got to that point yet thanks

 

[d_miracle36]

Amiodorone can be given to someone in wide complex v-tach with a pulse. 150 mg in 100 mL NS over 10 minutes or 300 mg in pulseless ventricular tach/fib arrest first dose of 300 mg followed by a second dose of 150 mg and thats all you can give.

Lidocaine has fallen out of favor last I checked. But it could be given in place of Amiodorone during a ventricular tach/vib arrest @ 1-1.5 mg/kg repeated to a max of 3 mg/kg followed by a maintenance infusion of 2-4 mg/minute.

You shouldn't be giving these medications if you don't know why or when to give them...and the protocol said so does not solve this problem.

Im a medic student, and im not giving anything yet, and we havent gotten to that point in class, I try to learn before hang. My bad.

 

[d_miracle36]

The treatment of what?



All of which have their uses ... but not all for the same thing



In the prehospital environment you shouldn't really be touching stable rhythms in unsymptomatic patients



Yes, for a patient who is significantly cardiovascuarly compromised from a tachyarrythmia syncronised cardioversion is indicated.

I think what Im wanting to know is are there any indications for given drugs in an arrythmia for a stable pt.

 

[MidwestFF]

With all the standard warnings that should apply.

http://www.heart.org/idc/groups/heart-public/@wcm/@ecc/documents/downloadable/ucm_317350.pdf

This should help with your rhythms and associated drugs. We were required to have completed ACLS prior to ever touching a patient even in clinicals. You need the full ACLS class, but this is a good reference, the best part it's free.

My suggestion is to go online and buy the most current copy of the 2010 acls textbook and then studying at least a month prior to taking the class. From what I have been told the new written test has a 50% failure rate, including those that are trying to renew.

 

[MrBrown]

An "ACLS" class is going to teach you zero information of any true value, you are far better off getting a cardiology and pharmacology book and reading those.

Basically no, a stable patient gets no medication

 

[SeanEddy]

An "ACLS" class is going to teach you zero information of any true value, you are far better off getting a cardiology and pharmacology book and reading those.

Basically no, a stable patient gets no medication

Are you defining stable as asymptomatic?

 

[MrBrown]

Are you defining stable as asymptomatic?

Yes, an unstable patient is one whose either a) in VT or b) has significant compromise from an arrhythmia

 

[Handsome Robb]

Are you defining stable as asymptomatic?

That was my question. Stable can have many different meanings, depending on who is defining stable.

I'll agree with Brown on this one, as well as SeanEddy, asymptomatic patients do not require treatment in the prehospital environment unless there is a long transport time. There are too many risks associated with treatments initiated by us in the prehospital environment trying to treat an arrhythmia that is 'stable' versus the 'rewards' from our treatments within our scope of practice.

 

[TomB]

Like!

I'll agree with Brown on this one, as well as SeanEddy, asymptomatic patients do not require treatment in the prehospital environment unless there is a long transport time. There are too many risks associated with treatments initiated by us in the prehospital environment trying to treat an arrhythmia that is 'stable' versus the 'rewards' from our treatments within our scope of practice.

 

[d_miracle36]

Ok thank you