Amiodarone and cardizem drip
Try ICU or ER?
2024.05.14 02:56 gbug24 Try ICU or ER?
Hi everyone! Baby nurse here, graduated in May 2022 and spent a year in the OR. Ended up leaving due to toxic environment and wanting more direct patient care. I’m now on a cardiac PCU with a ratio of 5:1… sometimes 6:1 (which definitely sucks), but 4:1 if we are the cath nurse or if we have titratable cardizem drips. I’ve been on this floor for 6 months and on my own for 4 months. I do enjoy my unit and I have great coworkers for the most part, it does feel kind of cushy if that makes sense.
Don’t get me wrong, I’m still learning everyday and gaining confidence in my skills… but apart of me is already getting bored of the 90 year old full code meemaws with afib or CHF. Plus, I feel we are more a med-surg tele floor at times and other times I feel we are more like a step down unit just with higher ratios….both sides are frustrating bc when I have higher acuity patients, I just don’t have the time to do the things I would want to do with a more critical patient. Then when I have a more med-surg like assignment, I get tired of all the BS and nonsense that goes with that.
I’m in no rush to leave my unit at this point as I’m still very early in my career, but I feel eventually I’m going to want more. I want to learn more and challenge myself more, I guess I feel that eventually I’m going to “cap out” on my unit if that makes any sense? I’ve always considered the ER or ICU, but not sure which direction would be best. Do you guys have any advice or can talk from personal experience on how you chose your specialty?
submitted by gbug24 to nursing [link] [comments]
Don’t get me wrong, I’m still learning everyday and gaining confidence in my skills… but apart of me is already getting bored of the 90 year old full code meemaws with afib or CHF. Plus, I feel we are more a med-surg tele floor at times and other times I feel we are more like a step down unit just with higher ratios….both sides are frustrating bc when I have higher acuity patients, I just don’t have the time to do the things I would want to do with a more critical patient. Then when I have a more med-surg like assignment, I get tired of all the BS and nonsense that goes with that.
I’m in no rush to leave my unit at this point as I’m still very early in my career, but I feel eventually I’m going to want more. I want to learn more and challenge myself more, I guess I feel that eventually I’m going to “cap out” on my unit if that makes any sense? I’ve always considered the ER or ICU, but not sure which direction would be best. Do you guys have any advice or can talk from personal experience on how you chose your specialty?
2024.04.24 22:04 mth724 Stepdown unit issues
Hi I work on a stepdown unit in a small community hospital. We seem to be the dumping ground for all patients that are “too sick” for med surg but not sick enough for ICU. It is a constant battle with the critical care intensivist who is a NP on night shift. The attending or house officer has to call the critical care NP to see if they will accept the pt to ICU. Which majority of the time they find every reason not to unless the pt coded. It’s incredibly frustrating. More times than not we have 6 pts to 1 RN, and the aides have 8-11 pts. I’m just wondering what everyone’s ratios are and what are your thoughts on an NP being able to dictate what comes to the ICU and how an NP can d/c transfer orders when an MD orders it. Also what is the best way to get the hospital CNO to understand 6:1 on a stepdown unit is impossible. I know they only care about money but it is getting more stressful and lots of nurses on my unit are burnt out. We have 4 nurses leaving, 2 from dayshift and 2 from nights. I’m sure the answer is to find a different job but I have worked on this unit for 12 years and this is the worst it has been. I am one of 2 nurses on night shift who have stuck around for this long. We get NIVs, high flow, cardizem, , amio, heparin drips, stroke pts, CHF, total care trach/peg pts, ETOH W/d, frequent iv meds. It’s a disaster waiting to happen. Is the grass ever greenier on the other side?
Also they closed the progressive care unit and transitioned most of the pts that use to go there to our unit- they were 1:3 or 1:4 but somehow we are 1:6. No difference day or nights. It’s difficult on nights but I don’t know how our dayshift nurses do it. The only types of pts we don’t take that the pcu did are insulin drips and levo/precedex/nitro d/t us not having monitors in the room just the portable tele in the pocket. Also the med surg/med tele/ and obs have the same ratios but yet we take pts that those units deem are not appropriate for their floors bc our floor can monitor them more closely. We also get rapids from other floors for various reasons. How is this okay? Sorry for the rant had a terrible shift last night and PMSing.
submitted by mth724 to nursing [link] [comments]
Also they closed the progressive care unit and transitioned most of the pts that use to go there to our unit- they were 1:3 or 1:4 but somehow we are 1:6. No difference day or nights. It’s difficult on nights but I don’t know how our dayshift nurses do it. The only types of pts we don’t take that the pcu did are insulin drips and levo/precedex/nitro d/t us not having monitors in the room just the portable tele in the pocket. Also the med surg/med tele/ and obs have the same ratios but yet we take pts that those units deem are not appropriate for their floors bc our floor can monitor them more closely. We also get rapids from other floors for various reasons. How is this okay? Sorry for the rant had a terrible shift last night and PMSing.
