#Amiodarone

[phonemantra-blog]

The Benefits and Risks of Pacerone: A Comprehensive Guide In the world of cardiology and the treatment of heart rhythm disorders, Pacerone, known by its generic name Amiodarone, shines as a vital medication. But what exactly is Pacerone, and how does it impact the cardiovascular health of those who rely on it? In this comprehensive guide, we'll delve into the nuances of Pacerone, exploring its uses, mechanisms, and both the benefits and potential risks associated with its use. [caption id="attachment_60250" align="aligncenter" width="1280"] pacer one[/caption] What is Pacerone? Pacerone, also referred to as Amiodarone is a medication that plays a crucial role in the realm of cardiology. But beyond its name, what is Pacerone? How Does Pacerone Work? The magic of Pacerone lies in its mechanism of action within the human body. Understanding how this medication operates is key to appreciating its significance in managing heart rhythm disturbances. Medical Indications Pacerone is not just another medication; it's a powerful tool in the hands of healthcare providers, primarily used for specific medical conditions and heart rhythm disturbances. Understanding its medical indications is essential: Heart Arrhythmias: Pacerone is often prescribed to individuals with various types of arrhythmias (irregular heart rhythms). These may include atrial fibrillation, ventricular tachycardia, and atrial flutter. By stabilizing heart rhythms, Pacerone helps prevent potentially life-threatening complications. Life-Saving Potential: In some cases, Pacerone can be a life-saving medication, particularly for individuals with ventricular tachycardia or ventricular fibrillation, which can lead to sudden cardiac arrest. It can be administered in emergencies to restore a normal heart rhythm. Dosage and Administration Understanding how to take Pacerone is just as important as knowing why it's prescribed: Oral Medication: Pacerone is typically administered orally in the form of tablets or capsules. The dosage and frequency are determined by the individual's specific condition and response to treatment. With or Without Food: It's important to follow the instructions provided by your healthcare provider or pharmacist regarding whether to take Pacerone with or without food. These guidelines help optimize its absorption and effectiveness. Regular Monitoring: While on Pacerone, regular check-ups and electrocardiograms (ECGs) may be required to monitor the heart's response to the medication. This ensures that the prescribed dosage remains appropriate for the individual's needs. Potential Side Effects Like any medication, Pacerone comes with potential side effects that individuals should be aware of: Common Side Effects: These may include nausea, vomiting, and fatigue. Inform your healthcare provider if these side effects become bothersome. Serious Side Effects: While uncommon, Pacerone can lead to more serious side effects, such as lung problems, liver issues, thyroid dysfunction, and skin reactions. It's crucial to promptly report any unusual symptoms to your healthcare provider. Regular Check-ups: Routine check-ups and blood tests are often recommended while taking Pacerone to monitor potential side effects and adjust treatment as needed. Precautions and Warnings While Pacerone can be highly effective, it's important to approach its use with certain precautions and awareness: Thyroid Function: Pacerone can affect thyroid function, potentially leading to hypo or hyperthyroidism. Regular thyroid function tests and monitoring are crucial while on this medication. Lung Function: In some cases, Pacerone can cause lung problems, including pulmonary fibrosis. If you experience unexplained shortness of breath, cough, or chest discomfort, seek medical attention promptly. Liver Function: Monitoring liver function is essential while taking Pacerone, as it can lead to liver abnormalities. Inform your healthcare provider if you notice symptoms such as abdominal pain, jaundice, or dark urine. Interactions with Other Medications Understanding potential drug interactions is vital when taking Pacerone: Inform Your Healthcare Provider: Always inform your healthcare provider about all medications, supplements, and herbal products you are taking. Some medications can interact with Pacerone, affecting its effectiveness or increasing the risk of side effects. Medication Adjustments: Your healthcare provider may need to adjust the dosages of other medications you are taking to ensure their compatibility with Pacerone. Patient Experiences Real-life experiences can provide valuable insights into the impact of Pacerone: Amanda's Journey: Amanda, a heart arrhythmia patient, shares her journey with Pacerone. She discusses how the medication has helped her regain a sense of normalcy and the importance of close monitoring by her healthcare team. Managing Side Effects: Mark, a Pacerone user, reflects on his experience managing potential side effects. He highlights the significance of communication with his healthcare provider in finding the right balance between benefits and side effects. FAQs About Pacerone Q: What is Pacerone used for? A: Pacerone (Amiodarone) is primarily used to treat irregular heart rhythms, including atrial fibrillation and ventricular tachycardia. Q: How does Pacerone work to control heart rhythms? A: Pacerone works by affecting the electrical signals in the heart, helping to restore and maintain normal heart rhythms. Q: What are the common brand names for Amiodarone? A: Besides Pacerone, Amiodarone is also sold under brand names like Cordarone and Nexterone. Q: Are there any dietary restrictions while taking Pacerone? A: It's important to avoid grapefruit or grapefruit juice while on Pacerone, as it can interact with the medication. Q: Can Pacerone be taken with other medications? A: Pacerone can interact with various medications, so it's essential to inform your healthcare provider about all the medications and supplements you are taking. Q: What are the potential side effects of Pacerone? A: Common side effects include nausea, fatigue, and skin changes. Serious side effects may include lung or liver problems. Q: How long does it take for Pacerone to start working? A: Pacerone's effectiveness can vary from person to person, but it may take several days to weeks to see its full effect. Q: Can Pacerone be used during pregnancy or breastfeeding? A: Pacerone use during pregnancy and breastfeeding should be discussed with a healthcare provider, as it involves complex considerations. Q: Is it safe to drink alcohol while taking Pacerone? A: Alcohol can interact with Pacerone and should be consumed in moderation, if at all. Consult your healthcare provider for specific guidance. Q: What should I do if I miss a dose of Pacerone? A: If you miss a dose, take it as soon as you remember. However, if it's close to the time for your next dose, skip the missed one and continue with your regular schedule. Conclusion: In the world of cardiac health and the management of heart rhythm disorders, Pacerone, known as Amiodarone in its generic form, stands as a formidable ally. This comprehensive guide has taken you on a journey through the intricate details of this medication, offering insights into its uses, mechanisms, benefits, and potential risks.

