Want to draw up Amio without the bubbles?

[Dustdevil]

I think Dust was joking about giving both but I could be wrong.

Hehe... yeah, anything I preface with, "Go big or go home!" is meant to be taken tongue-in-cheek.

I did have a cardiologist tell me he had seen several cases of asystolic arrest after simultaneous administration of amio and lido. Lido stabilizes membranes by blocking sodium channels while amio prolongs repolarization without altering the resting membrane potential. Lidocaine works on sodium channels in phase 0 and phase 4 (in high doses) while amio works on sodium channels in phases 2 and 3. So, his theory was that if you give both simultaneously you wipe out all phases of the cardiac action potential and asystole results. Interesting theory that may have merit.

Yes, there are increasing concerns over this, which is what prompted my previous jest. And if that is the case -- with the near-infinite half-life of amiodarone, you really can't wait long enough before going to lido. The risk is much greater with propranolol though, so lido is really your only back-up. At least with lido and propranolol, you didn't have to worry about the interactions.

I'm not one to jump immediately on board with "the next big thing," so I am still sceptical about amiodarone being all that. It's still not showing us any real benefits in survival rates. The best thing I can really say about it is that it helps keep protocol monkeys, who can't tell the difference between VT and SVT, from making too terrible of a mistake.

Of course, you could just go to Diltiazem instead. :wink:

[rdenman26]

Hehe... yeah, anything I preface with, "Go big or go home!" is meant to be taken tongue-in-cheek.

Right, Ill try to remember that.

[Spock]

Dust is right about the survival rates with amiodarone in the cardiac arrest patient. If you read the original research that lead to the inclusion of amio for cardiac arrests you will see that the incidence of ROSC was higher with amio than lido but the survival rates were the same. One study did not follow the patients through to discharge. Suboptimal research did not prevent the inclusion in the AHA guidelines because they were looking for a replacement for bretylium which went off the market.

Amiodarone is superior to many other meds for patients not in cardiac arrest. We start it for all CABG patients over 60 or CABG/valve patients because it has been proven to reduce the occurence of postop A-Fib. Amio is effective for just about every arrythmia except blocks. It is a good drug when used properly.

Live long and prosper.

Spock

[AZCEP]

You know what? I've never had a problem with "tween" when drawing up Amiodarone. I don't know how fast I'm drawing it up, but it's not that much slower than any of our other vial based meds.

I will also get in line to pick up some of the prefilled syringes, though.

[Trauma612]

we are told that amiodarone is incompatable with saline

How are you guy's pushing Amio across the pond and what dose? W/pulse here it's 150mg in 50-100 ml/NS over ten minute's

[RevMedic]

There are studies out now that indicate that it does not need to be diluted. I've seen nurses push the 150mg fast in a patient with a pulse, without any adverse effects. I cringed a little, though. I usually use a Volutrol (buretrol), with 17ml of saline & 3 of Amiodarone in the chamber. Administered @ 2gtts/sec, it goes in over 10 minutes. Had very good results with that approach.

I've pushed the 300mg (undiluted) fairly fast in a code with good results.

We have the pre-loads, BTW.

I prefer it over Lidocaine - I've had much better overall saves with amiodarone.

[akroeze]

Generally running it in a 100cc bag near to wide open gives you the 10 minutes (give or take a minute)

[Dustdevil]

I usually use a Volutrol (buretrol)...

If Santa Claus is reading this, please add some Buretrol's to my Christmas list!

I can order state-of-the-art, $20k biomedical equipment all day long with nobody batting an eyelash, but I can't get a couple Buretrols to save my -- or anybody else's -- life. :roll:

[akroeze]

If Santa Claus is reading this, please add some Buretrol's to my Christmas list!

I can order state-of-the-art, $20k biomedical equipment all day long with nobody batting an eyelash, but I can't get a couple Buretrols to save my -- or anybody else's -- life. :roll:

Are Buretrols really that useful? In my (admittedly limited) experience a small (50-100cc) bag with a microdrip set is just as good.

[Dustdevil]

Are Buretrols really that useful? In my (admittedly limited) experience a small (50-100cc) bag with a microdrip set is just as good.

They are extremely useful to those of us who can't get those little 50-100cc bags either. I just figure I have a better shot at somebody sending me Buretrols than IV bags.

But yeah, I prefer Buretrols to bags anyhow. If you need a volume other than 50 or 100, you're left guesstimating too much with the bags. The only thing I really like the bags for is antibiotics, where the exact volume isn't terribly important.