2024.04.08 05:13 -CarmenMargaux- VENT/RANT: Intermediate/PCU/Stepdown units are dumping grounds & horrifying.
 | I am a relatively new RN with approximately 7 months under my license in a step-down ICU. We are a dumping ground for the hospital. Our patients vary from simple COPD exacerbation to Cardizem drips titrated every 30 minutes. We run at 5 maximum & we are always at five. submitted by -CarmenMargaux- to nursing [link] [comments] I am trying my hardest to stick it out for as long as I can but I can't go on like this. It isn't even personal because I am new. We all run like this.. Every time I think I have reached my limit with insane acuity levels the unit just has to prove me wrong. Last week, I had one patient on three drips by the mid-point of my shift: Q6H Heparin gtt, Cardizem Q30 mins, and Q1H an insulin drip. His K+ was all over the place and we had Q4H BMPs and I kept having to change the cont IVF per protocol and replace K+, too. I also had four other patients one of which was COVID isolation. How do you expect anyone to do a full head-to-toe, medication pass, and put on/remove PPE before 30 minutes have passed? Charge RN was from another floor & also had a full assignment. I made clear after they added that insulin drip, too, that it is NOT safe for me to have a patient with this acuity on top of my 4 other patients. Suddenly, we could get a float from another floor that had a scut nurse. I saw red. Today, I had the most bizarre patient. Presented to ED for AMS the day before, BG >500 in EMS so on non-DKA insulin drip for roughly 20 hours. Patient is a poor historian, unable to tell us anything about their medications, caregivers, etc. Their family is non-reachable. We chased their BG up and down all day. Endocrinology eventually decided to give 150 units of HumulinU-500 (500 units/mL) AND SSI Humalog (100 units/mL) with meals. It hardly TOUCHED their glucose but finally could keep it down. I am FLABBERGASTED at the concept of someone needing the equivalent of 750 units of regular insulin at a "basal" rate 3x a day plus some Humalog. I am sure this is more common than I think but I was so scared as a newer nurse. Me, all day.. Another patient kept going into non-sustained v-tach on tele, longer duration over the day, and had the most insane ECG I have ever seen in my life & different from on admission. The auto-read it gave me felt like Simlish and the patient was completely asymptomatic and told me they felt great. Sinus arrhythmia with premature ventricular complexes & left anterior fascicular block, left ventricular hypertrophy, and lateral artifact age unknown. They were NSR with nonspecific T changes the day before. All electrolytes WNL, no new meds, no procedures, just hanging out in their chair snacking in non-sunstained VT \cries\** I almost had a friggin MI today but cardiology was like eh they're fine until tomorrow since they're asymptomatic let us know if it changes. I also had a CVA rule out with Q2H NIHSS scoring who spoke a different language. No acute changes in 48 hours and CT WNL. They ordered an MRI at 1804 with no transport and MARRTI was dead. Guess who did not get that MRI? Oh, and let's not forget to shout out to the one stable pt only there for case mgmt to f/u and their significant other who wanted to harass me and cuss out the tech because, in all the chaos, I didn't change their dry, intact protective Mepilex I'd placed the day prior soon enough for them or the PM RN who got angry with me because there was roughly 50 mL of 2-hour old urine in the suction canister from the PT they were getting after I had to put a Foley in because of retention in the pt PV residuals :) :) :) |
2024.04.05 14:14 SheShells23 Getting so very frustrated with this...
I was officially diagnosed with Afib last summer. At that point I probably got it 3-4 x yrly but was not liking the length of it (4-6 hrs). Thinking they would not catch it on the Zio home monitor (which they didn't - NS R the whole time with little bouts of other arrhythmias popping up here or there but not Afib). I then went for an ECHO which was normal, except that on going to the car I went into Afib that was all day. I later went back to the ED where they put me on an overnight Cardizem drip which finally around midnight got me to a lower rate and I converted on my own. Discharged on Cartia XT and blood thinner. (I do home INR testing as well). I was also given the non time release Cardizem to take during Afib episodes. For a while I was getting Afib on average once every other month. Now it varies from 4-6 weeks. The episodes can be up to 8hrs. I was given Flecanide as a p-i-p before this last episode but it did nothing but lower my rate a bit faster than the plain Cardizem did. Just had one last night as I was stressed over my disabled husbands medical conditions and an ED visit that ended up fruitless and a waste of time for him... This morning self testing INR - went thru 2 strips (which they dole out very sparingly as if they are gold) with error codes and have to call company cust. service. To make matters worse we leave on a trip very soon and it seems things around the house are having issues too. Forgive my whiney long tale of woe but I am getting frustrated with thinking - Was it the food I ate? Stress? Not enough water? Not enough sleep? Heck, I even got a sleep study and CPAP a month or so ago and was hopeful that it had helped as most of my episodes are at night and I hadn't had any since starting it. Have any of you felt this way? It is just overwhelming sometimes for sure...
