Is D5W Neccesary?

[Guest paramedico987]

Howdy y'all!

I just did my ACLS refresher today and a topic of discussion relevant to practical implimentation of tachyarrhythmia drug therapy came up.

They've been preaching amiodarone for some time now and we're always told to mid it in D5W. And now we have no choice but to put down our old friend lidocaine in NYC where it's been completely removed from the protocol. However a couple of different folks in the room had heard [from doctors] that it could be safely mixed in 0.9% Sodium Chloride [or even half normal for that matter] without any adverse reaction if it were only for a short period of time (e.g. 150mg over 10 min). This only comes up cuz now we'd have to start carrying D5W in our bags too which is really another 8oz I'd rather not carry up the stairs.

Has anybody heard anthing difinitive on the matter?

[paratrooper75 41]

I heard it's fine to mix with NS for short term infusions. D5W is the manufacturers recommendation due to the tests they have done. I guess it is "the most stable" in D5W for a long period of time. Thats all I've heard. Anymore help would be appreciated.

[Guest]

From the reading i did, it seems as though amiodarone is most stable in D5W solution.

[Skooter92 7]

I wouldn't toss lidocaine away so quickly. I've had far more success in converting with lido than with amiodarone.....call me old school, but a fair number of other s agree with me too!

[Guest partyrock]

I wouldn't toss lidocaine away so quickly.  I've had far more success in converting with lido than with amiodarone.....call me old school, but a fair number of other s agree with me too!

←

Too late...its gone

[Guest alsfirefighter]

Come find some D5W in my bag. lol.

I've also been told the same about Amiodarone and saline. I've had more problems with it foaming up if not stored properly then anything.

Do I still use lidocaine. Yes. Have I used Ami. Yes. Only in cardiac arrest resuscitation and unstable V-Tach where electrotherapy was utilized. Didn't see much difference in either, except the ami didn't seem to slow the rate as drastically as the lido often does.

Its been out of Westchester MAC protocols for Stable V-Tach for a few years. From what I'm reading I guess it will be tossed for a few more. Amiodarone's manufacturers must be spending tons of study money again.

[Guest paramedico987]

I got to see Ami used once in the ED [we don't carry it officially because it foams and unofficially because it's too expensive] for a patient with runs of VT that I had given Lido to [lido didn't work... I don't get it, I've always trusted lido. Maybe a bad batch?] and it worked GREAT.

The only REAL reason I like amiodarone is that it works on EVERYTHING from VF to Rapid A-Fib to WPW induced SVT so it can be safely administer to those "wide complex" tachycardias that you think are likely SVT w/BBB without risking too much.

[Guest]

If they're going to push Amiodarone soo hard, why don't they put the loading doses in a premixed Brisotjet and make life easy. Otherwise....VIVA La LIDO!!!!!!

[Guest alsfirefighter]

It doesn't bother me what its in, the majority of my meds aren't in burstajets anyway. One reason may be storage with the foam problem that occassionally occurs and it does make it easier to load a bag for an infusion etc.

Paramedico...lol. Nice to see some of the same things about $$$ and meds going on in other places. We solved the foaming problem with a container that the ami sits in and it still does slightly but not as bad as I saw in the beginning.

[WAS967 97]

I look at it this way. We carry NS. We carry D50. If you are worried about mixing Amiodarone in NS, then make yourself some D5. (Shaken not stirred).

I've been told by some that they've seen precipitate when they injected it into a NS line, but I have not seen that myself. I have used Amiodarone with success but even the studies admit that it might be more effective in the short term but does not lead to any long term benefit (ie...increase resuscitation to successful discharge rates). SO.

I think what most medics find daunting is the relative difficulty of use. It's a lot easier to slam in an amp of Lido and get on with other things than to sit there pushing Amio over 10 minutes. Plus we usually have a premixed bag of lido to hang whereas with Amio we have to sit there and mix up a bag to us then figure out HOW to use it.

Edited February 20, 2007 by WAS967