[drpedi07]

Amiodarone Drug

Medical information for Amiodarone on Pediatric Oncall including Mechanism, Indication, Contraindications, Dosing, Adverse Effect, Interaction, Hepatic Dose.

[mcatmemoranda]

The energy dose depends on whether the defibrillator is biphasic or monophasic. You should know how to operate the equipment used in your facility.

If using a biphasic defibrillator, follow the manufacturer’s recommendations for the initial dose (usually between 120 and 200 J). Subsequent doses should be the same as, or higher than, the initial dose. If the manufacturer’s recommendations for the initial dose are not known, use the highest energy dose available for the first and all subsequent shocks.

If using a monophasic defibrillator, set the energy dose at 360 J. Use this energy dose for each subsequent shock.

If defibrillation is initially successful in terminating the cardiac arrest rhythm but a shockable rhythm resumes, use the energy dose that successfully terminated the rhythm for subsequent shocks.

After 2 shocks have been delivered, epinephrine (1 mg IV/IO every 3 to 5 minutes) may be administered. The vasoconstrictive and positive ionotropic effects of epinephrine help to increase cerebral and coronary perfusion. Evidence suggests that epinephrine is most effective when administered early.

After three shocks have been delivered, consider administering an antiarrhythmic agent (amiodarone or lidocaine). The initial dose of amiodarone is 300 mg administered as an IV/IO bolus. If the arrest rhythm persists, consider giving a second dose of 150 mg as an IV/IO bolus 3 to 5 minutes later. Alternatively, lidocaine may be used if amiodarone is not available. The initial dose is 1 to 1.5 mg/kg IV/IO, followed by 0.5 to 0.75 mg/kg IV/IO every 5 to 10 minutes, up to a maximum dose of 3 mg/kg.

[cmtblogger]

Diagnostic Pathways for Idiopathic Neuropathy

“You have a serious illness of an undisclosed nature” says a doctor to a patient in a cartoon within Dr. Norman Latov, MD, PhD’s recent presentation on idiopathic neuropathy sponsored by the Foundation for Peripheral Neuropathy. There are many cases where people present neuropathic symptoms, but the causes are unclear. The current diagnostic pathways Dr. Latov maps out are familiar and…

[mednotecollection]

🧠 BLUE MAN SYNDROME MedNote Collection --------------------------------- instagram.com/mednotecollection t.me/MedNoteCollection pinterest.com/MedNoteCollection fb.me/MedNoteCollection --------------------------------- #medicine #medical_student #doctor #mednote_collection #MedNoteCollection #usmle #MRCP #pharmacology #amiodarone https://www.instagram.com/p/ConGiGMMKr3/?igshid=NGJjMDIxMWI=

[bluevelvetea]

Looking at this new illustration from the latest chapter and...

they put his cousin on the marriage candidate wall as well? 😭😭😂 Teruaki my boy you're not beating the allegations

[hopkinrx]

Hyperthyroidism: Its Important Symptoms, Causes, Treatment And Lifestyle

Hyperthyroidism: Symptoms, Causes, Treatment And LifestyleIntroductionFunction Of Thyroid GlandWhat is Hyperthyroidism?Causes of HyperthyroidismSymptoms Of Hyperthyroidism Physical Manifestations Emotional RollercoasterDiagnosis Of HyperthyroidismTreatment Options: Bringing Harmony Back Medications Radioactive Iodine Therapy Surgical InterventionEmbracing a New Rhythm: Living with…

[macgyvermedical]

Drug Orders and Doses

@whumpsmith

Cool, so I think the first thing to know is how medication is ordered.