submitted by SheShells23 to AFIB [link] [comments]
2024.03.30 18:06 Grammajean33 Asking for everyone’s help
Hello there ! My husband( 61) has been diagnosed with heart failure . His latest echo (TEE) showed EF of 20-25 percent and global hypokenesis .
His history is high blood pressure , slightly overweight . We both got a virus in February and his coughing and tiredness didn’t go away so he went to the doctor and was diagnosed with atrial fibrillation and was set up with cardiology but not for two weeks . He had some pretty mild SOB two days later and we went to the hospital . Well we just got home after 6 days there . He was on a Lasix continuous drip . He lost 20 lbs . The doctors said his fluid was all in his abdomen as he had no swelling in hands or feet . His kidney labs are normal .
He was cardioverted after TEE yesterday and sinus rhythm now in the low 70’s .
They started amiodarone , Entresto , metoprolol , Lasix , Xerelto and he continued his baby aspirin .
My question is this : what do you wish you knew when you started your heart failure journey that may help someone newly diagnosed ? I’m asking for advice so please give it if you have some ! We would so appreciate it . Anything you think might be helpful for someone starting out . We are doing 2000 mg low sodium diet . Any apps you found helpful for recording weights etc . Anything you wish someone had told you . His only symptoms now are being tired . He never felt the afib .
Thank you very much in advance .
submitted by Grammajean33 to Heartfailure [link] [comments]
His history is high blood pressure , slightly overweight . We both got a virus in February and his coughing and tiredness didn’t go away so he went to the doctor and was diagnosed with atrial fibrillation and was set up with cardiology but not for two weeks . He had some pretty mild SOB two days later and we went to the hospital . Well we just got home after 6 days there . He was on a Lasix continuous drip . He lost 20 lbs . The doctors said his fluid was all in his abdomen as he had no swelling in hands or feet . His kidney labs are normal .
He was cardioverted after TEE yesterday and sinus rhythm now in the low 70’s .
They started amiodarone , Entresto , metoprolol , Lasix , Xerelto and he continued his baby aspirin .
My question is this : what do you wish you knew when you started your heart failure journey that may help someone newly diagnosed ? I’m asking for advice so please give it if you have some ! We would so appreciate it . Anything you think might be helpful for someone starting out . We are doing 2000 mg low sodium diet . Any apps you found helpful for recording weights etc . Anything you wish someone had told you . His only symptoms now are being tired . He never felt the afib .
Thank you very much in advance .
2024.03.30 03:39 CageSwanson Cardizem drip to achieve heart rate under 80??
I work at a step down unit, and this patient has a cardizem drip running for a-fib with RVR. Most cardizem drip instructions say to titrate until you achieve a heart rate under 100. But recently that I've been getting patients that have instructions to achieve a heart rate below 80. I feel like that's a bit much, and more of a small window considering that u don't want the heart to go below 60 either. Are your cardizem drips the same or is it also 100?
submitted by CageSwanson to nursing [link] [comments]
2024.03.25 13:30 jtodd94 Cardizem Drip- help!
Hi all, I have a question about Cardizem drips and titration parameters. I had an order for a cardizem drip last night that stated to start the drip at 5mg/hr and titrate q30 mins to maintain a MAP between 60-80. The order stated to titrate no more than 2.5 mg/hr. How many mg do you titrate the drip by every time you titrate?
I got ripped into by my charge nurse because I was titrating by 0.5 every time I needed to titrate to stay within the parameters. For example, after the initial loading dose of 5mg/hour, my MAP was 58, so I reduced the drip to 4.5mg/hour. My charge was telling me I was supposed to titrate by 2.5 every time I titrated, so in the previous check, I would have reduced the drip from 5 to 2.5mg/hour. If I needed to titrate twice within an hour, it would be a 5mg total change. Isn’t that against what the order states? There was no indication in the order of how many mg titrate by every time a titration is needed. This is only my second time having a cardizem drip and I could have sworn in my training, I was told to titrate in increments of 0.5mg.
