Amiodarone Admistration Info for a Class

tntrn, ASN, RN · Sep 29, 2005

I just took ACLS this weekend (for the first time- what a nightmare). Epinephrine is the first drug to give in any cardiac arrest. Followed by Atropine.

Once you've given 3 dose of atropine (which is given after doses of epinephrine, then you can try amiodarone. Doses for that are 150 mg is the "live" dose (you have a heartbeat); 300 is the dead dose (you have no heartbeat.

Editorial Team / Admin · Sep 29, 2005

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.”

Hi, KneenaM,:balloons:

What do you need to know? Dose administered? 300mg. IVP during Vfib. Next shock, patient converted......

Do you need any other info? There are other times this is used.

Editorial Team / Admin · Sep 29, 2005

I just took ACLS this weekend (for the first time- what a nightmare). Epinephrine is the first drug to give in any cardiac arrest. Followed by Atropine.
Once you've given 3 dose of atropine (which is given after doses of epinephrine, then you can try amiodarone. Doses for that are 150 mg is the "live" dose (you have a heartbeat); 300 is the dead dose (you have no heartbeat.

I am sorry, but, you are incorrect. I believe you have your algorithms mixed up.

During a cardiac arrest, Vfib or pulseless Vtach, atropine is NEVER given.

Atropine during a cardiac arrest (no pulse) is given ONLY in PEA and asystole.

Atropine is given up to a total max dose of 0.4 mg/kg.

papawjohn · Sep 29, 2005

Hey KneenaM

Some smarter person will come along to straighten both of us out. It's one of the great things about nursing--we're surrounded by really brilliant people.

Let me tell you how I think about Amio. (Back years ago we used a lidocaine. It's like 'novacaine' that dentists use--slowed nerve conduction. Just like the dentist slowed the pain receptors in your jaw, LIDO slowed conduction in the heart. It wasn't hard to think about "novaine in the cardiac muscle" stoping VF or VT.)

Now there's this AMIO. Does everything. How's it do all that? Well, it just does. In my simple way--I imagine the heart in crisis as being on FIRE. The fire dept arrives. They pull out this FIRE HOSE. You were using the garden hose, right. You were trying to save the kitchen or the living room. Now the Fire Dep't is here. They are going to pump thousands of gallons per minute into your house. THAT is Amio.

Since it's going into the whole house--instead of just the kitchen where you know the fire is--a huge flood in necessary to start off with. OK?

So you start off with an IV BOLUS of AMIO; (if memory serves--150mg IV over 10min) (repeat in 10--30min prn). So you've filled the whole body and it's tissues with Amio. (ie. You've soaked the whole house.)

Then you give enough AMIO to put out the stove that's still hot--whoops--to de-energize the source of cardiac ectopics. (1 mg/min for 10hrs--most ways of reconstituting the drug make this about 34cc/hr.)

I found two websites:

http://www.aafp.org/20031201/218.html

http://www.drugs.com/amiodarone.htmt

Hope this helps til the smart guys get here

Papaw John

Editorial Team / Admin · Sep 29, 2005

Hey KneenaM
So you start off with an IV BOLUS of AMIO; (if memory serves--150mg IV over 10min) (repeat in 10--30min prn).

Hello, John,:Melody:

Amiodorone is given in different dosages for different situations. In pulseless Vtach and Vfib the dose is 300 mg. RAPID IVP for the first bolus.

papawjohn · Sep 29, 2005

Hey Siri

I know the various ways of giving these things, hon. (Can I say 'hon'? It's kind of a southern thing.)

But I really try to make a 'picture' so that intelligent people do not think they are stupid if they don't SUDDENLY know as much as you or me.

You are of course correct. And I was "guilty" of an over-simplification".

I take the business of "nurses eating their young" as a personal challenge, however. And try to "nurse" my baby-nurses.

But don't tell---everybody thinks I'm a cranky old B*ST*RD.....

Papaw John

zambezi, BSN, RN · Sep 29, 2005

For pulseless VT/VF-defibrillation first- remember the first three successive shocks first! If still pulseless either epi or vasopressin per protocol and consider antiarrhythmics- continue with shock/drug etc...amiodarone is something that is being given along with everything else. I know you didn't specificially ask about this part but I figured I would say it so those that are newer to the code thing don't forget about that part. Amiodarone is not the first line drug for a code (although it is the often the first line antiarrhythmic recommended.)

