………………………………………………………………………………………………………I’ve been perplexed by the increasing number of patients coming in with rapid atrial fibrillation or other tachyarrythmias, in which EMS has started amiodarone. Why amio, when there are other agents that work faster, are easier to mix up and dose, and are safe in pregnancy? It turns out the answer may come down to the nuts and bolts of business and government: many EMS trucks in my area don’t have refrigeration, and the manufacturer of the only room-temperature injectable form of diltiazem recently discontinued it (Biovail’s Cardizem Lyo-ject ). Other injectable diltiazem vials can only be stored at room temperature for a month – so EMTs are turning to amiodarone more often.
As I move through training I’m becoming more aware of how supply and demand sometimes dictate standard of care. One example that comes to mind is how ACLS guidelines changed (partly) in response to the worldwide shortage of bretylium (See pg 41 in the February 2001 edition of JOURNAL OF PHARMACY PRACTICE). Perhaps readers have other good examples, or insight into EMTs’ tendency toward amiodarone? Let us know, in the comments below!
