For any nurses or doctors.?

Question

In a code situation, how fast do you push drugs like epi, atropine, amioderone, and adenosine?

Answer 1

Adenosine degrades in only a few seconds. It has to be pushed as quickly as possible.

Epinephrine and atropine can be pushed at a quick but comfortable rate in a few seconds. There's no need to specify more closely.

Amiodarone I use rarely as a push. The reason it made it into the V-fib algorithm is that it's associated with a higher ROSC but not improved survivability to discharge, the exact same reason calcium was taken out of the asystole algorithm. A cynical person might even think the motive behind the reversal in logic has something to do with Wyeth's money being thrown around among the proponents of the drug. Diluted in 30 ml D5W, it obviously takes a bit longer to push.

You might want to dig out the old ALIVE trial from NEJM, though, for a less pessimistic view.

Answer 2

I only use Amio in treating symptoatic or very rapid AF w/ RVR, maybe refractory VF or VT, but probably pronestyl instead. For pulseless VT/VF, excessive symptomatic ectopy that's hitting close to R on T phenomenom Lidocaine still works better. In a code... IV slam! and flush well behind it, raise the arm if thats where your IV is. If your mixing amio don't agitate it too much, it's soapy.

Answer 3

Adenosine is not used in a code, if you're referring to cardiac arrest.  New ACLS protocols say shock (if shockable rhythm), CPR, push a drug..... basically you wind up pushing a drug about every minute.