amiodarone administration

[vs-eh?]

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.

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/minwhich gives you 0.5 mg/min.

What is this gtt/min garbage people are using? People do realize how widely an inferred mg/min could vary between people reading this right?

buckeyedoc - I can't even extrapolate your adminitration because you don't give the volume of fluid of D5W.

brock8024 - 150 in 25 is 6mg/ml. At 150gtt/min that is what? 80mg per min? 15mg/min? I assume you are using a microdrip? 60gtt/ml? Your second maintenance dosage indicates now it is likely a 60gtt/ml set...

Don't use gtt/min when describing infussion of medication. It really means nothing...

We do 150mg in a 30ml syringe with saline. Pushed manually over 10mins, ~ 3ml/min, or 15mg/min. This is for wide complex tach and/or aifb/aflutter at times.

Arrest is 300mg and 150 bolus.

[brock8024]

vs-eh? I will say I am sorry for using the Gtt/Min thing. I asked one of the doctors I work with to read what I wrote and he said I could have written it more clearly.

As far as using a drip set or syringe to push it, he said no difference. He said the only difference he seen was with the drip set it would be going in more constitanly and it would free up a medic. He said if you are having to push the drug that medic is unavailable to do other things. That medic has to watch the clock and make sure he is being constituent with the meds. With a drip it is dripping the same amount over the ten mins and the medic is freed to do other things.

So I will say I am sorry for not clearly writing, in my head it sounded right. He said though either 150 in 30ml over 10 mins or 150 in 25 ml over 10 mins is no difference since the amount of drug is the same.

[buckeyedoc]

What size D[sub:2ce930d954]5[/sub:2ce930d954]W?

150 mg Amiodarone in 50ml of D5W with macro-drip at 160 gtts/min.

[buckeyedoc]

What is this gtt/min garbage people are using? People do realize how widely an inferred mg/min could vary between people reading this right?

buckeyedoc - I can't even extrapolate your adminitration because you don't give the volume of fluid of D5W.

Well, I'm so sorry. Perhaps that I forgot to type it because I was holding my 13 month old in one hand and typing with the other. I'm sorry that you couldn't extrapolate.

brock8024 - 150 in 25 is 6mg/ml. At 150gtt/min that is what? 80mg per min? 15mg/min? I assume you are using a microdrip? 60gtt/ml? Your second maintenance dosage indicates now it is likely a 60gtt/ml set...

Don't use gtt/min when describing infussion of medication. It really means nothing...

We do 150mg in a 30ml syringe with saline. Pushed manually over 10mins, ~ 3ml/min, or 15mg/min. This is for wide complex tach and/or aifb/aflutter at times.

Arrest is 300mg and 150 bolus.

[brock8024]

"Don't use gtt/min when describing infussion of medication. It really means nothing... "

I do not understand this comment. How does gtt/min mean nothing, it means alot. Lets say you are using a pump and it breaks and you are in the middle of a transfer. You are going to have to use gtt/min I would think.

We are not taught how to use IV pumps at my school for this reason. We can learn that on the job, but they want to make sure we know how to calculate drips the old fashion way and use drip sets incase something goes wrong. We do not get to use drip charts, if we want to use a drip in a code our instructors make us calculate the drug and drip rates on paper.

My instructor told us something yesterday that makes a lot of sense.

He said give me a paramedic with a good base of understanding and basic materials than a paramedic with a some understanding and high tech materials.

I think what he means is iv pumps and monitors that do everything for you is nice, but when they malfunction you got to go back to you basic equipment and know how to use it.

So I personally think that Gtt/min does mean alot and works when that pump will not.

[brock8024]

brock8024 - 150 in 25 is 6mg/ml. At 150gtt/min that is what? 80mg per min? 15mg/min? I assume you are using a microdrip? 60gtt/ml? Your second maintenance dosage indicates now it is likely a 60gtt/ml set...

If we use this it is 6mg/ml. Now 150gtt/min is 2.5 ml a min which is 15mg/min times that by 10 is 150mg in 10mins.

so 150/60= 2.5ml.

2.5mlx 6mg is 15mg/min

15mg x 10= 150mg in 10 mins.

I would think this is better than a IV push. they are getting a consentant amount of med over the entire time.

with a IV push the med is not as constitant.

[brock8024]

brock8024 - 150 in 25 is 6mg/ml. At 150gtt/min that is what? 80mg per min? 15mg/min? I assume you are using a microdrip? 60gtt/ml? Your second maintenance dosage indicates now it is likely a 60gtt/ml set...

If we use this it is 6mg/ml. Now 150gtt/min is 2.5 ml a min which is 15mg/min times that by 10 is 150mg in 10mins.

so 150/60= 2.5ml.

2.5mlx 6mg is 15mg/min

15mg x 10= 150mg in 10 mins.

I would think this is better than a IV push. they are getting a consentient amount of med over the entire time.

with a IV push the med is not as constituent.

[vs-eh?]

150 mg Amiodarone in 50ml of D5W with macro-drip at 160 gtts/min.

This illustrates my point nicely with why you shouldn't use gtt/min as your infussion rate when describing it to someone else.

I hope other people already understand it...

For brock8024 and buckeyedoc...

So you run 150mg of amiodarone in 50ml with a macro-drip at 160gtt/min.

Me reading that = 3mg/ml

Macro set = 10gtt/ml... 160gtt=16.0ml

So you infuse the 150mg in just over 3mins?

There are many different kinds of macro drip sets and maybe more than 1 (is 60gtt the only one considered micro?) micro set. This is why it is far easier, more professional and universal to describe an infusion in mg/min or whatever.

If I said to any doctor that "we put 150mg in D5W & run it at 160 gtts/min for this wide complex tach" he/she would be like "huh, what was the mg/min?" Even if I put the volume in it still wouldn't mean much. You are talking about the WEIGHT of the medication, not the VOLUME infused.

However me saying "we gave 150mg amiodarone over 10 mins at 15mg/min" then they know regardless of the actual volume, at what rate the WEIGHT of the medication was given. I could have it in 50, 250, or 500ml...Whatever, they know the rate of medication given. Volume or "drips" doesn't matter and they won't care.

[vs-eh?]

Oh, and before people say things like "What? The amount of fluid/drips matter's ya dope!"

Ex.

A - "Doctor, I administered 150mg at a rate of 15mg/min"

B - "Doctor, I administered 150mg at a rate of 15ml/min"

C - "Doctor, I administered 150mg at a rate of 150gtt/min"

Which one of these will any doctor always know over what period of time the drug was administered? Regardless of any other variable?

The answer is A. ANY doctor will always know that the drug was given over the correct period of time i.e. 10 mins. Regardless of volume or drip set.

If you answer B and your fluid volume is anything more or less than 150ml, you will not be administering the drug over 10mins. Drips could be variable too. 150gtt? 180gtt? 800gtt?

If you answer C. You'd need to know both the volume and drip set again, know over what period of time the drug was given.

Fluid volume will matter of course to fluid restricted patient, volume concerns, etc...Which is why it is normally given in 100ml or less of fluid.

But given a hypothetical infinitely unrestricted fluid patient. The only understandable order in X time frame would be A. Which is why orders are given like that.

[Thunderchild145]

I do not understand this comment. How does gtt/min mean nothing, it means alot. Lets say you are using a pump and it breaks and you are in the middle of a transfer. You are going to have to use gtt/min I would think.

Very simple really. You can figure out gtt/min is you are given mg/min, but you can't really figure out mg/min when given gtt/min, thenfore it's always best to describe in mg/min. Everything else is variable, but mg/min should always be constant.