Generally speaking, it will be ordered in 5 parts, known as the "5 Rights" of medication administration:

#1 What patient is getting the medication

#2 What medication is to be given

#3 How much medication is to be given

#4 What time it is to be given (or how often)

#5 What route it is to be given

So an order might be "Give John Smith (5/13/1995) lorazepam 0.5mg IV once prior to MRI"

In this example, John Smith is the patient and 5/13/1995 is his birthday to differentiate him from all the other John Smiths. "Lorazepam" is the drug's generic name, "0.5mg" is the amount of the drug. "IV" is the route, and "once prior to MRI" is the time.

Drugs have generic and brand names. For example, acetaminophen is a generic name. Many companies make acetaminophen, and each has their own brand name for the drug. Probably the most well-known brand name for acetaminophen is Tylenol, but there are others, like Calpol and Panadol. For most people, it doesn't matter which brand of a particular drug is used, just that the active ingredient (the generic name) is the same. For some people it matters because the non-active ingredients may be different between brands, and they may be allergic to a non-active ingredient that is in one brand, but not another.

In a hospital setting, we're going to use the generic name, because the brand of the drug that is cheapest to the hospital pharmacy varies contract to contract, and there are a lot of drug shortages these days. That's why if you're in the hospital you might get an oval green pill one day and a round white one the next day. They're the same drug, just different brands.

The dose is given in milligrams, usually abbreviated "mg". Milligrams are a measure of weight. Cubic centimeter (cc), on the other hand is a measure of volume. At some point we switched from volume based to weight based measures because we had a lot of different concentrations and using volumes for everything made mistakes really common. If you're using weights, it doesn't matter if the concentration you have is 1mg/mL or 10mg/mL for a given drug, you can do the math and come up with a volume that is right instead of just hoping you picked the one the doctor was thinking about when they wrote the order.

There are many routes a drug can take into the body. There is oral (a pill or liquid), IV (injection in a vein), IM (injection in a muscle), SQ (injection into fat), rectal/PR (a suppository, gel, or liquid inserted into the rectum), SL (under the tongue), TD (a paste or patch that sends medication through the skin) and many more.

Times can be once, once every x hours, once every x hours as needed (PRN), once under a particular circumstance, daily, or pretty much any other interval you can think of. "Stat" is a term meaning "right now".

Here's a list of common medications and their dosages:

CODE DRUGS:

Epinephrine 1mg IV for cardiac arrest every 3-5 minutes, 0.3mg for anaphylaxis

Amiodarone 150-300mg IV over 10 minutes for cardiac arrest

Lidocaine 75mg for cardiac arrest initially, if that doesn't work then 37.5 10 mins later

Adenosine 6mg given very quickly for PSVT, if that doesn't work, give 12mg

Atropine 1mg every 3-5 minutes for low heart rate until heart rate is normal

OTHER DRUGS:

Albuterol 2.5mg in nebulizer for brochospasm/asthma attack

Metoprolol 5mg IV every 5 minutes up to 15mg for severe high blood pressure

Furosemide 20-80mg IV for fluid on lungs

D50 25g IV for low blood sugar

Diphenhydramine 12.5-50mg IV for allergic reaction

Morphine 2-10mg IV or IM for pain

Fentanyl 50-200mcg for sedation

Mannitol 20-150g for increased pressure inside the skull

Nitroglycerin 0.3-0.6mg every 5 minutes up to 3 times for chest pain (angina)

Naloxone 8mg nasal spray every 2-3 minutes for opioid overdose

Flumazenil 0.2mg IV for benzodiazepine poisoning, if that doesn't work give 0.3mg, if that doesn't work, give 0.5

Diazepam 15mg rectal gel for seizures that don't stop

Phenobarbital 1-1.5g IV for seizures that don't stop

Etomidate 22mg IV for anesthesia (for things like intubating someone)

Midazolam 5mg IV for sedation prior to surgery

Olanzepine 5-10mg IV for agitation (emergency sedation)

Haloperidol 0.5-10mg oral or IM for agitation (emergency sedation)

[whumpy-daydreams]

CPR in hospitals

I did a post on doing cpr as a 'civilian' (i.e. in public with no equipment). But most people who follow me are writers! So here's how it goes down in hospital.

It varies on where someone is in hospital having a cardiac arrest, so this is just for if a patient is in a hospital bed with monitoring on.

The first sign is going to the monitor going crazy and the patient unconscious.

Step 1 - pull the emergency button and start chest compressions (they are still the most important thing!)

Step 2 - someone else will give rescue 'breaths' using an oxygen mask and bag (technically called a bag valve mask or BVM). Two breaths after every 30 compressions

Step 3 - someone else is cutting clothes off and putting defibrillator pads on. An anaesthetist may also intubate the patient and put them on a ventilator (this means you can do compressions continuously)

Step 4 - the defibrillator will scan the heart rhythm. If it's shockable (ventricular tachycardia or fibrillation) then everyone steps away while it shocks. As soon as it's safe, CPR continues (most defibrillators determine the rhythm and calculate voltage automatically)

Step 5 - if it's a non-shockable rhythm, give IV adrenaline ASAP

Step 6 - if it's a shockable rhythm, wait 2 minutes after first shock, check and shock again. Repeat a third time.