Please advise me, as I’m probably going to have this patient back tonight and I don’t want to make the same mistake if I was titrating incorrectly.
submitted by jtodd94 to nursing [link] [comments]
I got ripped into by my charge nurse because I was titrating by 0.5 every time I needed to titrate to stay within the parameters. For example, after the initial loading dose of 5mg/hour, my MAP was 58, so I reduced the drip to 4.5mg/hour. My charge was telling me I was supposed to titrate by 2.5 every time I titrated, so in the previous check, I would have reduced the drip from 5 to 2.5mg/hour. If I needed to titrate twice within an hour, it would be a 5mg total change. Isn’t that against what the order states? There was no indication in the order of how many mg titrate by every time a titration is needed. This is only my second time having a cardizem drip and I could have sworn in my training, I was told to titrate in increments of 0.5mg.
Please advise me, as I’m probably going to have this patient back tonight and I don’t want to make the same mistake if I was titrating incorrectly.
2024.03.16 13:40 NightmareNyaxis Please just run the fluids.
Fluids are annoying and yeah sometimes we should absolutely get clarification on why they’re ordered (I work cardiac, we get a lot of CHF) but please don’t just ignore them and let them sit.
2 patients today both had fluids ordered during dayshift. Neither patient had fluids running when I got there. One had an EF of 35% but his fluids were ordered very slow for about 12 hours, post-cath for some kidney hydration. Of course even with me running them, his creatinine is higher than admit. The other patient - Large man, some pitting edema, no pBNP, in for afib RVR and sepsis. Didn’t tolerate cardizem, didn’t tolerate IVP metoprolol, not a candidate for digoxin. Amiodarone drip - not touching the heart rate, hanging out 150’s - 170’s. Got 3L in the ED, lactic barely elevated, abx, etc. But no one started the continuous fluids. Within 2 hours of starting the fluids, heart rate is coming down. By the time I left, 90’s (sleeping) - 120’s when up.
So please. Run your fluids. If you’re uncomfortable with it, call and clarify. Document your concerns and the providers response. But don’t just ignore them.
submitted by NightmareNyaxis to nursing [link] [comments]
2 patients today both had fluids ordered during dayshift. Neither patient had fluids running when I got there. One had an EF of 35% but his fluids were ordered very slow for about 12 hours, post-cath for some kidney hydration. Of course even with me running them, his creatinine is higher than admit. The other patient - Large man, some pitting edema, no pBNP, in for afib RVR and sepsis. Didn’t tolerate cardizem, didn’t tolerate IVP metoprolol, not a candidate for digoxin. Amiodarone drip - not touching the heart rate, hanging out 150’s - 170’s. Got 3L in the ED, lactic barely elevated, abx, etc. But no one started the continuous fluids. Within 2 hours of starting the fluids, heart rate is coming down. By the time I left, 90’s (sleeping) - 120’s when up.
So please. Run your fluids. If you’re uncomfortable with it, call and clarify. Document your concerns and the providers response. But don’t just ignore them.
2024.03.13 20:43 Specialist_Work_7783 Reflecting on my shift, I may of made a mistake. Would love feedback and solutions
New grad ER nurse with 4 months under my belt. I had a patient with a midline catheter (which is rare to see in my ED and was my first time using it) where I had heparin going in one port and vancomycin going in the other. I checked with the pharmacy initially to ensure I could run incompatible medications such as heparin and amiodarone. The pharmacist said yes since the two lumens are separated and medications won't be mixed. Fast forward, amiodarone was held since the BP became soft and I started a septic work which is where vancomycin came into play. After my shift, I started reading up on midline and learned that Vancomycin shouldn't run in midline at all because it's hard to identify extravasation if the midline goes bad. I am beating myself up because I didn't even consider that it was a vesicant when I was starting the medication. I also forgot I needed to stop the Heparin for 5-10 minutes before butterflying the pt for the next ptt since I could only get blood from the pt arm with the heparin drip since the other arm is restricted due to a dialysis fistula.
Anyways, I sucked today and such a bad nurse. Is there any way I can fix this or should I just trust that the next nurse will catch my mistake?
submitted by Specialist_Work_7783 to nursing [link] [comments]
Anyways, I sucked today and such a bad nurse. Is there any way I can fix this or should I just trust that the next nurse will catch my mistake?
2024.03.08 05:29 Leather_Government_9 Needing some insight!
