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epinephrine: 0.01 mg/kg every 3–5 minutes with max single dose of 1 mg [2] amiodarone: 5 mg/kg initially, can repeat 2 more times (total of 3 doses), max of 300 mg per dose, max 15 mg/kg, given for refractory VF and pVT [2] [5] lidocaine: 1 mg/kg initially with continuous infusion of 20-50 mcg/kg/min after, given for refractory VF and pVT [2] [5]
Amiodarone is an antiarrhythmic medication used to treat and prevent a number of types of cardiac dysrhythmias. [4] This includes ventricular tachycardia, ventricular fibrillation, and wide complex tachycardia, atrial fibrillation, and paroxysmal supraventricular tachycardia. [4] Evidence in cardiac arrest, however, is poor. [5]
The dose is 5–10 mg/kg and side effects are high blood pressure followed by low blood pressure and ventricular ectopy. Originally introduced in 1959 for the treatment of hypertension. [2] Its use as an antiarrhythmic for ventricular fibrillation was discovered and patented by Marvin Bacaner in 1969 at the University of Minnesota. [3]
Timing the shock to the R wave prevents the delivery of the shock during the vulnerable period (or relative refractory period) of the cardiac cycle, which could induce ventricular fibrillation. If the patient is conscious, various drugs are often used to help sedate the patient and make the procedure more tolerable.
Since these agents do not affect the sodium channel, conduction velocity is not decreased. The prolongation of the action potential duration and refractory period, combined with the maintenance of normal conduction velocity, prevent re-entrant arrhythmias. (The re-entrant rhythm is less likely to interact with tissue that has become refractory).
Amiodarone is also safe to use in individuals with cardiomyopathy and atrial fibrillation, to maintain normal sinus rhythm. Amiodarone prolongation of the action potential is uniform over a wide range of heart rates, so this drug does not have reverse use-dependent action. Amiodarone was the first agent described in this class. [4]
Ventricular tachycardia (V-tach or VT) is a cardiovascular disorder in which fast heart rate occurs in the ventricles of the heart. [3] Although a few seconds of VT may not result in permanent problems, longer periods are dangerous; and multiple episodes over a short period of time are referred to as an electrical storm.
Ventricular fibrillation (V-fib or VF) is an abnormal heart rhythm in which the ventricles of the heart quiver. [2] It is due to disorganized electrical activity. [2] Ventricular fibrillation results in cardiac arrest with loss of consciousness and no pulse. [1] This is followed by sudden cardiac death in the absence of treatment. [2]
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