Medication execution

Verify the pathway, prepare the product, and name the stop rule.

Draft — independent clinician review pending · source check 2026-10-16 · scheduled review 2027-01-15

Adult learning references for selected SVT and tolerated monomorphic WCT pathways; not patient-specific orders, a full formulary, or an arrest dosing guide. Current product information, local policy, formulary and clinician judgment govern care. No patient inputs, dose calculator, or generated orders are provided here.

Adenosine

Eligible regular SVT · pulse present

Before you push: what makes this rhythm eligible, and what must the ECG recording show you during the pause? Say your plan before opening the reference.

Check the execution plan

Confirm the branch: For suspected stable re-entrant SVT, attempt an appropriate vagal maneuver first. A regular narrow rhythm alone is not an indication: sinus tachycardia needs treatment of its cause. Unstable causal tachycardia needs the urgent electrical pathway. Adenosine is not for pre-excited AF or irregular/polymorphic WCT; use in WCT is confined to eligible stable regular monomorphic rhythms.
Source regimen—not an order: The adult peripheral-bolus label starts at 6 mg over 1–2 seconds; if PSVT persists after 1–2 minutes, 12 mg. The label permits a further 12 mg; the AHA algorithm displays first/second doses. Follow the adopted protocol rather than automatically repeating.
Prepare and verify: Verify the rapid-bolus product, patent access close to the patient, rapid saline flush and ECG recording. Have resuscitation capability ready; warn about brief flushing/chest discomfort. Do not substitute a stress-test infusion regimen.
Monitor and stop: Read atrial activity, AV conduction and perfusion—not just the final rate. High-grade block after a dose means no additional dose. Treat persistent adverse effects or deterioration rather than waiting on the short half-life.
Patient and handoff boundary: Exclude relevant nodal disease without a functioning pacemaker and asthma/bronchospasm. Check dipyridamole/carbamazepine sensitization, methylxanthine antagonism and transplant/central-access considerations before selecting the dose. Local protocol and full contraindications govern.

Sources: Fresenius Kabi adenosine rapid-bolus injection, 3 mg/mL AHA 2025 adult tachyarrhythmia with a pulse algorithm AHA 2025 Adult ALS — full guidance, sections 15–18

Mechanism, PK, interactions and selection in the drug atlas · Claim and review trail

Procainamide

Selected tolerated monomorphic WCT · pulse present

Which bedside observations end this infusion before the planned maximum is reached? Say your plan before opening the reference.

Check the execution plan

Confirm the branch: Choose a monitored, currently tolerated monomorphic WCT pathway with expert support and cardioversion ready. Prolonged QT or heart failure excludes the AHA procainamide branch; renal function and prior antiarrhythmics matter.
Source regimen—not an order: AHA reference: 20–50 mg/min, ending at rhythm suppression, hypotension, QRS increase >50%, or 17 mg/kg; its maintenance reference is 1–4 mg/min. The selected vial label instead describes a 1 g loading ceiling and different maintenance instructions. These are different source protocols—not interchangeable pieces.
Prepare and verify: Use the institution's approved dose, dilution, pump library and maximum. Independently verify mg/min versus pump units and baseline QRS/QT, pressure and renal function; do not improvise a concentration from memory.
Monitor and stop: Continuously assess ECG and pressure. Stop at the protocol endpoint or earlier concerning deterioration. The label also flags a pressure fall ≥15 mm Hg and progressive conduction changes. Do not wait for the maximum if the patient is worsening.
Patient and handoff boundary: PA and active NAPA accumulate when clearance falls. Reassess the cumulative QT/conduction burden before another antiarrhythmic. Unstable VT with a pulse changes to synchronized cardioversion; pulse loss changes to arrest care.

Sources: Procainamide hydrochloride injection — selected vial label AHA 2025 adult tachyarrhythmia with a pulse algorithm

Mechanism, PK, interactions and selection in the drug atlas · Claim and review trail

Amiodarone

Selected monomorphic WCT infusion · not an arrest push

Why can a correct drug and dose still be an unsafe order if formulation, infusion rate and access are missing? Say your plan before opening the reference.

Check the execution plan

Confirm the branch: This is the selected WCT infusion context, not pre-excited AF, undifferentiated irregular WCT, or a reason to delay cardioversion for instability. Separate guideline use from the IV label's refractory ventricular-arrhythmia indication.
Source regimen—not an order: AHA WCT reference: 150 mg over 10 minutes, repeat if VT recurs, then 1 mg/min for the first 6 hours. The concentrate label continues at 0.5 mg/min thereafter. This is not the pulseless-VT/VF bolus regimen.
Prepare and verify: For the cited 50 mg/mL concentrate, the label uses D5W dilution, a volumetric pump and in-line filter; central dedicated access is preferred. For infusions over an hour, concentrations above 2 mg/mL require central access. Verify the exact product, container, compatibility and local pump protocol; premixes have their own instructions.
Monitor and stop: Assess pressure, heart rate, conduction/QT and infusion site. Infusion-related hypotension calls for slowing and appropriate supportive treatment; bradycardia/AV block may require slowing or stopping and pacing support. Deteriorating VT still requires the electrical branch.
Patient and handoff boundary: Check cardiogenic shock, marked bradycardia, AV block without pacing, electrolytes and additive nodal/QT drugs. Reconcile interactions and ongoing exposure at handoff; do not automatically stack it after procainamide.

Sources: Henry Schein/Mylan amiodarone concentrate, 50 mg/mL — revision 9/2025 AHA 2025 adult tachyarrhythmia with a pulse algorithm AHA 2025 Adult ALS — full guidance, sections 15–18

Mechanism, PK, interactions and selection in the drug atlas · Claim and review trail

Product and guideline sources

Agent source reconciliation is not independent clinician approval. The original clinical material remains Draft; dates are review targets, not a guarantee that a label has not changed.

AHA 2025 Adult ALS — full guidance, sections 15–18

Open the exact source · Established guideline guidance

Population: Adult regular narrow-complex and wide-complex tachycardia; AF/flutter exclusions.
Method: Recommendation-specific guidance and supportive text, including central-access/transplant adenosine sensitivity.
Estimate: No new comparative estimate asserted in this teaching.
Limits: Recommendation strength varies; not a product preparation protocol or patient-specific order.