chbare Posted February 10, 2008 Author Share Posted February 10, 2008 Looks like we nailed the diagnosis. Thank you everybody. I will hand out style points for the ICD-9 code for this disorder. This is one of those imposter cases where strictly considering 12 lead ECG evidence without looking at the entire picture could lead us down the wrong path. The field treatment for this problem is limited; however, our assessment and history taking abilities could really help the receiving facility make the correct diagnosis. Will antidysrhythmic medications be helpful in preventing the recurrence of ventricular tachycardia or fibrillation? What medications could actually exacerbate the disorder or the findings associated with this disorder? Think about repolarization when considering this question. Take care, chbare. Link to comment Share on other sites More sharing options...
Niftymedi911 Posted February 11, 2008 Share Posted February 11, 2008 Adenosine, Cardizem... would be my guess meds that prolong the action potential. And WPW morphologies within the conduction system. Specifically the alternate conduction pathways. Antiarrythmics techincally are called per ACLS post V-Fib arrest. But no matter how much, or what is given, nothing can help besides bright lights and cold steel. Link to comment Share on other sites More sharing options...
brentoli Posted February 11, 2008 Share Posted February 11, 2008 Looks like we nailed the diagnosis. Thank you everybody. I will hand out style points for the ICD-9 code for this disorder. I cheated: 2006 ICD-9-CM Diagnosis 746.89 Link to comment Share on other sites More sharing options...
CBEMT Posted February 11, 2008 Share Posted February 11, 2008 I agree with amiodarone 150mg over 8 - 10 minutes, but the drip can wait till the hospital. How many ambulances carry 900mg of amiodarone to make up the drip What the hell do I need 900mg for? Call for the order, 150mg in a 100cc, PVC-free bag of D5W with a PVC-free IV line, set up the pump, and run it over 10 minutes (yes, that is my local protocol). Link to comment Share on other sites More sharing options...
chbare Posted February 11, 2008 Author Share Posted February 11, 2008 I cheated: 2006 ICD-9-CM Diagnosis 746.89 +5 style points. :thumbup: What about administering some of the class I agents? Help, hinder, none of the above? Protocol aside, will amiodarone actually be helpful in the management of this patient? Take care, chbare. Link to comment Share on other sites More sharing options...
Kaisu Posted February 11, 2008 Share Posted February 11, 2008 What the hell do I need 900mg for? Call for the order, 150mg in a 100cc, PVC-free bag of D5W with a PVC-free IV line, set up the pump, and run it over 10 minutes (yes, that is my local protocol). In Vfib/pulseless Vtach, bolus dose of 300mg IVP. Other arrythmias (patient has a pulse) bolus dose of 150mg IV over 8 - 10 minutes. In Vfib/pulseless Vtach, post resuscitation care the drip is 900mg in 500ml, 1 mg/hour for the first 6 hours, 0.5 mg /hour the next 18 - that's what the hell for Link to comment Share on other sites More sharing options...
firedoc5 Posted February 11, 2008 Share Posted February 11, 2008 Niftymedi911, Just out of plain old curiosity, why 5mcg/min/kg of Dopamine? Why not 7? (Guess I'm thinking out loud and want to learn more. Link to comment Share on other sites More sharing options...
triemal04 Posted February 12, 2008 Share Posted February 12, 2008 In Vfib/pulseless Vtach, bolus dose of 300mg IVP. Other arrythmias (patient has a pulse) bolus dose of 150mg IV over 8 - 10 minutes. In Vfib/pulseless Vtach, post resuscitation care the drip is 900mg in 500ml, 1 mg/hour for the first 6 hours, 0.5 mg /hour the next 18 - that's what the hell for Not to be rude or anything but...1mg/hour for 6 hours is only 6mg. .5mg/hour for the next 18 is only 9. I'm guessing what you meant was 1mg/min, but hey, I've always hated math so maybe I'm wrong. Not to mention that even with my longest transport I won't be seeing a patient for 6 hours. I'm sure there are places like that out there, but generally speaking...there aren't many, and a lot don't seem to be ALS. Point being there is nothing wrong with mixing 150mg of Amiodarone into 50cc of D5W (or 100cc) and running it in at 1mg/min. Gives you 2.5 hours to get them to a hospital. Any problems with that? Link to comment Share on other sites More sharing options...
Kaisu Posted February 12, 2008 Share Posted February 12, 2008 [quote="triemal04 Not to be rude or anything but...1mg/hour for 6 hours is only 6mg. .5mg/hour for the next 18 is only 9. I'm guessing what you meant was 1mg/min, but hey, I've always hated math so maybe I'm wrong. Not to mention that even with my longest transport I won't be seeing a patient for 6 hours. I'm sure there are places like that out there, but generally speaking...there aren't many, and a lot don't seem to be ALS. Point being there is nothing wrong with mixing 150mg of Amiodarone into 50cc of D5W (or 100cc) and running it in at 1mg/min. Gives you 2.5 hours to get them to a hospital. Any problems with that? Link to comment Share on other sites More sharing options...
triemal04 Posted February 12, 2008 Share Posted February 12, 2008 You're right.. I did mean per minute... but math isn't one of my strongpoints either... The place I work at has 45 minute intercepts - with both of us running towards each other... and often, when the helicoptor isn't flying, we have an hour or so after our community hospital care to definitive care.. so long transports are one of the things we do. We don't start amiodarone drips (although we have pumps and will have nitro and heparin drips during these transports) because of the very long half life of amiodarone... as far as what is wrong with what you are doing.. probably nothing.. this is our protocols and are as per AHA recommendations.. Stay safe Good. My only point was that you don't need the entire amount of amiodarone right there when you start a drip; the rate it goes at is pretty slow and amio generally comes in 150mg vials/ampules, so you're pretty safe; if you need to run a drip, then run it regardless of if you have 150mg or 600mg on hand. As you said, the halflife is pretty damn long also. I'm sure it could happen, but the chances of a drip being started prehospital, and then still be running prehospital 6 hours later are fairly low. Not to say that it couldn't happen though... Link to comment Share on other sites More sharing options...
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