Amiodarone

[BecomingNursey]

Hello All!

The other day I was thrown into a rather uncomfortable position. A patient came into the ED where I work and the patient initially presented in asystole. After working the code for 10-12 minutes we were performing another rhythm check and noted that the patient was in pulse less v-fib. We shocked the patient, continued CPR and the physician ordered for 150 mg bolus of amiodarone to be given. I confirmed the order with the physician and started administering the medication IVP over 10 minutes as that is the rate I've been taught and that is what is in my drug book (I came home and confirmed it). My charge nurse was watching me and told me to just finish pushing the medication about 2 minutes in and proceeded to tell me that during a cardiac arrest event the 10 minute push doesn't matter. I didn't agree and continued to do a slower push.

So here is my question; Does it matter in a code situation, how long you give amiodarone over?

And to go ahead and address it: I wouldn't just take someone from a nursing forums advice over extensive research. I just wanted some experienced nurses (if people are honest) opinions! Thanks :)

[elijahvegas, ASN, RN, EMT-P]

as per ACLS protocols ive always known it to be 300mg, then 150mg, bolus'd pretty rapid. Reason being is that your next few rounds of epi are coming in between, and thats around every 2-3 minutes.

[NickiLaughs, ADN, BSN, RN]

It should have been 300 mg rapid IVP. Nothing is given over 10 minutes to a pulseless pt. The 150 over 10 minutes is someone with a pulse that's tachycardic

https://acls-algorithms.com/acls-drugs/amiodarone-and-acls/

[RNKPCE]

He's been pulseless for 10-12 minutes. In a code time is precious it would be given as a rapid IV push not over 10 minutes. As other's have said typically first dose is 300mg.

[applesxoranges, BSN, RN]

To be honest, by the time it circulated the body it would be awhile. Their heart isn't perfusing the body so it is dependent on high quality CPR. The odds of high quality CPR being performed is slim. We like to think we do a good job but most CPR is ****. Even the most fit get worn out during CPR. I can have great compressions in the beginning where doctors will say they feel a pulse but it disappears once I stop.

The 10 minutes is when you're going to give them a drip. The ALCS pulseless thing is 300 mg IVP and then another round with 150 mg IVP later. But... you can't mix lidocaine and amiodarone. Use one then stick with one. I am sort of amazed at how much amiodarone is used. It used to be all about the lidocaine.

[Christy1019, ASN, RN]

I agree with all of the above posters, just wanted to add that v-fib is ALWAYS pulseless, so no need to say "pulseless v-fib ". V-tach, however, can be pulseless or the pt can have a pulse. If they have a pulse, they get the dose over 10min, if there is no pulse, push it fast.

[supakimchee]

You said yourself the physician ordered the Amiodarone for bolus administration. So, why would you push it over 10 minutes? In a code situation, you don't use recommended IV push or infusion rates. The point is to get the drug into the client ASAP. What I am trying to figure out is, why are you concerned about adverse effects of rapid administration on a client that is in V-fib?

[SpEdtacular, MSN, RN, EMT-P]

Everything is IVP in a code. You should review ACLS protocols. That's the gold standard for codes.

And at the risk of sounding like a Troll, I have to wonder what kind of "extensive research" you did on the subject because it sounds like you've never taken ACLS or seen ACLS algorithms.

[RescueNinjaKy]

Hello All!

The other day I was thrown into a rather uncomfortable position. A patient came into the ED where I work and the patient initially presented in asystole. After working the code for 10-12 minutes we were performing another rhythm check and noted that the patient was in pulse less v-fib. We shocked the patient, continued CPR and the physician ordered for 150 mg bolus of amiodarone to be given. I confirmed the order with the physician and started administering the medication IVP over 10 minutes as that is the rate I've been taught and that is what is in my drug book (I came home and confirmed it). My charge nurse was watching me and told me to just finish pushing the medication about 2 minutes in and proceeded to tell me that during a cardiac arrest event the 10 minute push doesn't matter. I didn't agree and continued to do a slower push.

So here is my question; Does it matter in a code situation, how long you give amiodarone over?

And to go ahead and address it: I wouldn't just take someone from a nursing forums advice over extensive research. I just wanted some experienced nurses (if people are honest) opinions! Thanks :)

Are you acls certified? Because if you work in ED you should get certified asap. Giving an amio bolus via drip is different from giving an amio bolus in a code situation. The code requires a rapid ivp. And honestly, you need to use some critical thinking rather than just following textbook nursing.

[Sun0408, ASN, RN]

Pushing something over 10 minutes in a code setting is too long. Hell in most cases by the time you finished pushing it the pt would be dead and long gone. Brain tissue as well as heart tissue is dying!! Push it!

[AgentBeast, MSN, RN]

There are no mistakes in codes only mistakes in documentation. The patient is dead you can't make them more dead. You push meds as fast as they will go in with a dead patient.

[sailornurse]

This Med is usually "slammed" i.e. As fast as you an push the barrel of syringe.