Amiodarone Admistration Info for a Class

Specialties CCU

Published

Hi all,

I am enrolled in NS426 a critical care class and am looking for a little help. I think I might have bitten off a lot, but I am willing to chew. I graduated from an ASN program five years ago, took my NCLEX this summer and passed, but have no real life experiences yet. I am hoping some one might be willing to be my interviewed colleague. I have attached the question the professor has asked us to research below:

"The newest ACLS guidelines include amiodarone as a first line drug for ventricular tachycardia and fibrillation. Think of a patient who received amiodarone.

What dose did you administer, and what effect did you observe?

If you have not administered amiodarone, interview a colleague who has used this drug."

Specializes in Education, FP, LNC, Forensics, ED, OB.

Like I said, it seems that we usually shock the patient out of it. Thinking back, I have pushed it once or twice. But usually (lately anyway) the patient is shocked back into a perfusing rhythm (usually with continued ectopy)- which calls for the drug administered over 10 minutes. I don't disagree that after the first three shocks, if the patient is still in a non-perfusing VT/VF that it should be slammed in. The quote that you quoted me on states to push 300 mg iv (per acls, it should be diluted with 20-30 cc though)...

American Heart Association has in the ACLS protocols to push the Amiodarone 300 mg. in Vfib/pulseless Vtach. (second dose is 150 mg). And, since this does not come premixed, you do dilute in 20 - 30 cc. (Then you can drip the drug after you convert with shock.)

You are correct in that hopefully the patient converts with the initial shock/s before having to go further into the code.

Specializes in CCU (Coronary Care); Clinical Research.
American Heart Association has in the ACLS protocols to push the Amiodarone 300 mg. in Vfib/pulseless Vtach. (second dose is 150 mg). Then you can drip the drug after you convert with shock.

You are correct in that hopefully the patient converts with the initial shock/s before having to go further into the code.

That is what I am saying too! 300 mg IV push- just dilute it in a syringe with 20-30 mL -then push. We don't have premixed syringes yet (I heard they were coming out though?). The times that I have seen it pushed, it has been diluted just a bit. The point we are both discussing is the same though- regardless, it is 300 mg IVP.

This is a direct quote from the ACLs Provider Manuel (page 83, 2001 book).

"To administer, draw up the contents of 2 glass ampules through a large gage needle (to redue foaming) diluted in a volume of 20-30 mL of D5W. If VF/VT recurs consider administration of a second dose of 150 mg IV"

Specializes in ICUs, Tele, etc..

Hi...nice discussion over here...Siri great job since u know the AHA book inside out, cover to cover, front to back, upside down, from teaching ACLS every weekend ;) I was trying to look in the AHA site for the Amiodarone recommendations for a quick link for usage during and before a code and i can't find it. I haven't really navigated that site before...But I found this... http://www.guideline.gov/summary/summary.aspx?view_id=1&doc_id=4155 though not directly from AHA it gives classifications...Anyways really great topic you guys!!!

Specializes in Education, FP, LNC, Forensics, ED, OB.
that is what i am saying too! 300 mg iv push- just dilute it in a syringe with 20-30 ml -then push. we don't have premixed syringes yet (i heard they were coming out though?). the times that i have seen it pushed, it has been diluted just a bit. the point we are both discussing is the same though- regardless, it is 300 mg ivp.

this is a direct quote from the acls provider manuel (page 83, 2001 book).

"to administer, draw up the contents of 2 glass ampules through a large gage needle (to redue foaming) diluted in a volume of 20-30 ml of d5w. if vf/vt recurs consider administration of a second dose of 150 mg iv"

yep, we are in total agreement, zambezi:balloons: yes, i do hope they come out with the premix, but, just not sure.....:) good talking with you.

Specializes in Education, FP, LNC, Forensics, ED, OB.
hi...nice discussion over here...siri great job since u know the aha book inside out, cover to cover, front to back, upside down, from teaching acls every weekend ;) i was trying to look in the aha site for the amiodarone recommendations for a quick link for usage during and before a code and i can't find it. i haven't really navigated that site before...but i found this... http://www.guideline.gov/summary/summary.aspx?view_id=1&doc_id=4155 though not directly from aha it gives classifications...anyways really great topic you guys!!!