Step 7 - if the patient is still in cardiac arrest after 3 shocks, give IV adrenaline and amiodarone

Step 8 - continue CPR and give adrenaline every 5 minutes.

The person giving compressions should switch every 60 compressions (two cycles of 30) - the next person is counted in so there's no time without compressions

There are 10 main causes of cardiac arrest - while all of this is happening a team of doctors will be trying to work out the cause so they can treat it. I won't go into the causes because it's boring and technical.

CPR, defibrillation, and drugs will continue until the cardiac arrest stops or the patient is declared deceased.

If someone is in hospital because of hypothermia, remember! They're not dead until they're warm! (there have been cases of hypothermia patients being successfully resuscitated after over 5 hours of CPR!)

[its-my-whump]

Medwhump May- Day 5

"Stay with me."

@medwhumpmay

Tw: gore, cpr, resus and absolutely no medical accuracy or knowledge of medication, sorry! (always happy to learn something new, feel free to tell me)

Part 5 (all others here)

Everybody had their hands away from the dead body with the fibrillating heart.

Electricty jumped throughout that fragil frame of a woman.

Her head lolled to the side, the ambu bag pulling at her lips. Arms exploded in the air and fell back. The IV line jiggled, her feet also fell back with a distinct thud on the table.

The assistent had a bloody gloved hand on her shoulder a few moments after. "Come on little miss, stay with me."

The jumble on the monitor formed a single spike. And turned into an unstable sinus rhythm.

"That's it, hunny." His hand squeezed her shoulder encouraging. "We're going to get you through this."

But as if fate had her hands in it, the jumble appearing on the monitor again, begged to differ. "Shit!" The assitent yelled again and pressed his straightened arms down on her bruised sternum without hesitation.

By his third compression, a rib shifted and cracked. The sound echoing through the busy OR.

The anestesioligist had his hands on the ambu bag again and was squeezing air into her useless lungs.

After about 18 compressions, the surgeon demanded a status check again. His assitent, breathing heavily from the strain pulled his hands away from her bruised sternum. Despite, the still pumping anesthesiologist, everybody had their eyes on the equipment.

The young lady was clinically dead, but her bloody, opened body, covered in red and blue bruises from cpr, was slightly shaking from her fibrillating heart. "Still in vfib. Shocking her again." The head surgeon anounced strongly, already the paddles, handles covered in her blood, in hand.

"Clear!" Everybody had their hands visibly away from the table.

Another electric shock jumped through the lifeless form. Another few thuds from extremities following gravity back to the metal surface. Her head already fallen to the side, just wiggled slightly.

No change on the monitor. A frantic line consisting out of tiny spikes lining themselves against another. Two zeros blinking at the edge of the display. The assitent was just about to get his hands down on her broken ribs.

"AGAIN!" The surgeon cried from the other side of the table. "CLEAR!"

No one had really moved. The small body jolted on the table. This time hands and feet flying even higher, just to fall back looking more lifeless. Her feet had fallen to the sides. The outstretched arm with the IV lay where it had fallen, slightly bend. The other hand had landed on her belly.

"Come on, little miss! Come on!" The assitent was looking in her pale, expressionless face as the anesthesiologist took a hold of the ambu bag again.

The surgeon, paddles still in hand, was eyeing the monitor, ready to shock her again.

Nothing. Two tense seconds passed and the sinus rhythm was back. "That's it, baby girl! I know, you could do it!" He gave the unconscious woman on his table a sympathic smile. Then his face and tone turned professional again. "Amiodarone now. We don't want to lose her again."

->Day6

My masterlist

[clinicalmedicine]

Embark on a journey with Jennifer Carlquist, PA-C, and course director of The Urgent Care EKG Course as she shares 12 essential insights for navigating through EKGs in the urgent care setting. 

1. When a patient has an irregular rhythm, it is important to look closely for P waves. If they are the same shape and distance from the QRS complex, you could be dealing with sinus arrythmia. This is usually caused by breathing.

2. If you have a patient with palpitations, you may find a clue to the cause by asking the patient when the palpitations happen. Often, palpitations only occur when the patient is about to go to sleep which could be caused by anxiety, although this is a diagnosis of exclusion.

3. When you have a patient with tachycardia, make sure you can explain why. Pulmonary embolus can cause tachycardia and will not always be associated with an s1q3t3.

4. If you have a very short PR interval, the first thing you should look for is a delta wave. This is what you will see with Wolff-Parkinson-White syndrome, which can be fixed with an ablation.

5. If a patient has experienced a recent stressful event such as the death of a spouse and has new onset heart failure, consider Takotsubo cardiomyopathy. This can present a myriad of EKG findings, including STEMI.

6. PVCs are not always benign. They can lead to heart failure if there are enough of them. 

7. There is always a reason for sinus tachycardia, while supraventricular tachycardia (SVT) comes on suddenly for no good reason. It’s hard sometimes to tell the difference between the two, but when you start to sort through the history, that’s where it really starts to make sense. Sinus tachycardia will have volume loss, fever, anemia, or anxiety, while SVT patients will usually have none of those. The exception would be if a patient has anxiety after they started feeling the SVT, which is a whole different story.

