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Dr. Akhil MD 🇮🇳 🚑 Profile picture
@DrAkhilRaghavan
Sep 17 • 10 tweets • 3 min read Twitter logo Read on Twitter
💥AMIODARONE is a class III antiarrhythmic drug which is widely used in ER for treating arrhythmias.

A 🧵 on situations where blind use of amiodarone in emergency can be counterproductive ⚠️⚠️⚠️

With alternate therapeutic options

Read on...👇
#MedTwitter #MedEd #MedX Image
❌️Arrhythmias secondary to prolonged QT interval.

Amiodarone can furthur prolong QT resulting in asystole or VF.

✅️Use DC shock in unstable , MgSO4 in stable TdP, treat underlying cause of prolonged QT.

image @LITFLblog Image
❌️Atrial Fibrillation associated with Left atrial thrombus or AF with unknown onset

Amiodarone can chemically cardiovert an AF to sinus rhythm leading to disbursement of the clot to arterial circulation

✅️Use beta blockers/CCBs/Digoxin for rate control

Image @LITFLblog Image
❌️Atrial fibrillation in preexcitation

Amiodarone increases AV nodal refractoriness leading to preferential conduction of fibrillatory impulses via the accessory pathway ➡️ uninhibited propagation through the ventricles ➡️ high ventricular rate ➡️ degeneration into VT or VF.
✅️ In preexcited AF with or without hemodynamic stability , DC synchronized electrical cardioversion (biphasic) can be used.

✅️ In stable patient intravenous procainamide if available can be used.

image @LITFLblog Image
❌️ Arrhythmias due to digoxin toxicity

Amiodarone can increase digoxin levels in blood by decreasing digoxin excretion which furthur potentiates digitoxicity.

✅️ Lignocaine can be used to treat arrhythmias due to digitoxicity

image @LITFLblog Image
❌️Atrial fibrillation in hyperthyroidism

Iodine load in amiodarone can precipitate accelerated thyroid hormone synthesis in a patient of hyperthyroidism leading to thyroid storm and furthur deterioration of hemodynamic status.

✅️Use beta blockers to control ventricular rate
❌️ VT mimics like hyperkalemia, Na channel blocker toxicity and accelerated idioventricular rythm can all have broad complexes in ECG which if misdiagnosed as VT & amiodarone administration can be catastrophic.

✅️Recognition of these VT mimics in emergency & proper Rx
The following videos by doctor @amalmattu can help with proper understanding of this topic👇




@amalmattu #MedTwitter #MedEd #IMGs #medicaleducation #CardioTwitter #medicalinternship #medicineresidency #internalmedicine #doctors #madaktari #Medicos #medicina #врачи #médecins #Likitoci #medicine #medical #FOAMed #FOAMim #FOAM4GP #FOAMcc

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More from @DrAkhilRaghavan

Dr. Akhil MD 🇮🇳 🚑 Profile picture
Sep 5
A🧵

35yr 👨 known HIV+ve 💉IV drug abuser presents in status epilepticus at ER

Impossible to secure an intravenous line due to thrombosed veins and ongoing seizures.

Which drug can be given intramuscular to control seizures❓️

#MedTwitter #MedEd #MedX
#epilepsy Image
Which drug can be given via intramuscular route in management of Status Epilepticus?

Answer in 🧵
Status epilepticus (SE ) refers to continuous seizures or repetitive, discrete seizures with impaired consciousness in the interictal period.
Read 21 tweets
Dr. Akhil MD 🇮🇳 🚑 Profile picture
Aug 28
60 Yr old man reports new onset right sided headache, sometimes severe at night for past one week.

What is the treatment of choice ❓️

#MedEd #MedTwitter #RheumTwitter #MedX Image
Drug of choice❓️
Temporal arteritis/Giant Cell Arteritis is a large vessel vascuilitis affecting the arteries of the external carotid system, particularly the temporal branches, resulting in a subacute granulomatous inflammatory exudate of lymphocytes, leukocytes and giant cells. Image
Read 21 tweets
Dr. Akhil MD 🇮🇳 🚑 Profile picture
Jun 25
PRAZOSIN is helpful in management of which among the following conditions?
#MedTwitter
A 🧵 on STORMS in medicine.

Brief overview of these emergency conditions.

Extrapoints if you can point out which one of these require DISASTER MANAGEMENT STRATEGY

💥Electrical storm
💥Cytokine storm
💥Thunderstorm Asthma
💥Thyroid storm
💥Dystonic storm
💥Autonomic storm
Electrical storm or VT storm refers to the occurrence of three or more episodes of Ventricular Tachycardia or Ventricular Fibrillation within 24 h requiring intervention for termination.
Read 19 tweets
Dr. Akhil MD 🇮🇳 🚑 Profile picture
Jun 23
A patient of diabetic ketoacidosis presented in a stupourous state with hypotension. ABG ➡️ pH -7, HCO3 - 9 mEq/L, K-5mmol/L. Along with other measures a decision was made for alkali therapy with IV sodium bicarbonate for severe acidosis. How should the Rx be given?
#MedTwitter
A.50 mEq of NaHCO3 in 300 mL of saline over 45min with target blood levels of HCO3 to 12mEq/L & pH upto 7.2

B.Isotonic NaHCO3 drip at 100ml/hr till pH>7.35

C.IV bolus 2 mEq/kg every 5min to raise pH to 7.4

D.IV bolus 1mEq/kg every hour to raise HCO3 upto 16mEq/L
Intravenous sodium bicarbonate therapy can be lifesaving in a number of critical conditions. Indications for sodium bicarbonate use are:
Read 26 tweets
Dr. Akhil MD 🇮🇳 🚑 Profile picture
May 28
INTRAVENOUS THROMBOLYSIS (fibrinolytic therapy) can be successfull if given

A. Within 30minutes to 12 hrs in STEMI

B. Within 3-4.5 hrs in Acute ischemic stroke

C. Within 14 days in Pulmonary embolism

Choose the ✅️correct statement/s among the above.

#Medtwitter #MedEd Image
✅️TRUE statement/s among the above three
Fibrinolytic agents are plasminogen activators(PA) that act by converting plasminogen to plasmin. Plasmin then degrades the fibrin matrix of thrombi and produces soluble fibrin degradation products resulting in clot lysis. Image
Read 15 tweets
Dr. Akhil MD 🇮🇳 🚑 Profile picture
May 24
Drug of choice for ANAPHYLAXIS in a patient with no response to Epinephrine?
Patient is on Propranolol 60 mg BD for essential tremors.
#MedTwitter #emergencymedicine #CriticalCare Image
Which drug should be given?
#MedTwitter #MedEd #MedicalStudentTwitter #IMGs #IMG #medicaleducation #medicalinternship #medicineresidency #internalmedicine #doctors #madaktari #Medicos #medicina #médecins #Medizin #Likitoci #medicine #medical #FOAMed #FOAMim #FOAM4GP
Anaphylaxis is a severe, life threatening systemic hypersensitivity reaction characterized by being rapid in onset with potentially life threatening airway, breathing, or circulatory problems and is usually, although not always, associated with skin and mucosal changes.( ICD-11)
Read 9 tweets

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