Torsades Treatment

[TatuICU]

Sorry I meant amiodorone

No. Amiodorone is notorious for QTc prolongation and is often the culprit in medication induced torsades. Despite the panacea everyone thinks amiodarone to be, it can and does have associated proarrhythmic effects. Add procainamide to this list too.

Treatment of torsades is geared toward correcting the underlying cause whether it be a congenital prolonged QT syndrome, a medication (like amiodarone), or an underlying electrolyte imbalance.

If you (or the patient rather) are dead in the water and you just have to try something else, lidocaine is an option and can help initially but the torsades will reoccur pretty quickly thereafter, so its not really an advantageous tx, just something else you can throw at it. If the torsades is brady dependent, isuprel works, but I doubt you'll carry that on an EMS unit.

Mag is your drug in this instance bud. For the patient in extremis, cardiovert or just straight up defib if you can't sync, which you may not be able to.

 

[Aidey]

10%???? 10% solution of what? Its supposed to be in a 0.9% NS solution.



Has anyone actually had torsades and pushed mag for it? I know it is extremely rare.

10% Mag....

as in a 1:10 ratio of mag to whatever it is diluted with.

 

[RocketMedic]

I'd reckon the next best treatment would be amiodarone.

 

[TatuICU]

I'd reckon the next best treatment would be amiodarone.

Amiodarone is not a tx for torsades

 

[RocketMedic]

I think you misunderstood my reply, Tatu. A poster asked what an alternate treatment for polymorphic vtach in the absence of magnesium could be in arrest- amiodarone, I think.

Definitely not optimal and I may be wrong.

 

[STXmedic]

I think you misunderstood my reply, Tatu. A poster asked what an alternate treatment for polymorphic vtach in the absence of magnesium could be in arrest- amiodarone, I think.

Definitely not optimal and I may be wrong.

No. Amiodorone is notorious for QTc prolongation and is often the culprit in medication induced torsades. Despite the panacea everyone thinks amiodarone to be, it can and does have associated proarrhythmic effects. Add procainamide to this list too.

Treatment of torsades is geared toward correcting the underlying cause whether it be a congenital prolonged QT syndrome, a medication (like amiodarone), or an underlying electrolyte imbalance.

If you (or the patient rather) are dead in the water and you just have to try something else, lidocaine is an option and can help initially but the torsades will reoccur pretty quickly thereafter, so its not really an advantageous tx, just something else you can throw at it. If the torsades is brady dependent, isuprel works, but I doubt you'll carry that on an EMS unit.

Mag is your drug in this instance bud. For the patient in extremis, cardiovert or just straight up defib if you can't sync, which you may not be able to.

I think this is what tatul was getting at. Two or three posts above yours.

 

[beantown native]

This part of florida it is 1-2 grams diluted in 10mls of d5w, IV push. If it is with a pulse or an acute MI with hypomagnesia, loaded dose of 1-2 gr in 50 to 100 mls of d5 over 10 min.

 

[epipusher]

Amiodarone is not a tx for torsades

Not yet, I'm sure AHA will find a way to work that in there.