FIELD REFERENCE
Full criteria & treatment guidance
Indications
- VF/pulseless wide-complex tachycardia or the specified unstable wide-complex tachycardia-with-pulse pathway. Adult and pediatric regimens differ.
Contraindications & local exclusions
- IV product label: component hypersensitivity (including iodine), cardiogenic shock, marked sinus bradycardia, or second-/third-degree AV block without a functioning pacemaker. These are product-label exclusions; apply the separate OCEMS resuscitation or pulse-present pathway and obtain direction for a conflict.
Precautions
- Monitor ECG and blood pressure; IV amiodarone can cause hypotension and bradycardia. Pulse-present slow administration and cardiac-arrest dosing are distinct.
- These are selected safety checks, not a complete prescribing monograph. Product labeling and OCEMS authorization answer different questions; confirm the actual product, patient population and applicable order.
Check before giving
- A pulse changes the administration sequence and rate.
- Slow administration in patients with a pulse is important: SO-C-040 warns about profound hypotension.
Use in OCEMS
- An antiarrhythmic option in the OCEMS VF/pulseless-VT sequence and the unstable wide-complex tachycardia pathway.
- Stable adult wide-complex tachycardia is generally monitored and transported under SO-C-040 without cardioversion or antiarrhythmic treatment.
Adult / adolescent
| Indication / route | Dose & limits |
|---|---|
| VF / pulseless VT | 300 mg IV/IO; may repeat 150 mg once after 3 minutes in the resuscitation sequence. |
| Unstable wide-complex tachycardia with a pulse | 150 mg slow IV/IO after unsuccessful initial cardioversion. Follow SO-C-040 for repeat cardioversion and the second 150 mg dose. |
Pediatric
- SO-P-040: for persistent VF/pulseless VT, 5 mg/kg IV/IO; it permits repeat 5 mg/kg doses at 5 and 10 minutes and lists a maximum dose of 450 mg. Follow the full arrest sequence and obtain base contact.
- I-20 marks VT with a pulse as a base-order indication and lists infusion over 10 minutes. Use the ordered dose and the correct weight-band entry; do not substitute the arrest administration method.
Pediatric weight table — Persistent VF / pulseless VT
- SO-P-040 pediatric dose: 5 mg/kg IV/IO.
- Initial arrest dose: 5 mg/kg IV/IO. Repeat doses may be given at 5 and 10 minutes, with a maximum of 450 mg; account for medication already given before any repeat.
- Base contact is required. This table is for pulseless arrest, not VT with a pulse. The base-ordered perfusing-VT regimen is a separate slow infusion.
- Calculated examples for the exact weights shown, using the named standing-order/procedure formula. Do not round the patient’s weight to the nearest row. For another weight, calculate from the stated formula and apply the limits. These are not the rounded I-20 weight-band volumes.
- Volumes are mathematical examples rounded to at most three decimal places. Verify the vial concentration, dose, and measurable syringe volume before administration; follow agency preparation/rounding practice.
| Exact weight | Dose — IV/IO | Volume at 50 mg/mL |
|---|---|---|
| 3 kg | 15 mg | 0.3 mL |
| 4 kg | 20 mg | 0.4 mL |
| 5 kg | 25 mg | 0.5 mL |
| 6 kg | 30 mg | 0.6 mL |
| 8 kg | 40 mg | 0.8 mL |
| 10 kg | 50 mg | 1 mL |
| 12 kg | 60 mg | 1.2 mL |
| 15 kg | 75 mg | 1.5 mL |
| 20 kg | 100 mg | 2 mL |
| 25 kg | 125 mg | 2.5 mL |
| 30 kg | 150 mg | 3 mL |
| 35 kg | 175 mg | 3.5 mL |
| 40 kg | 200 mg | 4 mL |
| 45 kg | 225 mg | 4.5 mL |
| 50 kg | 250 mg | 5 mL |
| 60 kg | 300 mg | 6 mL |
Pediatric weight bands — VT with a pulse
- I-20 pages 1–10: base hospital order required; infuse over 10 minutes using the ordered route. This is not the pulseless-arrest bolus.
