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management
clinical skills
medications
paramedic
care pathway

Paramedic use of IV amiodarone to terminate supraventricular tachycardia

02 December 2020
Features
02 December 2020
Volume 12 · Issue 12

Abstract

The introduction of specialist services within the hospital network has increased conveyance times for many patients, as paramedics look to deliver them to the most appropriate hospital first time. Patients with potentially life-threatening arrhythmias can decompensate quickly, increasing the need for pharmacological management of these conditions en route. 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. With appropriate training and education, paramedics could safely deliver amiodarone to this sub-group of cardiac patients, while en route to hospital for definitive treatment.

The introduction of specialist cardiac care centres within the hospital network in England in 2015 has led to increased conveyance times for acutely unwell patients accessing the ambulance service (Association of Ambulance Chief Executives (AACE), 2015). This problem is even more significant in rural areas (AACE, 2014) and has created a need for additional treatment for potentially life-threatening arrhythmias by appropriately trained paramedics, prior to arrival at hospital.

To treat each cardiac condition most appropriately, paramedics need to be able to accurately recognise many arrhythmias and target them with specific drugs. Prehospital practice relies upon doing the ‘best for the most’ with the least risk, and England (2016) espouses that drugs are often selected on their ability to perform more than one function. This approach is already reflected in the current paramedic guidelines (Brown et al, 2019), using hydrocortisone succinate to treat an adrenal crisis, anaphylaxis and life-threatening asthma.

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Amiodarone
Tachyarrhythmia
Paroxysmal supraventricular tachycardia (PSVT)
Supraventricular tachycardia (SVT)
Pharmacological cardioversion