Hi all, I have been offered two spots at a hospital as an RN and I have no one to ask about how to pick. One is like a med surg obs unit that is still very new and in the managers words is kind of like a pilot program. It’s 11 beds, no isolation patients, 2 RNs and a PCT. The other is like a critical care step down unit where you get drips, IV pain meds, and IV cardizem and is more like a progressive unit. This unit has 24-28 beds with some semi private rooms and your ratio is either 1:6 with a tech or 1:12 with an LPN and a tech. Both are night shift and come with a very nice sign on bonus that is not taxed upfront. I am not new to the nursing world and I have 12 years of experience behind me between being a CNA and being an LPN. The thing is, the manager from a critical care unit I really liked emailed me as well to talk but they do not have the sign on bonus that I really need to get by right now. The terms of the sign on are two years on nights which isn’t a problem for me, I’ve already worked for the same hospital for almost 10 plus years off and on. I just don’t know which one is the best option and how to pick. Anyone have any insight to this or have worked on similar units with similar patients and ratio?
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2024.02.28 05:14 More_Entertainment78 New onset Afib with RVR
I am 20 years old, female, fresh out of the hospital from a 5-6 hour stent of Afib that reverted back to normal sinus rhythm in the hospital on a Cardizem bolus and drip. It happened at 5am after a long 10 hour shift. Ive never had anything like this before, and they couldn’t really pin why it happened. I am concerned because I am so young. I haven’t even enjoyed my 21st bday yet. Will I even be able to have a drink and not go back into AF? I already have health anxiety and this just made it 100x worse. They decided that I didnt need blood thinners due to my CHADSVASC score only being 1 (for being female). I am already diagnosed with POTS so I was already taking propranolol when the Afib happened and am still taking it. Will this happen again or was it a one time thing? I feel like I have no answers. :((
submitted by More_Entertainment78 to AFIB [link] [comments]
2024.02.13 11:25 mangagirl07 My aunt is not improving after open heart surgery
My 63F aunt had open heart surgery on Jan 3rd to address multiple valve issues and afib. She had her mitral and pulmonary valve repaired, her aortic valve replaced with a tissue valve, a maze procedure, and single bypass. She has had afib for over 20 years after being diagnosed in the Philippines, but she couldn't get proper cardiac care until coming to the US.
She had a 20 day hospital stay due to a pleural and pericardial effusion. At one point we were told she had a kidney injury and was on a dopamine drip, but another nurse told me there was no injury and she just needed support for the kidney.
Since being discharged 2 weeks ago she has been readmitted and diagnosed with pneumonia, which she took a round of antibiotics for. She was then admitted to the ER last week because the home health nurse was concerned about her breathing, and her left lung was drained (my mom said 6 liters, which is hard to believe) and she was kept on oxygen. Before discharge we were told that she would need to remain on oxygen at home, but she was already discharged when we went to visit her on the 3rd day in the hospital and we couldn't speak to a nurse about her oxygen and there were no orders given to us.
She still struggles with breathing. She coughs a lot and takes shallow breaths. She cannot lie down. It is hard for her to walk more than 10 feet. She is a normal BMI, maybe a little underweight at this point, and has no other co-morbidities.
We're so scared she is going to die like my dad did. He got his 3rd pacemakedefib installed a week before his 73rd birthday and his incision site never healed for 4 months--so many visits to PC doctors and his cardiologist but he continued to deteriorate until a heart attack took him less than 5 months after surgery.
I just want to know who we should bring her to. It seems like every week since her discharge there has been a life-threatening emergency and her cardiac surgeon seems unconcerned. She has an appointment with her cardiologist next week...but my dad died the day of his second cardiologist follow-up and I'm so scared she won't make it. She is not getting better and no one can tell us why.
I'll include a list of her medications below:
Additional medications after last week's ER visit:
submitted by mangagirl07 to AskDocs [link] [comments]
She had a 20 day hospital stay due to a pleural and pericardial effusion. At one point we were told she had a kidney injury and was on a dopamine drip, but another nurse told me there was no injury and she just needed support for the kidney.
Since being discharged 2 weeks ago she has been readmitted and diagnosed with pneumonia, which she took a round of antibiotics for. She was then admitted to the ER last week because the home health nurse was concerned about her breathing, and her left lung was drained (my mom said 6 liters, which is hard to believe) and she was kept on oxygen. Before discharge we were told that she would need to remain on oxygen at home, but she was already discharged when we went to visit her on the 3rd day in the hospital and we couldn't speak to a nurse about her oxygen and there were no orders given to us.
She still struggles with breathing. She coughs a lot and takes shallow breaths. She cannot lie down. It is hard for her to walk more than 10 feet. She is a normal BMI, maybe a little underweight at this point, and has no other co-morbidities.
