amiodarone administration

[zzyzx]

How is amiodarone administered for a wide complex tachycardia? Is it given by IVP or by an infusion? What's the dose? What's second dose? Has anyone ever used it for this application? What are the contraindications and things to watch out for?

[canuckEMT]

Amiodarone

Class III antiarrhythmic

Some of the adverse effects of this drug are: Hypotesion, bradycardia, malaise, tremors and of course N/V

May cause digitalis toxicity if given with digitalis preperations; potentiate the effects of some anticoagulants

contraindications: Hypersensativity to drug or Iodine, Sinus node dysfunction, bradycardia

It is given IVP 300mg then if Vtach recurrs a second dose of 150mg. If it converts, an amiodarone drip of 0.5mg/min to maintain

Please fill in the blanks if I have missed anything.

[Thunderchild145]

Whoa whoa. 300mg IVP is for WCT -Arrest- patients. If the patient is not in cardiac arrest you infuse 150mg of the drug over either 10 minutes or 360mg over 6 hours depending on how high you want the serum concentration. Then again your protocols may be different. Anyway.

We give 300mg IVP for VF/VT diluted in 20-30ml of Normal Saline with a repeat of 150mg IVP q 3-5 minutes. For Stable WCT, you mix 150mg of Amiodarone with 100ml NS or D5W and run at 10ml/min for a 10 minute infusion which you can repeat once if it fails to convert. The repeat is the same as the first. 150mg over 10 minutes.

For a slow infusion you mix 1000mg in 500ml of solute and run at 30 ugtt/min (1mg/min).

Finally for peds, it's 5mg/kg IV/IO.

Contraindications are hypotension, cardiogenic shock, hypersensitivity, pulmonary congestion, and 2nd or 3rd degree AV blocks. The most common side effects I've seen when using it is headache and dizziness, but it can also cause hypotension, bradycardia, AV conduction problems, flushing, and excess salivation.

[canuckEMT]

Guess I should have read it a little better.........

[tniuqs]

It wasnt specified in arrest or not...whateve bothe good posts.

It sure is foamy crap and hard to get all the bubbles out.

Just a suggestion, use a large bore cath instead of a hypo, and don't put too much suction when drawing up..

Another point is that used over a period of time pumlonary concerns should be followed up with DLCO testing.

Diffusion Limited Carbon Monoxide testing has indicated "in some studies" that pulmonary fibrosis could be a future concern.

Mortality morbidity is less than the standard Lidocaine, to door discharge.

cheers

[AZCEP]

Where, pray tell, did you find a lower morbidity/mortality with amiodarone over lidocaine?

At 12 months, regardless of the agent used, the patient will still be dead. If you are quoting the pre-2000 guidline change AHA research, there are plenty of holes shot through that pile to not even be worthy of further discussion.

Amiodarone, supplied in vials, is a soap based medication. When you draw it up too fast, you create soap bubbles in the syringe. This also reduces the available drug, and the amount that has been drawn, and the syringe it is in need to be discarded. Using a large gauge needle, and drawing slowly is the only way to avoid this from happening. The same goes for administration. When pushing it IV, push slowly with a large needle, or it will foam up(tween) and you will not deliver the right dose to the patient.

[buckeyedoc]

We put 150mg in D5W & run it at 160 gtts/min for wide complex VT. We draw it up w/ an 18 or 19 ga filtered needle to prevent glass shards from being drawn up. 300 mg is used in arrests.

[Dustdevil]

We put 150mg in D5W & run it at 160 gtts/min for wide complex VT.

What size D[sub:6734c72ef3]5[/sub:6734c72ef3]W?

[Doczilla]

Amiodarone is technically a class III antiarrhythmic (potassium channel blocker, like ibutilide or bretyllium), but also has class I (like Lidocaine), class II (beta blockers, like metoprolol), and class IV (calcium channel blockers, like diltiazem or verapamil) effects on the heart. The class II and IV effects are why you see can see AV block and hypotension with the drug and why it is contraindicated for AV blocks or bradycardia.

And it looks like somebody got a homework assignment for paramedic class and took the easy way out.

'zilla

[brock8024]

In my class we mix up 150mg in 25ml and drop it at 150gtt/min. This is for WCT.

Maintaince for v-fib or v-tach if they convert is 540mg in 540ml and drop it at 30gtt/min which gives you 0.5 mg/min.

For v-fib or v-tach we give 300mg IVP then in 5 mins we can try 150mg IVP