8. When interviewing a patient about their palpitations, it is always helpful to ask if they have anxiety as well. If they do, ask them which came first: the palpitations or the anxiety. If the anxiety came first, then it is most likely anxiety causing the palpitations, although this would be a diagnosis of exclusion. If the patient feels palpitations and then anxiety comes on, that’s more likely arrhythmia based.

9. It is impossible to diagnose Takotsubo cardiomyopathy from an EKG alone. There are many different presentations of the condition, including STEMI, nonspecific STT-wave changes, T wave, and inversions that are symmetric. If you have a patient with a classic story that involves recent major stress in their life, then absolutely consider this diagnosis. It can be seen during their angiogram, where it will look like apical ballooning, and they will have a reduced ejection fraction.

10. ST-segment elevation can be very minimal and still deadly. It is important when you are screening for ST elevation to look closely at the TP segment. This is the most isoelectric line, and this is where you should draw your line to see if there’s any elevation or depression. As little as 1 mm can be significant for STEMI in the inferior leaves, so it really does matter here. Get serial ECGs.

11. When looking at the intervals at the top of the EKG, one of the most important numbers to look at is the QTC. The QTC should be <460 ms to be normal in women and <450 ms in men. If it is longer than that, consider adjusting the patient’s QT-prolonging medication. We do not usually see Torsades de Pointes until they get >500 ms, but it’s still a good idea to minimize risk by getting the patient off any QT prolongers you can.

12. Torsades de Pointes is lethal and most likely stems from a prolonged QT. Unlike in VT, the treatment is magnesium, but prevention is always the key. Amiodarone can also prolong the QT and can be proarrhythmic, so you may have to choose a different drug in some cases. 

This course is ideal for PAs and NPs practicing in urgent care. Whether you’re new to practice or have many years of experience, you’re sure to learn practical, evidence-based tips you can use on your next shift. You can sharpen your EKG interpretation skills, improve your accuracy, become more proficient, and boost your clinical confidence with The Urgent Care EKG Course.

Visit https://www.ebmedicine.net/ekg to learn more.

Even more content:

Check out one of our latest reels (less than one minute!) by Jennifer Carlquist, the course director.

[bethiniancorpuscle]

Cytochrome P450 Inducers & Inhibitors

The main ones can be remembered using "CRAP GPs spend all day on SICKFACES.COM".

Cytochrome P450 Inducers

These induce CYP450 activity, and thus reduce the concentration of drugs which are metabolised by this system.

Carbemazepine Rifampicin Alcohol (chronic use) Phenytoin Griseofulvin Phenobarbitone Sulphonylureas, St John's Wort, Smoking

Also topiramate.

Cytochrome P450 Inhibitors

These inhibit CYP450 enzyme activity and thus increase the concentration of drugs which are metabolised by this system.

Sodium valproate Isoniazid Cimetidine Ketoconazole Fluconazole Alcohol (acute use), Amiodarone, Allopurinol Chloramphenicol Erythromycin Sulfonamides, SSRIs Ciprofloxacin Omeprazole Metronidazole

Also grapefruit, cranberry juice, diltiazem, verapamil, clarithromycin.

Common Interactions

Medications which commonly interact with CYP450 inhibitors and inducers are:

Warfarin

Phenytoin

Combined Oral Contraceptive Pill (COCP)

Theophylline

Corticosteroids

Tricyclic antidepressants

Statins

Lamotrigine

Midazolam

[mortemoppetere]

TIMING: current. PARTIES: @rn-zane & @mortemoppetere SUMMARY: zane witnesses emilio 'taking care' of one of his clanmates. they're probably not going to buy friendship bracelets. CONTENT WARNINGS: none.

Rainy nights were always worse, somehow. Emilio wasn’t sure what did it. The smell, maybe, or the extra ache that the heaviness in the air added to his bad knee. His temper was always just a little shorter, his nerves just a little more frayed. Juliana would say it made him sloppy. She’d never shied away from calling him out, even when they’d been in the ‘courtship, looking to impress’ phase of their relationship. But she wasn’t here to call him out now, and the sloppiness remained.

Normally, he would have made sure there was no one else in the alley outside the hospital where he’d chased this particular vampire down to. He’d look around, sweep the perimeter, cover his bases. But the rain and the smell and the ache in his knee all served to distract, and he pounced without thinking first. The vampire turned to dust, and that feeling that made the hair stand up on the back of his neck, the one that told him there was a vampire nearby? 

It stayed. 

Emilio whipped his head around, eyes wild as they landed on a man in scrubs standing a few feet away. If his senses were right — which they always had been — this guy was a vampire, too. In scrubs. Working in a hospital. 

Talk about recipe for disaster.

Turning to face the other fully, Emilio held up his stake in warning. “Tell me who you are,” he said, accent twisting around the words as the adrenaline pounded in his veins, “slowly.”

