amiodarone

[Special31]

Hi...I was recently at a rapid response..where a patient was have runs of accelerated svt. The doctor and a ton of other medical personel were at the bedside. After carotid massage, the doc decided to start the patient on a amiodarone drip after the 150mg bolus was given. The 150mg vial was already available on the code cart. The issue was instead of going to pharmacy for the 10 minute bolus that is still 150mg. How come we just couldn't give the 150mg IVP? And then hang the drip?

[Dinith88]

The IV-push dose is given in codes...when the patient is down.

10 minute 'rapid load' is for people who are in a fast rhythm but not yet down.

IVP isnt recommended IVP for people who arent actively coding d/t the potential side effects...most notably (but not limited to) severe hypotension (esp. if given IVP!). If patient was on the brink...the IVP amio could send them over...

[luvinicunurse]

Correct...In our unit, we hang the 150 mg Amiodarone via a 100 ml bag of D5W, over 10 minutes, then get the Amiodarone bag from pharmacy.

Also, if the pt. is down, then we give 300mg (in V.Fib or pulseless V.tach) after the 1st does of epi or vasopressin.

If they are in unstable v.tach, we give adenosine

[Dinith88]

If they are in unstable v.tach, we give adenosine

??? Are you sure you mean this???

...Will someone please stand-up and correct this statement ?

[elthia]

Adenosine is a firstline drug for most stable narrow complex pre-entry SVT, and can be used for unstable narrow complex SVT prior to cardioversion.

[APNgonnabe]

I was taught that if you are ever going to say unstable you should be cardioverting.

[chare]

the following is from the 2005 aha guidelines for cpr and ecc, part 7.3: management of symptomatic bradycardia and tachycardia:

if the patient is unstable with narrow-complex reentry svt, you may administer adenosine while preparations are made for synchronized cardioversion (class iib), but do not delay cardioversion to administer the drug or to establish iv access.

[criticalHP, MSN, RN]

??? Are you sure you mean this???

...Will someone please stand-up and correct this statement ?

I will... I bet you're having a problem with the "VTach" part of that statement, right? Adenosine is given for narrow complex tachycardia; amiodarone is given for VF/VT and wide QRS tachycardia. The AHA ACLS algorithm on tachycardia with a pulse diverts the provider to the 'narrow QRS' box if there is question of V tach versus SVT with aberrancy, which can often look like V tach at a glance. So, what if you give adenosine to a patient in SVT with aberrant conduction? That depends on what outcome you are going for...My advise...don't give it!

If the original postor has had the experience of giving adenosine for V tach in the past, I would hope it was based on EKG findings that the rhythm was SVT with aberrancy. If the patient was unstable then a better choice would have been cardioversion and amiodarone.