Post on 13-Jan-2017
Antiarrhythmic agent
Class
Potent antiarrhythmic agent and the first-line antiarrhythmic agent given during cardiac arrest.
Has been clinically demonstrated to improve the rate of ROSC and hospital admission in adults with refractory ventricular fibrillation and pulseless ventricular tachycardia.
Description
Prolongs the action potential duration in all cardiac tissues.
Affects sodium, potassium, and calcium channels and has alpha- and beta- adrenergic blocking properties.
Mechanism of Action
How Supplied
Amiodarone Hydrochloride Injection, 50 mg/mL is supplied in:
3 mL (150 mg)
Life-threatening cardiac arrhythmias such as ventricular tachycardia and ventricular fibrillation. Also:
Stable, regular, and wide complex tachycardia.
To control rapid ventricular rate due to accessory pathway.
Indications
cardiogenic shock
Severe sinus node dysfunction resulting in marked sinus bradycardia.
Second- or third-degree AV block
Symptomatic bradycardia.
Known hypersensitivity.
Contraindications
Use with caution in patients with latent or manifest heart failure because failure may be worsened by its administration.
Precautions
Monitor the patient’s ECG for:
Bradycardia
Increased ventricular beats
Prolonged PR interval, QRS complex, and QT interval
Watch for signs of pulmonary toxicity such as dyspnea and cough.
Hypotension
Side Effects
Hypotension is the most common adverse effect seen with Amiodarone and may be related to the rate of infusion. Hypotension should be treated by slowing the infusion or with standard therapy: vasopressor drugs, positive inotropic agents, and volume expansion.
The most important treatment-emergent adverse effects are hypotension (16%), bradycardia (4.9%), liver function test abnormalities (3.4%), cardiac arrest (2.9%), VT (2.4%), CHF (2.1%), cardiogenic shock (1.3%), and AV block (0.5%).
Amiodarone
May react with:
Warfarin
Digoxin
Procainamide
Quinidine
Phenytoin
Interactions
Why is Amiodarone only diluted in D5W?
This is the only fluid in which
amiodarone is stable. Amiodarone when mixed in other fluids can precipitate out into solid form.
https://acls-algorithms.com
Three or more ventricular complexes in succession at a rate of 100 beats per minute or more
Overrides the heart’s normal pacemaker
Ventricular Tachycardia
Bledsoe/Porter/Cherry/Snyder, Intermediate Emergency Care: 1985, Third Edition
©2008 by Pearson Education, Inc., Upper Saddle River, NJ
Ventricular Tachycardia
Bledsoe/Porter/Cherry/Snyder, Intermediate Emergency Care: 1985, Third Edition
©2008 by Pearson Education, Inc., Upper Saddle River, NJ
Wide complex > 0.12 secs
Myocardial ischemia
Increased sympathetic tone
Hypoxia
Idiopathic causes
Acid-base disturbances
Electrolyte imbalances
Etiology
Bledsoe/Porter/Cherry/Snyder, Intermediate Emergency Care: 1985, Third Edition
©2008 by Pearson Education, Inc., Upper Saddle River, NJ
Usually results in poor stroke volume
Patients may have a normal blood pressure, may be hypotensive, or may be in cardiac arrest
Ventricular tachycardia is always significant
Whether ventricular tachycardia is perfusing or non-perfusing dictates the treatment
Ventricular tachycardia may eventually deteriorate into ventricular fibrillation
Clinical Significance
Bledsoe/Porter/Cherry/Snyder, Intermediate Emergency Care: 1985, Third Edition
©2008 by Pearson Education, Inc., Upper Saddle River, NJ
Stable patient with a pulse
Administer oxygen and place an IV line
Administer amiodarone 150 milligrams over 10 minutes
Repeat as needed to a maximum dose of 2.2 grams over 24 hours
If patient is or becomes unstable, as evidenced by chest pain, altered level of consciousness, or falling blood pressure, initiate cardioversion immediately after placing an IV line and administering oxygen. If time allows, sedate the patient first.
Pulseless patient should be treated as ventricular fibrillation
Treatment
Bledsoe/Porter/Cherry/Snyder, Intermediate Emergency Care: 1985, Third Edition
©2008 by Pearson Education, Inc., Upper Saddle River, NJ
CCFEMS Protocol Adult Tachycardia
For regular rhythm, monomorphic complex
this means V-tach or SVT with Aberrancy
*consider adenosine 6mg rapid push, may repeat 12mg IV/IO x 2
IF rhythm does not covert NEXT • Amiodarone 150mg in 100ml of D5W over 10 minutes
(15mg/min), may repeat x 1 if no response
Dosage-Wide Complex Tachycardia (with a pulse)
100 mls
Dosage-Wide Complex Tachycardia (with a pulse) continued
Next if still no response •Amiodarone 450mg /250 ml’s of D5W (1mg/min or 33ml/hr)
Chaotic ventricular rhythm usually resulting from the presence of many reentry circuits within the ventricles
There is no ventricular depolarization or contraction
No organized rhythm
P waves, PR interval, and QRS complex absent
Ventricular Fibrillation
Bledsoe/Porter/Cherry/Snyder, Intermediate Emergency Care: 1985, Third Edition
©2008 by Pearson Education, Inc., Upper Saddle River, NJ
Ventricular Fibrillation
Bledsoe/Porter/Cherry/Snyder, Intermediate Emergency Care: 1985, Third Edition
©2008 by Pearson Education, Inc., Upper Saddle River, NJ
A wide variety of causes have been associated with ventricular fibrillation
Most cases result from advanced coronary artery disease
Etiology
Bledsoe/Porter/Cherry/Snyder, Intermediate Emergency Care: 1985, Third Edition
©2008 by Pearson Education, Inc., Upper Saddle River, NJ
Ventricular fibrillation is a lethal dysrhythmia
The absence of cardiac output or an organized electrical pattern results in cardiac arrest
Clinical Significance
Bledsoe/Porter/Cherry/Snyder, Intermediate Emergency Care: 1985, Third Edition
©2008 by Pearson Education, Inc., Upper Saddle River, NJ
CCFEMS Protocol V-Fib, Pulseless V-tach
Initial dose is 300 mg IV push.
Repeat at 150 mg IV if no response.
Dosage Ventricular fibrillation or pulseless ventricular tachycardia
DosageVentricular fibrillation or pulseless ventricular tachycardia
IF RHYTHM CONVERTS:
administer 1mg/min or 450mg/250 ml D5W (33ml/hr) IV or IO