We're so scared she is going to die like my dad did. He got his 3rd pacemakedefib installed a week before his 73rd birthday and his incision site never healed for 4 months--so many visits to PC doctors and his cardiologist but he continued to deteriorate until a heart attack took him less than 5 months after surgery.
I just want to know who we should bring her to. It seems like every week since her discharge there has been a life-threatening emergency and her cardiac surgeon seems unconcerned. She has an appointment with her cardiologist next week...but my dad died the day of his second cardiologist follow-up and I'm so scared she won't make it. She is not getting better and no one can tell us why.
I'll include a list of her medications below:
- Amiodarone 200 MG (once daily)
- Docusate-senna 50 mg-8.6 mg (once daily)
- Potassium chloride K-dur 10, extended release (once daily)
- Atorvastatin 40 mg (once daily)
- Furosemide 20 mg (once daily)
- Metoprolol 25 mg (twice daily)
- Rivaroxaban 20 mg (once daily)
- Aspirin 81 mg (once daily)
Additional medications after last week's ER visit:
- amLODIPinr 5 mg (once daily)
2023.12.22 14:33 Beautiful-Stand5892 Afib RVR refractory to amiodarone drip and changes to SVT when drip restarted
 | These are pictures to follow up to my last post talking about a patient that was in afib rvr, started on amiodarone drip, converted to SVT (as seen on ekg) when on drip, the converted back to afib rvr when drip stopped. Also included pictures of telemetry straps showing what's been going on submitted by Beautiful-Stand5892 to Cardiology [link] [comments] |
2023.12.22 13:17 Beautiful-Stand5892 Contraindications to diltiazem in management of afib rvr?
Oncology nurse here with a couple of questions. I have a patient who has been in and out of both Afib RVR and SVT for the past couple of days and the rate and rhythms have only been temporarily responsive to treatment. We've done multiple amiodarone boluses then followed by titrated drips have done diddly squat. In fact this evening the patient's telemetry after starting the latest amiodarone drip showed afib rvr with a rate of 150-160s, appeared to attempt to convert into sinus tach a couple of times, but then converted to svt with narrow qrs complexes with a rate of 160-170 while still on the drip. The nocturnist had me pause the amiodarone with the intention on then administering adenosine, but shortly after the amiodarone was stopped the patient converted back into afib rvr rate 140-150s. I have ekgs showing this as well. So my first question is, what could cause the patient to convert to svt when amiodarone is initiated rather than the rate simply slowing down or converting to sinus? Second question is what would be contraindications to using a diltiazem drip for treatment of the initial afib rvr? The nurse I got report from said that the last echocardiogram showed an EF of 46% and he also said that cardiology had mentioned something about ventricular insufficiency, but because he didn't understand all of it he tuned it the rest of the reasoning for why the team decided not to do diltiazem. I haven't been able to find the latest cardiology note to find the reasoning either, so I was hoping some of you might be able to elaborate on reasons why you wouldn't use diltiazem for treatment of afib rvr. It's looking like the next step for the patient may be cardioversion after anticoagulation with a heparin drip, but I'm curious what other interventions could be tried in this situation. Metoprolol IV works for maybe 2 hours, oral metoprolol tartrate has done nothing, same with oral amiodarone. Having the patient breathe through a straw helps, but that can only really happen when they're awake
submitted by Beautiful-Stand5892 to Cardiology [link] [comments]
2023.12.21 12:01 brcg2 Heart rhythm going but no pulse-first patient death
6 months nurse on a cardiac med/surge floor. I got a pleasant reasonably 94 year old patient with a pacemaker 4 hours before my shift ended. He was A/O x4 and told me he didn’t know what DNR was. He told me he had an estranged son and seldom talk to him. He showed me he was fairly strong while doing head to toe assessment. Afib between 120 and 82. Freshly off cardizem from ED. BP was low but coming up from (80/60) His BP was never high enough to meet the perimeter for metoprolol attending prescribed. He also had CHF with fluid restriction. So I wasn’t quite sure about NS drip. I got the charge nurse involved with the doctor. He prescribed amiodarone bolus and drip. Charge nurse was concerned and ordered me to slow down the rate of bolus. I charted in his room so I could keep an eye on him. PCA and I noticed that he looked awfully pale and quiet. He was unarousable. No pulse while the monitor still showed a arrhythmia rhythm. We got help and in the frenzy of CPR. We contacted the son and he thought vaguely he had a DNR. Dug it out of the system from May 2022 and all motions stopped. Looking back I should’ve noticed the signs-black tarry BM he kept excreting(which we gathered for lab), the nausea/ vomit he had( we thought from indigestion), the short of breath,( which happened after we turned him to clean so dismissed it as SOB with exertion) the pale complexion( dismissed it as old age) Moving forward, I don’t think o can ever leave my pacemaker patient alone. I want to comfort myself that he was old and had multiple diseases yet meanwhile, I wonder if I were more experienced, the outcome might’ve been different. What did I do wrong?
