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The Daily Insight

What do you give for Vtach

Author

Rachel Hickman

Published Mar 14, 2026

Amiodarone is the drug of choice for the treatment of hemodynamically unstable VT that is refractory to other antiarrhythmic agents. Prehospital studies currently suggest that amiodarone is safe and efficacious for use in out-of-hospital cardiac arrest.

What do you give for V tach with Pulse?

  • Attempt vagal maneuvers.
  • If unsuccessful, administer adenosine 6 mg IV bolus followed by a rapid normal saline flush.
  • If unsuccessful, administer adenosine 12 mg IV bolus followed by a rapid normal saline flush.

How do you treat unstable Vtach?

Unstable patients with monomorphic VT should be immediately treated with synchronized direct current (DC) cardioversion, usually at a starting energy dose of 100 J (monophasic; comparable biphasic recommendations are not currently available). Unstable polymorphic VT is treated with immediate defibrillation.

Can you give adenosine for Vtach?

Adenosine is the drug of choice for paroxysmal supraventricular tachycardia (PSVT) and is once again Advanced Cardiac Life Support-approved for differentiating PSVT with aberrancy from ventricular tachycardia (v tach) in patients with monomorphic wide complex tachycardias.

How do you give amiodarone to ventricular tachycardia?

First dose: Give 300 mg (6 mL) IV direct UNDILUTED. A filter is not required for IV direct administration. Second dose: If patient remains in pulseless ventricular tachycardia or ventricular fibrillation 5 minutes after the first dose, give a second dose of amiodarone 150 mg (3 mL).

What is amiodarone used for in EMS?

Amiodarone is carried as part of the existing paramedic formulary and is used to terminate paroxysmal supraventricular tachycardia (PSVT), resistant to cardioversion, in the hospital.

Do you give amiodarone in VFIB?

For cardiac arrest, amiodarone is used after the third shock for ventricular fibrillation and ventricular tachycardia that is unresponsive to shock delivery, CPR, and vasopressors. For tachycardia with a pulse, amiodarone may be considered, and expert consultation should be obtained prior to its use.

How do you treat SVT in WPW?

The management of SVT in children with WPW syndrome should begin with the use of a beta-blocker with the addition of digoxin or procainamide for treatment failures. The use of digoxin monotherapy, although frequently used by many practitioners in infants and children with WPW, cannot be recommended.

When is lidocaine used to treat ventricular tachycardia?

Lidocaine administered intravenously has been highly effective in terminating ventricular premature beats and ventricular tachycardia occurring during general surgery, during and after cardiac surgery, following acute myocardial infarction, and in the course of digitalis intoxication.

How is asystole treated?

Asystole is treated by cardiopulmonary resuscitation (CPR) combined with an intravenous vasopressor such as epinephrine (a.k.a. adrenaline). Sometimes an underlying reversible cause can be detected and treated (the so-called “Hs and Ts”, an example of which is hypokalaemia).

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How do you give amiodarone IV?

The current dosing recommendation for intravenous amiodarone is to give ≈1000 mg over the first 24 hours. The initial infusion should contain 3 mL of amiodarone injection (150 mg) in 100 mL D5W (concentration of 1.5 mg/mL). One should infuse this 100 mL over 10 minutes (15 mg/min) for a total of 150 mg.

How do you administer amiodarone?

To treat all acute tachyarrhythmias in adults, amiodarone can be given IV 150 mg over 10 minutes, followed by a 1 mg/min infusion for 6 hours, followed by an infusion at 0.5 mg/min. The recommended total dose over 24 hours should not exceed 2.4 grams.

How do you give amiodarone injection?

Add 3 mL of Amiodarone HCl Injection (150 mg) to 100 mL D5W (concentration = 1.5 mg/mL). Infuse 100 mL over 10 minutes. Followed by Slow: 360 mg over the NEXT 6 hours (1 mg/min). Add 18 mL of Amiodarone HCl Injection (900 mg) to 500 mL D5W (concentration = 1.8 mg/mL).

How fast do you give amiodarone in a code?

Epinephrine1 mg q3-5 min. Drip: 0.1- 0.5 mcg/kg/minVasopressin40 units IV x 1Amiodarone300mg IV over 1-2 seconds May repeat 150 mg IV x 1.Lidocaine1 – 1.5 mg/kg over 2-3 min, then may repeat 0.5-0.75 mg/kg in 5-10 min. Max: 3 mg/kg.Calcium Chloride5-10 ml (0.5-1 gm) over 2-5min

Can you give epinephrine and amiodarone together?