- Values below are the published I-20 band doses. Confirm the base order and chart; do not extrapolate beyond these bands.
| I-20 weight band | Base-ordered dose over 10 minutes | Volume at 50 mg/mL |
|---|---|---|
| 3–5 kg | 20 mg | 0.4 mL |
| 6–7 kg | 30 mg | 0.6 mL |
| 8–9 kg | 40 mg | 0.8 mL |
| 10–11 kg | 50 mg | 1 mL |
| 12–14 kg | 70 mg | 1.4 mL |
| 15–18 kg | 75 mg | 1.5 mL |
| 19–23 kg | 100 mg | 2 mL |
| 24–29 kg | 125 mg | 2.5 mL |
| 30–36 kg | 150 mg | 3 mL |
| 37–49 kg | 150 mg | 3 mL |
Preparation & reassessment
- The listed preparation is 50 mg/mL. Confirm ordered milligrams and the matching volume.
- Maintain rhythm and perfusion monitoring. Medication is one part of the electrical-treatment/resuscitation pathway.
VISUAL FIELD REFERENCE
Adult amiodarone: pulseless versus a pulse
Adult & pediatric guidance · ALS
Adult pathways only. Pediatric arrest and base-ordered perfusing-VT doses are separate below.
- 300 mg → 150 mg
VF / pulseless VT
300 mg IV/IO; may repeat 150 mg once after 3 minutes in the resuscitation sequence.
- 150 mg · slow
Unstable wide-complex tachycardia with a pulse
150 mg slow IV/IO after unsuccessful initial cardioversion. Follow SO-C-040 for repeat cardioversion and the second 150 mg dose.
- Slow administration in patients with a pulse is important: SO-C-040 warns about profound hypotension.
- Stable adult wide-complex tachycardia is generally monitored and transported under SO-C-040 without cardioversion or antiarrhythmic treatment.
Selected checkpoints; read the complete guide for criteria, exclusions, doses, and ongoing care. I-15 · I-20 · SO-C-010 · SO-C-040 · SO-P-040
UNDERSTAND THE CARE
Why the presence of a pulse changes preparation
The arrest and pulsed-tachycardia uses share a drug name but have different administration sequences and rates. The stable adult wide-complex branch generally favors monitoring and transport under the condition order rather than automatic antiarrhythmic administration.
Applying the guidance
Before preparing medication, identify the branch, age group, dose, concentration, route, rate and prior doses. The pediatric arrest formula and base-ordered perfusing-VT weight bands serve different indications. Monitor circulation during administration in a patient with a pulse and document pressure changes, because the local order warns about hypotension with rapid delivery.
Dose, concentration and volume
Diagram text & teaching checkpoints
- Pulse status
- Arrest versus perfusing rhythm.
- Clinical branch
- Stable monitoring versus unstable treatment.
- Preparation
- Dose, concentration, rate and previous totals.
- Response
- Rhythm and blood-pressure/perfusion trend.
Sources for this explanation
Original OCMedic teaching synthesis of the references below. Educational expansion updated ; this is not a new independent clinical-review date. Source-specific dates and limitations remain in the full guidance.
- I-15 — Adult / Adolescent Standing Order Drug Guide
- I-20 — Pediatric Medication Volume Dose by Weight
- SO-C-010 — Cardiopulmonary Arrest - Adult / Adolescent Non-Traumatic
- SO-C-040 — Wide QRS Complex Tachycardia with a Pulse - Adult/Adolescent
- SO-P-040 — Cardiopulmonary Arrest - Pediatric
- Product label — AMIODARONE HYDROCHLORIDE injection, solution
Keep one medication history through rhythm changes
Maintain a single account of medication already administered even if the rhythm or pulse status changes. Record the indication, dose, route, administration time and response. At a crew handoff, distinguish an administered dose from a syringe that was prepared but never given; the next clinician needs the actual cumulative history.
The adult pulse-present pathway follows the unsuccessful initial synchronized-cardioversion step and uses slow administration. The pediatric arrest instructions and the base-ordered perfusing-VT band table answer different questions. Selecting a table by patient weight alone is insufficient; the presence of a pulse and the applicable order must be established first.
For example, a child with a pulse who has a base-ordered infusion should not receive the administration method copied from the nearby pulseless-arrest table. State the indication and ordered infusion instructions in the read-back. In a patient with circulation, communicate blood-pressure and perfusion changes along with the rhythm. If pulse status changes, reassess the treatment pathway explicitly rather than continuing a plan based only on the earlier rhythm.