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2023.12.08 06:10 Electronic-Store6196 Taking patients without Epic access
I am beyond pissed. I work in home health, and I also work at a hospital PRN, which are both the same hospital system. For some reason tonight I didn’t have access to the patients in the hospital when I went in for my PRN shift tonight. I immediately told the charge nurse that I couldn’t get into epic to see my patients. She told me to call IT. I was on the phone with IT for a while, and I kept telling her and the nurse trying to give me patients that they didn’t know how long it was going to take. I thought maybe they should just split the patients up across the floor since all the other nurses only had four patients. I would take the patients back if I got into the charts. But this floor is notorious for being every man for himself, and both the charge nurse and the dayshift nurse forced me into taking patients after I told them multiple times I wasn’t comfortable doing it. Now this is on me, I should’ve stood my ground. It was hard with two different nurses were pushing me, saying oh my they’ll be able to fix it. I got the shittiest report ever, but I couldn’t see anything about them. One was on a heparin drip, and another was on an amiodarone drip, heparin drip, and the cardizem drip was just discontinued. Another patient was on Tikosyn. We are supposed to sign off the drips when we do shift changes but obviously that couldn’t happen if I didn’t have computer access. I eventually went to my charge nurse on the floor I usually work on, and she called the supervisor and had them pull me from the floor. I just can’t believe they would think it’s OK for me to take patients with all these drips. If I needed to call the doctor or secure chat them, guess what I also can’t freaking do that either. I’m just so ticked.
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2023.12.02 16:28 CraftyObject I'm a new grad in an ED. I think I need a psychiatrist or a therapist.
Having some major anxiety because of this job. I'm an AEMT too so I thought I'd have a better handle on this. I've been in healthcare for 8 years. I didn't think this would be easy at all but I didn't think it would be this hard. Why am I constantly overthinking things? I agonized about giving IV digoxin to a pt that was on max cardizem and it really backed up the waiting room. I don't want to rush giving out meds period, but especially not cardiac meds.
I totally missed the signs of a head bleed because dude had a bunch of alcohol too. Thankfully, the PA did a head CT and caught it. I knew something was off about that guy but I didn't escalate and I should have even though it probably wouldn't have made a difference.
I had my first ICU pt from start to finish bibems and my first levo drip. Damn near maxed him out on accident if I hadn't double-checked myself. He got to ICU alive but damn I was all over the place. It was embarrassing.
Does this uncertainty and anxiety get better? I don't feel like I belong here because I feel so damn stupid half the time.
What do you guys do for this feeling?
submitted by CraftyObject to nursing [link] [comments]
I totally missed the signs of a head bleed because dude had a bunch of alcohol too. Thankfully, the PA did a head CT and caught it. I knew something was off about that guy but I didn't escalate and I should have even though it probably wouldn't have made a difference.
I had my first ICU pt from start to finish bibems and my first levo drip. Damn near maxed him out on accident if I hadn't double-checked myself. He got to ICU alive but damn I was all over the place. It was embarrassing.
Does this uncertainty and anxiety get better? I don't feel like I belong here because I feel so damn stupid half the time.
What do you guys do for this feeling?
2023.11.23 06:57 avocadotoast996 POLL: can you Y site a non-titrated drip (amiodarone, pantoprazole, octreotide, etc.) to IV fluids going at 30-100mL/hr, yes or no and why or why not?
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2023.11.18 15:39 Soft-Discount1776 Why does amiodarone tubing always get so much gas in the iv tubing?!?!?
I have been a bedside nurse for 10 years and for the past few months have been working on a cardiac ICU/PCU where I end up maintaining ALOT of amiodarone drips on patients. The cardiologist in this facility will often leave patients on a maintenence infusion for several days and during this time (it seems much more common when the same tubing is used >24 hours) I have noticed that the amiodarone somehow and for some reason begins to vaporize inside the tubing. I can clear the tubing completely of air bubbles and 30 mins to 1 hour come back and there will be lots of small gas bubbles in the tubing.
