Amiodarone help!

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New nurse here looking for help. Has anyone pushed amiodarone 300mg for a patient in VTACH with a pulse. Pt was unresponsive and post cardiopulmonary arrest. HR was over 130 and BP was 180's/90's (i know hypotension is an issue) No medications administered prior to this order. Only a shock at 200j per EMS prior to arrival. I have given amiodarone bolus of 150mg over 10 minutes then 1mg/min after that. I have pushed amiodarone 300mg for a pulseless patient. I work in a small hospital with no interventional cardiology services. Just wondering if its a standard I'm missing. If so, can someone recommend a resource or reference?

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why was the pt unresposive w/ a SBP 180?

300 amio IVP is usually given w/ VF/unstable VT. This sounds like hemodynamically stable VT if I'm reading you right.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

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I took it as the patient had a cardiac arrest and was subsequently non-responsive then had and e[pisode of V-Tach. But I am curious too, for that dose is indicated for pulseless V-Tach. (by ACLS protocols) Stable VT/Tachycardia is adenosine.

ACLS Study Guide

Tachyarrhythmias In The ED: Best Evidence

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I'm pretty sure amio can be given in any case of vtach pulseless or not. Its an antiarrhythmic agent and per acls the dose is 300mg iv push for the first dose and 150 after.

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Specializes in ICU.
New nurse here looking for help. Has anyone pushed amiodarone 300mg for a patient in VTACH with a pulse. Pt was unresponsive and post cardiopulmonary arrest. HR was over 130 and BP was 180's/90's (i know hypotension is an issue) No medications administered prior to this order. Only a shock at 200j per EMS prior to arrival. I have given amiodarone bolus of 150mg over 10 minutes then 1mg/min after that. I have pushed amiodarone 300mg for a pulseless patient. I work in a small hospital with no interventional cardiology services. Just wondering if its a standard I'm missing. If so, can someone recommend a resource or reference?

I'd be more concerned about the fact that the patient's pulse pressure is wide. He may be having some neurologic events, although it usually is accompanied by bradycardia, not tachy. But VTach at 130 with a pulse? I don't think 300mg is the appropriate dose. Maybe more appropriate to give 150 slowly and start the gtt.

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Specializes in ICU, CVICU, E.R..

Was this ordered by the Physician?

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Specializes in Neuro ICU and Med Surg.

As I remember per ACLS guidelines you give 300mg if the pt has NO pulse. If the pt HAS a pulse then you give 150mg, followed by a drip of 1mg per hour for so many hours (can't remember exactly how many), then 0.5mg/hr and then off. I think total the drip runs for 16 hours.

I took it as the pt had a cardiac arrest was the subsequently non responsive, and had an episode of V-tach.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
I'm pretty sure amio can be given in any case of vtach pulseless or not. Its an antiarrhythmic agent and per acls the dose is 300mg iv push for the first dose and 150 after.

Amiodarone is best used for complex tachycardia in the presence of ventricular dysfunction. The dose is 150 mg over the first 10 minutes. The begin a slow infusion of 1mg/min for the next 6 hours....for a total dose infused of 360 mgs. For pulseless VT or VF the dose is then 300mg IV push (per the Kudenchunk study) with .....of course a completely different dosing for children.

The dose you mention, per the ACLS protocol, if for pulseless VT/VF.

I, personally, have not given a 300 mg dose for a VT with a SBP of 180

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Specializes in ED. ICU, PICU, infection prevention, aeromedical e.

Doctors are not always ACLS certified. Which means that they may not be up to date on the latest guidelines. Per the latest ACLS guidelines 300mg IVP is for dead people only - No Pulse. I find that as a member of the code team sharing this information with the provider can be a good clue to prevent wrong dosages. You could have stated it: "I thought that the correct dosage for a stable pt was 150mg IVPB over 10 min?". You're never wrong to ask or clarify.

Be empowered and share your knowledge.

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Specializes in Flight RN, Trauma1 CVICU STICU MICU CCU.

Are you really stable if you are unresponsive? Bp or not, the patient is post code. Doesn't sound stable to me.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
Are you really stable if you are unresponsive? Bp or not, the patient is post code. Doesn't sound stable to me.

This patient may be unconscious post resuscitation and this may be hours post code......if there is a good B/P of 180 systolic I would not call that unstable VT IMHO

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Specializes in ICU.
This patient may be unconscious post resuscitation and this may be hours post code......if there is a good B/P of 180 systolic I would not call that unstable VT IMHO

not an opinion. a fact.

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