amio

2. Antiarrhythmic agent
Class

3.  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

4.  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

5. How Supplied
Amiodarone Hydrochloride Injection, 50 mg/mL is
supplied in:
3 mL (150 mg)

6.  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

7.  cardiogenic shock
 Severe sinus node dysfunction resulting in
marked sinus bradycardia.
 Second- or third-degree AV block
 Symptomatic bradycardia.
 Known hypersensitivity.
Contraindications

8.  Use with caution in patients with latent or
manifest heart failure because failure may
be worsened by its administration.
Precautions

9.  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

10.  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

11.  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

12.  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

13. 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

14.  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

15.  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

16.  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

17. CCFEMS Protocol
Adult Tachycardia

18.  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

19. 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)

20.  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

21. Ventricular Fibrillation
Bledsoe/Porter/Cherry/Snyder, Intermediate Emergency Care: 1985, Third Edition
©2008 by Pearson Education, Inc., Upper Saddle River, NJ

22.  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

23.  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

24. CCFEMS Protocol
V-Fib, Pulseless V-tach

25.  Initial dose is 300 mg IV push.
 Repeat at 150 mg IV if no response.
Dosage Ventricular fibrillation or
pulseless ventricular tachycardia

26. DosageVentricular fibrillation or
pulseless ventricular tachycardia
IF RHYTHM CONVERTS:
 administer 1mg/min or
450mg/250 ml D5W (33ml/hr)
IV or IO