:rotfl: :rotfl: you told the truth there, hrtprncss!!:rotfl: :rotfl:

if it isn't acls, it's pals. every weekend. i feel like a robot. "first you establish unresponsiveness, then do your a-b-c-'s, then if not breathing, give two breaths and then check a pulse. no, no......you don't start an iv first, you give them two breaths if they aren't breathing. no,no, you don't sync cardiovert in pea, doctor"......and on, and on, and on.....:rotfl: :rotfl: :rotfl: :rotfl:

Specializes in ICUs, Tele, etc..

no,no, you don't sync cardiovert in pea, [/size]doctor"......and on, and on, and on.....:rotfl: :rotfl: :rotfl: :rotfl:

that's very funny lol

Specializes in Education, FP, LNC, Forensics, ED, OB.
no,no, you don't sync cardiovert in pea, [/size]doctor"......and on, and on, and on.....:rotfl: :rotfl: :rotfl: :rotfl:

that's very funny lol

i'm telling ya, hrtprncss. the last time i did pals (about 2 weeks ago.....have another class this weekend), the doctor wanted me to instruct them on how to insert a line into the.....now get this......the venous sinus......are you ready....:uhoh3: ....the venous sinus of the brain.:eek:

if you knew me, you could visualize my face. :stone i just paused and cleared my throat, looked at the floor and then at him. told him that the american heart association had not incorporated that particular procedure as yet. :rolleyes: then i excused my self while the other instructor took over.

i left the room and cracked up laughing.:rotfl: :rotfl: :rotfl: i told the medical director about it and he just shook his head and said, "was it dr. so and so?" he knew exactly who it was. scary, huh?

Specializes in ICUs, Tele, etc..

LOL wow...well at least it made your saturday...

Specializes in Education, FP, LNC, Forensics, ED, OB.
LOL wow...well at least it made your saturday...

Good talking to ya tonight. Goodnight, hrtprncss.:balloons:

Specializes in L & D; Postpartum.

You are funny. I have MANY students who feel the same way you do. It scared the heck out of me the first time I took it many years ago. Now I teach it and try my best to make the students feel less intimidated, but, usually they are so nervous, it does not matter what I do.:)

Glad to be the comic relief. Really. I'm okay laughing at my own insecurities. Our instructors were, except for one, good. They are folks we know and work with so that helped. I fault the administration of our hospital and ultimately, the corporate PTB for budget things. First of all, none of the Labor nurses had ever been required to have ACLS before. Some of us have been nursing for 30 years or more. So the Corporate gurus decide this would be a good thing to brag about. BUT, our unit was allowed only 4 books to use as study guides. Classes at our hospital are done quarterly and this time there were 10 of us in class. Do the math: 6 people had no book to study from.

In the past, there were pre-ACLS classes taught (paid time) so that one could prepare properly. Let's face it: unless you have someone who knows what all that stuff really means, just reading the book isn't going to do it for you. So no pre-classes anymore, because the instructors and the students would have to be paid. Oh my! We wouldn't want the stock holders to be upset because their stock values were only 40 % over what it was a year ago. Now they want it to stay at 50 or 60%. Not to mention, the hospital administrators are already planning what to do with their performance bonuses.

Now, throw all the students, rookies and veterans alike, into one classroom and proceed as if everybody is just reviewing. The teachers were reviewing, as they would normally, but for us, it might as well have been conducted in Latvian or some other little known language. Acronyms everywhere. Shoot, it took me all day just to find out what ACS stands for, and guess what, heart attack. So you see, your efforts to make people relax, are well-meant, but we're up against a huge stump.

The one thing I would fault our instructors for, and a couple of them are good friends and co-workers of mine, would be that I felt they trivialized my own fears a little too much. Reassuring me that I would do fine was a good thing, but seriously, I wasn't sure I would pass. And when I left on Saturday afternoon, I was more depressed than I've been in a long long time. It wouldn't have taken much at all for me to have just stayed in bed Sunday morning.

Which is another thing: Classes started at 0800. Many of us work 3-11 or 7p-7a or 11p-7a. How does messing up our body schedules help us learn?