Amiodarone has mulitple effects on the sodium, potassium, and calcium channels. Like papawjohn said, it does all kinds of things! It is kind of like the fire department putting out a big fire. So after you shock, shock, shock, give some epi, do some CPR- patient is still if VT or VF- somebody is preparing that syringe of Amiodarone. Drug/Shock etc is continued and Amiodarone 300mg IV push can be given as treatment for cardiac arrest due to shock resistant VF or pulseless VT. Dilute the drug with 20-30 cc of D5W. If VF/Vt recurs you can consider a second dose of 150 mg IV. The max cumulative dose is 2.2g over 24 hours.

If after you receive a perfusing rhythm- an IV continuous antiarrhythmic should be considered. A rapid infusion of 150 mg over 10 minutes should be bolused if the patient reverts back to pulseless VT/VF, then a continuous infusion of 360 mg (1 mg/min) over 6 hours (33.33 cc/hr in you are mixing 900mg in 500d5) then a maintenence infusion of 540 mg over the next 18 hours (0.5 mg/min or 16.6 cc/hr). Of course you can consider lidocaine or procainamide as well...

That being said- I almost never see amiodarone given IVP...it seems we shock most people out of pulseless VT/VF with one of the first three shocks at which time we administer either 300 mg or 150 mg mixed in 100cc and run it in over 10 minutes. Then we start a drip as I outlined in the above paragraph. Our docs all start amiodarone if there has been issues with Vt or VF.

Our docs start amiodarone alot. It is a nice drug because you can use it on both impaired and noraml hearts. OUr docs will often start if for freqent pvcs or pacs or little runs of either (depending on the patient/lab values/other issues examined) we also frequently use it for stable VT, pulseless VT, VF, AFIB (both rate control and rhythm conversion).

I hardly ever see lido used and procainamide even less (in fact, I think that I have only used this once- and the patient was already on amio/lido etc... she didn't do so well).

http://www.americanheart.org/downloadable/heart/1053714937281ACLSPROV_App3.pdf

tntrn, ASN, RN · Sep 29, 2005

You're right, I am not correct. I did mention I thought ACLs was a nightmare, right? Following the path of an algorithm is like looking at a one-frame cartoon of a kid who's going outside to play. Lucky me, I drew Asystole for my mega code, the only one I could really follow and truly understand.

We WERE told that Atropine up to 0.3 only, however. Even this medicine varies from place to place.

My new goal in life is to never have to take ACLS again. In 2 years I'll be nearly 59 and have decided I will be not subject myself to that again. Like people who fear the OB ward and anybody who's ever missed a period, that's me, only in the cardiac arena. Thankful for those who do groove on it and love it, but want to be as far away as possible from it.

Editorial Team / Admin · Sep 29, 2005

. Amiodarone 300mg IVpush is a treatment for cardiac arrest due to shock resistant VF or pulseless VT. Dilute the drug with 20-30 cc of D5W. If VF/Vt recurs you can consider a second dose of 150 mg IV
That being said- I almost never see amiodarone given IVP...it seems we shock most people out of pulseless VT/VF with one of the first three shocks at which time we administer either 300 mg or 150 mg mixed in 100cc and run it in over 10 minutes. Then we start a drip as I outlined in the above paragraph.

Amiodarone is given rapid IV push in Vfib-pulseless Vtach.

I see it given very often during ACLS codes. And, never run it in over 10 minutes if you have Vfib/pulseless Vtach. Slam that drug in.

zambezi, BSN, RN · Sep 29, 2005

. Amiodarone 300mg IVpush is a treatment for cardiac arrest due to shock resistant VF or pulseless VT. Dilute the drug with 20-30 cc of D5W. If VF/Vt recurs you can consider a second dose of 150 mg IV
Amiodarone is given rapid IV push in Vfib-pulseless Vtach.
I see it given very often during ACLS codes. And, never run it in over 10 minutes if you have Vfib/pulseless Vtach. Slam that drug in.
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)...

Editorial Team / Admin · Sep 29, 2005

You're right, I am not correct. I did mention I thought ACLs was a nightmare, right? Following the path of an algorithm is like looking at a one-frame cartoon of a kid who's going outside to play. Lucky me, I drew Asystole for my mega code, the only one I could really follow and truly understand.
We WERE told that Atropine up to 0.3 only, however. Even this medicine varies from place to place.
My new goal in life is to never have to take ACLS again. In 2 years I'll be nearly 59 and have decided I will be not subject myself to that again. Like people who fear the OB ward and anybody who's ever missed a period, that's me, only in the cardiac arena. Thankful for those who do groove on it and love it, but want to be as far away as possible from it.

I knew you had gotten mixed up, tntrn. :balloons:

No, Atropine is up to a max dose of 0.4 mg/kg. That equals to about a total of 3 mg for the adult. It is given in increments of 0.5 mg to 1 mg. depending upon the algorithm. Whoever told you this (0.3???) was incorrect.........

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.:)