2nd line anti-arrhythmic w/ amio? Amal Mattu, MD (@amalmattu) from ResusX:2025 explains. #shorts

Added: 2026-05-23

[00:00:00]Want to throw some lidocaine in there as a second option? That's okay. It's got no beta-blocking effects, but you don't want to combine amiodarone procainamide cuz that can cause hemodynamic instability. Lidocaine's great because it doesn't cause hemodynamic instability. So, amiodarone first line, and if you want to add something additional antiarrhythmic-wise, you can add lidocaine. Now, some of you may say, "Well, if you want to give a beta-blocker, why not just use a beta-blocker?" Perfect thinking. And so, I'd throw some beta-blocker in there also. Usually, we'll go with propranolol or metoprolol, whatever you have. And some of you may love esmolol. MS great.

[00:00:33]Esmolol's primarily beta-1. The problem in my emergency department with esmolol is if I order esmolol right now, it probably won't run into the patient for about 10 minutes because the nurses need to go get it out of the Pixis, they need to double-check, triple-check, and then run it in, whereas um the other beta-blocker just has a single dose, really easy to give.