Conclusion: Amiodarone can be safely administered simultaneously in combination with adrenaline and such a combination results in similar haemodynamic support as adrenaline alone. Amiodarone administered alone produces significantly lower coronary perfusion pressure than when combined with adrenaline.

Do you shock V tach?

Ventricular tachycardia is a poorly perfusing rhythm; patients may present with or without a pulse. Most patients with this rhythm are unconscious and pulseless and defibrillation is needed to “reset” the heart so that the primary pacemaker (usually the Sinoatrial Node) can take over.

What is atropine used for in an emergency?

It is used in emergency situations when the heart beats too slowly, as an antidote to for example organophosphate insecticide or nerve gas poisoning and in mushroom poisoning. It can be used as part of the premedication before general anaesthesia.

Can adenosine be given with amiodarone?

amiodarone adenosine Combining these medications can increase the risk of an irregular heart rhythm that may be serious and potentially life-threatening, although it is a relatively rare side effect. You may need a dose adjustment or more frequent monitoring by your doctor to safely use both medications.

How do you give adenosine SVT?

Adenosine should be administered by rapid intravenous (IV) bolus injection into a vein or into an IV line. If given into an IV line it should be injected through as proximally as possible, and followed by a rapid saline flush. If administered through a peripheral vein, a large bore cannula should be used.

When do you take amiodarone or lidocaine?

The guidelines recommend administration of amiodarone for sustained ventricular fibrillation (Vf) and ventricular tachycardia (VT) refractory to CPR, defibrillation, and vasopressor in out-of-hospital cardiac arrest. Lidocaine is recommended as an alternative to amiodarone.

Can you give amiodarone and lidocaine together?

In some clinical conditions, such as local anesthesia or ventricular tachycardia (VT), a patient receiving amiodarone therapy may also receive lidocaine. An interaction between amiodarone and lidocaine has been observed in vivo.

Can lidocaine and amiodarone be used together?

Aggressive correction of electrolytes imbalance and acidosis with concomitant administration of intravenous infusion of amiodarone with lidocaine is an effective approach in treating electrical storm in patients with dilated cardiomyopathy and severe left ventricular dysfunction.

Can you give amiodarone in WPW?

The effect of amiodarone in prolonging the refractory period of the accessory pathway makes this drug especially useful in patients with the Wolff-Parkinson-White syndrome and atrial fibrillation.

What is the drug of choice for WPW syndrome?

The drug of choice for the treatment of regular supraventricular (reciprocating) tachycardia with narrow QRS complexes, which is the most common arrhythmia in the WPW syndrome, is propranolol.

What medicine used to treat SVT is contraindicated specifically in WPW?

Digoxin is contraindicated in patients with WPW syndrome, although it may play some role in children only.

Do you give atropine for asystole?

Atropine is inexpensive, easy to administer, and has few side effects and therefore can be considered for asystole or PEA. The recommended dose of atropine for cardiac arrest is 1 mg IV, which can be repeated every 3 to 5 minutes (maximum total of 3 doses or 3 mg) if asystole persists (Class Indeterminate).

What meds are given for asystole?

Standard drug therapy for asystole during cardiac arrest includes epinephrine, atropine, and calcium chloride (CaCl). Recent studies have shown that ventricular fibrillation (VF) can appear to be asystole when recorded from the chest surface.

How is asystole ACLS treated?

Asystole is not a shockable rhythm and treatment for Asystole involves high quality CPR, airway management, IV or IO therapy, and medication therapy which is 1mg epinephrine 1:10,000 every 3-5 minutes rapid IV or IO push. Remember, CPR should not be stopped for the delivery of medications.

How do you administer atropine?

Atropine can be administered by intravenous (IV), subcutaneous, intramuscular, or endotracheal (ET) methods; IV is preferred. For ET administration, dilute 1 mg to 2 mg in 10 mL of sterile water or normal saline before administration. For pediatric ET, double the usual IV dose and dilute in 3 to 5 mL.

When do you give atropine?

Atropine is a prescription medicine used to treat the symptoms of low heart rate (bradycardia), reduce salivation and bronchial secretions before surgery or as an antidote for overdose of cholinergic drugs or mushroom poisoning. Atropine may be used alone or with other medications.

When do you hold amiodarone in nursing?

Hold the medication if HR < 60/min or > 120/min. Assess other vital signs like blood pressure and respirations. Check cardiac monitor for presence of dysrhythmias.