Want to draw up Amio without the bubbles?

[stever]

We carry amio in 150 mg pre-filled syringes. I'll do a SIVP, over mixing it in a 100 cc bag.

[Capman]

No Amio in Maine EMS at the time. At least I get to learn about it every two years in ACLS though.

[Roostmonkey]

I'm sure that all you guys do a SIVP of amio on a pulsed V-tach...

[Asysin2leads]

So how do you figure out which one worked so you can start a drip of it afterward?

Hey, were EMS, we don't care what's causing it, we just want it to stop.

[Contadinella]

I'll have to try that!

...Although I tried to use a blunt tip to draw up Ativan last week and ended up pushing the freaking rubber stopper (what you put the needle through) all the way through into the vial. Whoops... had to explain that one to the pharmacy. Our Amio vials are pretty small, I wonder if the same thing wouldn't happen...

Stupid question from Germany, but why do you have to explain to the pharmacy what happened to the vial?

Conta

[akroeze]

They make preloads of Amio? Sweet! Hook me up with some of that!

Have to suggest the drawing up saline first....

[stever]

Yep, we carry the pre-loads of amio. At my old service we had pre-loads of benadryl . . . not sure why.

[akroeze]

wow, is there anything that doesn't come in a pre-load? lol

[rdenman26]

we are told that amiodarone is incompatable with saline and should not be given if lidocaine has been given. Are you guys joking around or is this a difference in medical opinion and procedure between our countries. Maybe I should go to be, it is 23:10 over here.

[Spock]

I mix amiodarone with saline all the time and have never had a problem although the AHA ACLS guidelines mention using D5W to dilute it.

I think Dust was joking about giving both but I could be wrong. I have given both but not at the same time. I usually give amio and then wait for an effect before going to lidocaine. I also use magnesium with the amio. This is done in the context of v-fib during the rewarming phase of an open heart procedure. In the ambulance we go with amio and have gotten away from using lidocaine although we still carry it.

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.

I think a big advantage of amio over lido is in the patient with an aberrant SVT. Lido doesn't work on SVT but amio does. So if you aren't sure if it's VT or an aberrant SVT amio is the drug of choice.

Live long and prosper.

Spock