So I have some issues with how classes were scheduled and taught as well. I don't know how many times you have students in your classes who are first-timers, but when you do, find out more about them before assuming they already know all about 12-leads, where they go, what they show, rhythms and what they tell you, etc. We didn't know any of these things, but it was assumed that we did. We definitely were not dumped into a learning environment that was optimal for confidance and retention.

That being said, I did pass the damned thing. Glad I did, but truly, I have plans to be out of it before it becomes necessary to abuse myself one more time in that way. Goal-setting is a good thing, and this one will be powerful for me.

Specializes in Utilization Management.

I heard that amiodarone can stay in the bloodstream for about six months. And that it can cause fibrosis for patients who have certain underlying pulmonary conditions.

Of course, I'm talking stable V-Tach patients here, not pulseless ones....

Is my info correct?

Specializes in Education, FP, LNC, Forensics, ED, OB.

Glad to be the comic relief. Really. I'm okay laughing at my own insecurities. Our instructors were, except for one, good. They are folks we know and work with so that helped. I fault the administration of our hospital and ultimately, the corporate PTB for budget things. First of all, none of the Labor nurses had ever been required to have ACLS before. Some of us have been nursing for 30 years or more. So the Corporate gurus decide this would be a good thing to brag about. BUT, our unit was allowed only 4 books to use as study guides. Classes at our hospital are done quarterly and this time there were 10 of us in class. Do the math: 6 people had no book to study from.

In the past, there were pre-ACLS classes taught (paid time) so that one could prepare properly. Let's face it: unless you have someone who knows what all that stuff really means, just reading the book isn't going to do it for you. So no pre-classes anymore, because the instructors and the students would have to be paid. Oh my! We wouldn't want the stock holders to be upset because their stock values were only 40 % over what it was a year ago. Now they want it to stay at 50 or 60%. Not to mention, the hospital administrators are already planning what to do with their performance bonuses.

Now, throw all the students, rookies and veterans alike, into one classroom and proceed as if everybody is just reviewing. The teachers were reviewing, as they would normally, but for us, it might as well have been conducted in Latvian or some other little known language. Acronyms everywhere. Shoot, it took me all day just to find out what ACS stands for, and guess what, heart attack. So you see, your efforts to make people relax, are well-meant, but we're up against a huge stump.

The one thing I would fault our instructors for, and a couple of them are good friends and co-workers of mine, would be that I felt they trivialized my own fears a little too much. Reassuring me that I would do fine was a good thing, but seriously, I wasn't sure I would pass. And when I left on Saturday afternoon, I was more depressed than I've been in a long long time. It wouldn't have taken much at all for me to have just stayed in bed Sunday morning.

Which is another thing: Classes started at 0800. Many of us work 3-11 or 7p-7a or 11p-7a. How does messing up our body schedules help us learn?

So I have some issues with how classes were scheduled and taught as well. I don't know how many times you have students in your classes who are first-timers, but when you do, find out more about them before assuming they already know all about 12-leads, where they go, what they show, rhythms and what they tell you, etc. We didn't know any of these things, but it was assumed that we did. We definitely were not dumped into a learning environment that was optimal for confidance and retention.

That being said, I did pass the damned thing. Glad I did, but truly, I have plans to be out of it before it becomes necessary to abuse myself one more time in that way. Goal-setting is a good thing, and this one will be powerful for me.

Hello again,

I am so very sorry you had such a bad experience with ACLS. When we have new students, I ask them first what experience they have in this area and then make the scenerios suite them, not the other way around. I also, teach the basics as if they do not know and or understand the pneumonics involved. This has really helped many. We/I get great reviews on the post course evaluations.

Our classes are approx. 30 each time. So, you can imagine the different ones there: docs, nurses, paramedics, etc. We try to make them all feel special and at the same time, learn.

Sounds as if your institution is just not supportive at all. Throw you to the wolves, so to speak. Having only a few books for many to study......not well planned out at all.

And, I am not laughing at you at all. I just found your analogy about the cartoon very funny. I would never belittle someone for their fears. And, ACLS can be most fearful.:balloons:

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