When will we give first dose of amiodarone

NEET PG
#1

When will we give first dose of amiodarone according to acls…is it sir when there is vf or pvt and we have tried already 2 attempts of epinephrine and then if the patient’s rhythm is shcokable…?

Chart of acls creating confusion…thanks in advance sir…

According to the Advanced Cardiac Life Support (ACLS) guidelines, amiodarone is administered during the management of ventricular fibrillation (VF) or pulseless ventricular tachycardia (pVT) that is unresponsive to initial defibrillation and epinephrine. Here is a step-by-step breakdown to clarify the process:

ACLS Algorithm for VF/pVT

  1. Initial Assessment and CPR:
  • Start CPR (chest compressions and ventilation).
  • Attach defibrillator/monitor.
  1. Rhythm Check:
  • If VF/pVT is identified, proceed with defibrillation.
  1. First Defibrillation Attempt:
  • Deliver one shock.
  • Resume CPR immediately for 2 minutes (do not check the rhythm immediately after defibrillation).
  1. Epinephrine Administration:
  • If VF/pVT persists after the second shock, administer epinephrine (1 mg IV/IO) every 3-5 minutes.
  • Continue CPR for 2 minutes after each epinephrine dose.
  1. Second Defibrillation Attempt:
  • After the second 2-minute cycle of CPR, perform another rhythm check.
  • If VF/pVT persists, deliver another shock.
  • Resume CPR immediately for 2 minutes.
  1. Amiodarone Administration:
  • If VF/pVT persists after the third shock, this is when you administer amiodarone.
  • The first dose of amiodarone is 300 mg IV/IO push.
  • Resume CPR immediately for 2 minutes after administering amiodarone.

Summary

  • First dose of amiodarone: Administered after the third shock if VF/pVT persists.
  • Epinephrine: Given every 3-5 minutes (usually after the second shock if VF/pVT persists).

ACLS Cardiac Arrest Algorithm for VF/pVT:

  1. Start CPR and give oxygen, attach defibrillator/monitor.
  2. Rhythm check - shockable rhythm (VF/pVT).
  3. First shock - followed by immediate CPR for 2 minutes.
  4. Rhythm check - shockable rhythm (VF/pVT).
  5. Second shock - followed by immediate CPR and administration of epinephrine.
  6. Rhythm check - shockable rhythm (VF/pVT).
  7. Third shock - followed by immediate CPR and administration of amiodarone (first dose: 300 mg).

Key Points

  • Amiodarone is introduced after persistent VF/pVT following the third shock.
  • Epinephrine is administered after the second shock, every 3-5 minutes during CPR.
  • Continue to follow the cycle of rhythm checks, defibrillation, and administration of drugs according to the ACLS guidelines.

Second Dose of Amiodarone

  • If VF/pVT persists, a second dose of amiodarone (150 mg IV/IO) can be administered.

Conclusion

Amiodarone is given after the third shock if the patient’s rhythm remains shockable (VF/pVT). It is crucial to follow the sequence of defibrillation and drug administration as outlined in the ACLS algorithm to ensure the best possible chance of resuscitation. If you have any more questions or need further clarification, feel free to ask!