—

Zane had been running all night. Even though stamina wasn’t really an issue anymore, his brain was completely fried. After almost mixing up adrenaline with amiodarone, he was ushered off to take a breather and come back once he’d composed himself. It wasn’t exactly possible, composing yourself in five minutes in the bathroom with the sound of chaos still seeping in through the door but an attempt was made. A few breaths, not really bringing oxygen but centering him in a way that had always helped when he was still breathing, and a quick check at his phone. “You have time for a quick delivery? Am outside, no rush tho, buddy :D”

He really didn’t have time but this was his job with the community. A job he did well and kept him important and liked. Not that they didn’t like him for him but still. Zane couldn’t take the chance of messing up this soon and losing this precious position no one else in the community could fill. So he made the time, sneaking out of the bathroom and rushing for the emergency blood cooler. The only good thing about this ER chaos - no one questioned a bag or two missing, putting it down to a mistake in charting. Those happened a lot when people were being barreled into the ER with strange bites, weird wounds and high on some drugs no one could classify. Mixed in with the occasional hypertensive elderly woman who forget her meds this morning. 

Two bags of blood in hand, covered by the ratty sweater he always brought with him, Zane traversed the less crowded hallways and down the abandoned stairwells until he reached the rarely used door to the empty alley. It used to be where they kept the organic waste dumpsters but after those kept getting broken into, the dumpsters had since been moved inside under lock and key. And there he was. Until he wasn’t. 

Jack’s red eyes were visible in the dark, not quite hidden by the hulking frame of the stranger whose back was turned to Zane, until they suddenly weren’t glowing anymore. It was like he’d evaporated into thin air, if not for the thin sheen of dust now floating through the air, catching the dim street light. There was no time to think, no time to wonder if this was how he was going to die one day, just evaporating into dust, before he was being addressed. Standing, frozen with the blood still covered by his sweater, Zane’s grip tightened on the door in his hand. The wood creaked slightly in his hand. 

“I work here,” was all he could muster as a response, eyes flicking to the weapon in the broad shouldered man’s hand. Had he killed Jack? Accident? No, not very likely. Was it a vampire thing or just some regular shady ass business? His feet were, on instinct, shuffling very slowly, 1/10th of an inch at a time, back towards the open doorway. “And I should get back inside…”

—

He worked here. Obvious enough, given the outfit. Emilio might not have a ton of familiarity with hospitals or doctors, but he knew enough to know that nobody dressed like that unless they were expecting to end up covered in blood. And despite the fear dancing in the vampire’s eyes, he didn’t seem outright surprised to have seen someone turn to dust in the alley outside. That probably meant he knew there was a reason for it, right? Was he in on it? Paranoia clawed at Emilio’s chest, desperate and uncertain. 

“More than that, I think,” he said lowly, taking a step towards the man. “Stop moving.” He didn’t want to kill the vampire without reason — Emilio’s code of ethics made little sense to anyone outside of Emilio himself, but it did exist — but he’d do it if the only other choice was to let an unfamiliar vampire flee into a hospital full of vulnerable people. Too much damage could be done otherwise, and he could justify that risk.

Taking another step forward, Emilio wagged the stake in front of him in warning. He did his best to hide his limp as he walked, sacrificing comfort for intimidation. “You know him? This asesino I just took care of? He was a friend of yours?”

—

Zane froze in place, the low grumble of the man’s voice settling in his spine with an uneasy feeling of genuine fear. The stranger was getting closer, menacingly waving the weapon - a stake? - in his hand. Was he going to get impaled?

Despite being told to stop moving, Zane dropped the sweater covered bags to the ground and raised his hands slowly. The rules of vampire versus stake were probably different than being held at gunpoint but Zane’s brain was short circuiting and he really didn’t want to die tonight. ‘This asesino I just took care of.’ It took a second to register the Spanish thrown in there and then a few more to properly swallow its meaning, not to mention the casually macabre way this man spoke about the loss of life (or unlife) that had just taken place. 

“He isn’t - or wasn’t, a murderer. Or not that I… You’re the one that just impaled him and are threatening me, I haven’t hurt anyone. Ever. I wouldn’t. Not just because of the healthcare code and all that, just in general.” He was rambling, wondering what, if anything, could get this man to simply disappear. Maybe nothing would work, Zane had seen his face and the characteristic nose and beard would be burned into his retinas forever. Not to mention the icy glare in those eyes, covered by what seemed like years of stress and not too much smiling, maybe. Would Zane get killed to protect this man’s identity?

“And I won’t tell anyone. That I saw you, I mean. Or Jack. I can keep a secret, they’ll just think he ran off or got into some trouble and you won’t need to be connected to this. I just want to get back to work.” 

��

The vampire dropped what he was holding, and Emilio’s eyes flickered down briefly to the ground. The sweater, which had been covering the real prize gathered in the man’s arms, shifted as it was dropped, revealing the plastic underneath. It looked like… a bag of blood? Someone more familiar with hospitals would have likely known what it was for, but to a man who’d grown up among people who’d much rather die with glory than visit any kind of real medical professional, it seemed foreign. He had no way of knowing where the blood had come from; given the way he was raised to feel about vampires, he could only assume something sinister. 

