NORTH COAST EMERGENCY MEDICAL SERVICES Policy # 5405

POLICIES AND PROCEDURES

Subject: Medical Direction

Associated Polices: 06/21/97

1. Class:

1. Antiarrhythmic.

2. Therapeutic Effects:

1. Increases fibrillatory threshold.
2. Increases action potential duration and effective refractory period without increasing the heart rate.
3. Decreases disparity in action potential duration between normal and infarcted myocardium.
4. Increases impulse formation and firing rate of pacemaker tissue and increases ventricular conduction velocity.

3. Indications:

1. Ventricular fibrillation and ventricular tachycardia refractory to Lidocaine and DC countershock.

4. Contraindications:

1. Absolute: None when used as indicated above.
2. Relative: Digitalis toxicity.

5. Adverse Effects:

1. Postural hypotension.
2. Transient hypertension and tachycardia.
3. Nausea and vomiting.

6. Administration and Dosage:

1. Ventricular fibrillation:

1. Adult or pediatric: 5 mg/ kg rapid IV push. May repeat at 10mg/ kg every 5 minutes to a maximum dose of 30mg/ kg.

1. Refractory or recurrent ventricular tachycardia:

1. Adult or pediatric: Dilute 500 mg of Bretylium (10 ml) in 50 ml and give 5-10 mg/ kg over 8-10 minutes. May repeat in 10 to 30 minutes and, if necessary, every 6-8 hours thereafter.

7. Special Information:

1. Can also be given as an IV infusion at a rate of 1-2 mg/ minute.
2. Pediatric patient may also be administered IO bolus or IO infusion at above doses. This medication is not available on Pediatric Resuscitation tape.