I am just curious if anyone here has an explanation as to what is going on here. Is this just a property of the amiodarone itself or is it a reaction with the iv tubing? Maybe it's something I am totally missing. Thanks in advance to anyone who cared to read this far hoping someone shares a curiosity in this and can steer me toward an explanation.
submitted by Soft-Discount1776 to pharmacy [link] [comments]
I am just curious if anyone here has an explanation as to what is going on here. Is this just a property of the amiodarone itself or is it a reaction with the iv tubing? Maybe it's something I am totally missing. Thanks in advance to anyone who cared to read this far hoping someone shares a curiosity in this and can steer me toward an explanation.
2023.11.18 02:17 brcg2 Time management frustration
(4 1/2 mo new grad. Background: cardiac med surg) I’m perplexed to say the least and seeking honest feedbacks: 1)morning med pass- from getting patient’s meds to dispense them( and educate them on side effects), assessment and flushing IVs. It takes me 1/2 hour with each patient.( I also have to retake their BP if their previous vitals is outside of the 30 minute window of me giving them BP meds) They told me that other nurses never listened to their heart or breathing but they were charted. Hummm? 2) Manager told us we are not allowed to look at patients’ info before shifts and not allow to stay L8 to chart. I try to look at clinical notes before med pass so I can give report at rounding at 10Am. Sometimes patients want stuff or going off for tests or toileting and take time away. Then I put off giving meds to patients before 10 so I can catch up on reading the clinical notes for report and I am late giving out meds to the last two patients. I don’t have time! 3)Yesterday I was pretty caught up by noon. Then 2 discharges, one started dialysis and needs blood work. The other one needs cross match for surgery next day and also 2 IV antibiotics and Cardizem drip running at the same time. At 18:45, one new admit and another at 19:00( shift change) while I was hanging a new antibiotic IV in another room. I managed to finish initial nurse patient history input with the 18:45 admit. Night shift nurse asked me about the patients at shift change(19:00). I gave barebone info on 18:45 one and knew nothing on the 19:00 admit at shift change. Eyeroll from the night shift nurse and I felt I sucked big time but meanwhile I felt it was out of my control.
All day I was running around while I see other nurses have time eating lunch and chatting. I know they are better at time management but it still takes time to do the same charting I am doing? I just want to know what I do wrong to speed up more!
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All day I was running around while I see other nurses have time eating lunch and chatting. I know they are better at time management but it still takes time to do the same charting I am doing? I just want to know what I do wrong to speed up more!
2023.11.14 17:45 HeChoseDrugs Amiodarone without filter tubing?
Patient was in A-flutter 150s. Amiodarone bolus ordered. No filter tubing anywhere on unit. There was a discussion about whether we could just draw it up out of the bag and give it IV push- but we were unsure if doing so was safe. I asked if I should get it out of the crash cart but MD said to just wait. It took 15 minutes to have it tubed.
I know filter tubing is important d/t serious risk of phlebitis. But is it kind of like Levo in that Levo is ideally given through central line but can be given peripherally in emergencies d/t benefits outweighing risks? Can Amio be given without filter in emergencies? I know that the Amio in the crash cart does not need to be drawn up with filter tubing. I looked this up under ACLS and it looks like the reason is because amiodarone can absorb into the plastic used for standard IV bags after 2 hours. So my understanding is that bolus without filter= ok, but a continuous drip needs a filter.
Is this correct? I'm just mentally preparing myself for how to handle this next time because my hospital's a shit show and I know it will happen again.
submitted by HeChoseDrugs to CriticalCare [link] [comments]
I know filter tubing is important d/t serious risk of phlebitis. But is it kind of like Levo in that Levo is ideally given through central line but can be given peripherally in emergencies d/t benefits outweighing risks? Can Amio be given without filter in emergencies? I know that the Amio in the crash cart does not need to be drawn up with filter tubing. I looked this up under ACLS and it looks like the reason is because amiodarone can absorb into the plastic used for standard IV bags after 2 hours. So my understanding is that bolus without filter= ok, but a continuous drip needs a filter.
Is this correct? I'm just mentally preparing myself for how to handle this next time because my hospital's a shit show and I know it will happen again.
2023.11.02 23:03 PartyNightAway Should I accept a Tele contract if I mostly have MS experience?
I’ve been a nurse for the last 5 years. I’ve mostly worked on MS floors in the past, but a lot of my patients are usually on tele monitors. I am comfortable when it comes to certain cardiac drips.. like cardizem, amiodarone, heparin, lasix... and I’ve seen a fair share of cardiac cath patients but I don’t have much experience with other cardiac procedures. Should I accept a tele contract? Im a fairly fast learner but I just don’t want to be looked at as incompetent if I don’t know how to do something cardiac wise.
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