“Where did you get that?” He gestured to the blood bags on the ground, suspicion clear in his expression. “You drain someone for it? Have your fill and decide to save more for later?” Was that what he was doing in the hospital? Using it as a way to troll for his next victim? It was a scary thought, the idea that a vampire was smart enough to extract blood from someone and put it into a bag to make use of later.

His eyes darted briefly to what remained of the dust on the concrete, a sharp laugh cutting through the air. “If you think that, maybe you didn’t know him.” There was every possibility that this man had just gotten wrapped up in something too big for him to understand. If that were the case, Emilio almost felt sorry for him. Almost. The blood bags on the ground were still suspicious enough to arouse Emilio’s paranoia to the extent that it was difficult to feel real empathy for the vampire. 

“Tell anyone? Who would you tell?” Not his coworkers in the hospital, surely; none of them would see any sanity in the claim that he’d seen someone turn someone else to dust outside their place of employment. Other vampires, maybe? If he knew one, did he know more? Paranoia crawled in again.

—

Zane followed the stranger’s gaze to the rumbled sweater, the corner of a bag peaking out, and it took everything he had not to start cursing out loud. Stupid, impulsive brain, making him throw his literal loot to the ground for everyone to take a peek at. How nice it would be, to have a functioning head that gave a split second ‘maybe you should think about this’ before his body just did whatever the heck it wanted to. In the same vein, lying didn’t exactly come naturally to him under the most relaxed of circumstances, which this certainly wasn’t. So a truth bomb it was. 

“Drain someone, what…” Eyebrows furrowed and he was almost tempted to ask a follow up question to what kind of operation this man thought the hospital was running but thankfully, the very serious air of the question stopped Zane from insulting this man and most likely getting stabbed. “No, that’s just… I stole it. Not from a person, just from the… fridge. It’s from a blood donation but just… not being donated to someone in the ER like normally.” Did that make sense? Maybe, it was hard to tell when his attention kept passing from the stake to the speckles of dust that used to be his Netflix binge watching buddy and back to watch every twitch in the man’s muscles for a glimpse of an upcoming attack. 

There was no real answer to how well Zane had known the vampire-turned-dust, however. He’d known his name, how long he’d been with Alma and that he liked suspenseful shows. It had more so been the fact that there was no way he’d been living with a group of murderers, or even a single murderer, for this many months without realizing it. The whole reason for providing the blood bags was so that no one would have to get hurt and no one would have to starve… right?

Obviously, displaying the looted bags of blood hadn’t been Zane’s only slip up, evident when the interrogation about who he would tell started. “No one,” he blurted out, seeing something rise behind the other man’s eyes that made Zane’s skin crawl. “Really,” he added for pointless emphasis, wondering if he’d have time to grab the bags of blood before slamming the door shut. It locked from the inside and would at least give him a moment to think about his next steps. Maybe not, but it was worth a try. 

One foot sweeped at the sweater covered bags, swooping them most of the way back into the hallway before the sweater got stuck on a stray nail. He was already trying to hurriedly close the door so when it slammed on the bags, leaving a good few inches of open door between him and the armed stranger, all he could hope was that this guy wasn’t a fast runner.  

—

If it was a lie, it was a bad one. He stole the bags from a fridge? Whose fridge? Another vampire? Emilio’s head spun with the possibilities, eyes darting from the bags of blood on the concrete to the man who’d dropped them with no small amount of suspicion. What was he supposed to do here, exactly? He knew the vampire he’d killed had deserved it, but he couldn’t say the same for this one. On the surface, he seemed like a scared hospital employee who’d just witnessed something unexpected. If not for the bags of blood he was trying to make off with, Emilio might have wondered if his senses were lying to him with their claim that the man was undead. But the blood was a dead giveaway. 

And so was the fact that his next statement was a much more obvious lie. Maybe that was a good thing, considering; Emilio had a baseline now, a known lie to play off of. If that was how he sounded when he was bullshitting, it seemed much more possible that he’d been telling the truth about where he’d gotten the bags. The immediate defensiveness in response to the question was enough to lead Emilio to believe there were, in fact, more vampires in this guy’s inner circle. That probably meant the blood bags weren’t just for him, then, which also made sense. It’d be a lot of blood for one man alone. 

“You can be honest with me,” he said, still brandishing that stake, “or we can have a problem. And I don’t think you want to have a problem.” Threats, with vampires, tended to be the kind of thing that could go either way. Back in Mexico, when his family name had always allowed his reputation to precede him, they’d been effective more often than not. But now? Emilio hadn’t used his surname in years for fear of what it might bring to his doorstep. The only thing he had to back up his threats was him. Luckily, in this case, that seemed like it might be enough. The vampire had just seen him stake one of his buddies, after all. And he looked pretty uneasy about the whole thing. Good. 

But… sometimes even the most well-believed threats didn’t have the effect you were hoping for. Emilio had wanted to scare the guy into talking. Instead, he ran. And that was… less than ideal. There was a time when Emilio had been far faster, able to keep up with anyone and everyone, but that time had ended in Mexico, when everything else ended with it. His bad knee screamed at the mere concept of making a break for it, but he ran anyway. 

If not for the jacket catching in the door, that would have been the end of it. Emilio wasn’t fast enough to keep up and, if that door had closed, there was no way he’d have been able to get into that hospital undetected. But the door remained open just enough for him to slide his fingers through and yank it the rest of the way, sliding inside and taking off after the vampire.

—

Fuck, fuck, fuck. Zane could hear footsteps thudding down the halls after him and something told him this guy wouldn’t have any qualms about being spotted sprinting down hospital halls, seeing that he’d just casually murdered someone. A vampire, but someone nonetheless. Not that the odds of running into someone down here were very high - these halls only had traffic around shift changes and that was hours from now. Zane was well and truly alone down here. Pens and bottle caps jangled in his pockets as he ran, a few even slipping from their safety and tumbling to the ground. Escape routes, escape routes…

The sound of running still closing in behind him, Zane sped up and turned the corner, just barely avoiding the abandoned stretcher that someone had been planning to fix for months now, with a dexterity that only came about from avoiding patients on the move every day in the ER. Slippers hanging on by pure will, he tried to regain speed from the turn which was hard enough without the slippery hospital floors and ill fitting slippers. Fuck, he was going to catch up to him, he was going to drive that scary looking stake right through his heart and no one would ever know where Zane disappeared to and no one would probably even care enough to notice much anyway-

Clang.

Zane’s head whipped back around which really made it hard to run fast but it was instinct - you hear a noise, you look towards it. The stranger was clutching his knee, the stretcher now askew and clearly, not everyone was as good as dodging stretchers. Even static ones. For a second, Zane slowed and stared, the instinct to treat the wounded taking over before his brain rebooted back to the situation at hand. Imminent death. Right. Slowly but surely backing up towards the nearest access restricted door, Zane fumbled for his keycard and swiped at the reader behind his back. As it beeped, the words slipped out before he could really stop them. “Sorry.”

The door shut behind him and he sprinted until he reached the entrance to the ER, feeling like he definitely should have been panting by now. Head reeling, the first thought on his mind, and the dumbest, was that he’d just lost his favorite sweater.

—

The hall was empty. It was definitely a relief, both because Emilio wasn’t looking to explain to any concerned doctors or nurses why he was chasing one of their coworkers through the hallway and because it meant there was no one for the vampire to grab and use as leverage. Hostage situations got sticky fast, and Emilio had never been particularly good at navigating them. 

Of course, even with not curious bystanders, this situation wasn’t ideal. He was at the disadvantage here and he knew it. Not only did his old injury slow him down, but the vampire also had the advantage of knowing these halls. Whatever else he’d lied about, the claim that he worked in this hospital seemed to be a true one. He navigated the twisting halls with relative ease, leaving Emilio to follow and do his best to keep up.

It was a losing battle. He knew that. He knew there was no world where he caught up, knew that it was a matter of time before this vampire found someone or something to use against him. He didn’t expect that to come in the form of a haphazardly placed gurney in the middle of the hall. So focused on following the vampire, Emilio didn’t register the obstacle until he’d barrelled straight into it. He couldn’t keep himself from toppling to the ground, bad luck ensuring that his bad knee took the brunt of it. The hunter couldn’t bite back a string of curses as he fell, clutching his knee and gritting his teeth against the pain.

Ahead of him, the vampire stopped. Emilio tensed as he turned, scrambling for his stake only to find that it had landed out of reach. And, Christ, this was it, wasn’t it? He’d taken off after a vampire through the empty halls of a hospital, and now he was going to die here, alone and forgotten. Estúpido. 

Except… the vampire didn’t make a move towards him. Instead, puzzlingly, he apologized. He said sorry, and he looked like he meant it. Before Emilio could unpack that, the vampire was gone, disappearing behind a locked door with a definitive beep and leaving the slayer on the floor in an empty hallway, feeling more lost than he had in a while now. 

Wicked’s Rest. Weird place.

[mcatmemoranda]

Adenosine is given 0.1 mg/kg for peds pts who weigh less than 50 kg with SVT. If ther first dose of 0.1 mg/kg doesn't work, then you can give 0.2 mg/kg for the second dose.

For adults, it's 6 mg, then 12 mg. In the ED, I've seen adult pts just get 12 mg the first time.

Procainamide, amiodarone, or verapamil can be used to cardiovert peds pts who are still in SVT after failing the two doses of adenosine.

[writer-in-theory]

thinking about that time in lecture when our prof said that amiodarone could cause pulmonary infarction and i very audibly gasped and said "oh my god, heart attack of the lung" and my professor laughed for seven minutes straight

[goneatlas]

been watching exu calamity to rest in between studying and so the list of things i've looked up on google is so weird because right above like "methimazole dosing regimen" and "how does amiodarone cause hypothyroidism" are things like "rary's telepathic bond" and "do you need line of sight to counterspell"