Cardizem bolus

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. :((

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?

50/F. My first episode of afib lasted a few weeks (I thought I just had a rough virus with a lot of fatigue because I also have multiple sclerosis), and ended on 12 Jan 2023. I went to the ER and converted back to NSR after 2 Cardizem boluses, an ambulance ride to the heart hospital, and about 12 hours on a Cardizem drip. Echo was normal. At post hospitalization appt, we agreed to discontinue Xarelto since my CHADS 2 score was 0, and I was monitoring with the newest Apple watch. At my 3 month follow up, EP lowered Cardizem dosage from 180 mg to 120 mg which is lowest possible.
12 July 2023 - 4 hours of afib. Converted back to NSR at home.
20 Sept 2023 - 17 hours of afib. Converted back to NSR at home, but made urgent appt with my EPs NP.
21 Sept 23 - NP increased Cardizem dosage back to 180.
24 Oct 23 - Saw my EP/clinic director. Expected to have to convince him to just go right to ablation before I am any less young. The first words out of his mouth when he sat down were, “I’d like to schedule you for an ablation as soon as I have an opening”. He also had me schedule a chemical stress test for next Wednesday, 1 Nov 23.
Today: 26 Oct 23 - I’m minding my own business, and I get a call from the cardiology nurse. My EP has had a cancellation, and my name “popped into his head” as a good fit. I also think it’s a little bit of favoritism since we get along extremely well and most appts run long with lots of laughs. So I am having my ablation 2 weeks from today. 😬
I’m not sure if I am looking for reassurance, thoughts, or just to get the words out since I am not really telling anyone but immediate family and my inner circle. Wish me luck!
Fortunately, I trust in my surgeon completely ❤️

So I just finished a busy shift and have been doubting myself. My previous hospital under no conditions do we do verbal orders.
Now at my new facility they say no but RNs would do so anyways at times despite the MDs being aware of the push of not putting in verbal, but dont seem to care.
Well my pt went hypotension after being on a cardizem gtt, which i stopped, and I gave them a fluid bolus per the md orders. Md later called me back to ask about the BP and said he wanted to change the pts maintenance fluid rates as he was on his way home, which he repeated and I confirmed. When I got off the phone I assumed that he would put it in until it dawned on me that after waiting about 5 minutes he did not.
I saw his epic chat still said he was avaliable so I messaged him, to clarify if he would put it in or if I should do it as a verbal. A random resident in the chat ended up responding verbal and the cross coverage md who was covering overnight also confirmed verbal after I written out word per word what the order was for them to have context since the original MD i spoke over the phone with didnt respond.
I ended up putting in the verbal order about 30 min after the phone call under the md who i spoke with over the phone, just so I could consult with others to clarify if it was OK for me to do. I confirmed with the cross coverage and my charge nurse.
I'm used to not doing verbal. Now I'm just anxious what if the MD forgets to cosign the order or a crazy scenario where they would say they didn't order it to save themselves?
I learned my lesson now and will fight verbals, even though it is the culture of this hospital for my own peace of mind. But I'm still just scared of the what ifs.
Thanks for the advice

Had my first a fib RVR the other day. Gave cardizem over two minutes as an IV push and she cardioverted back to afib. Is there a way to bolus it over the two minutes? Just looking to see if there is a better way.

So I'm in the baby stages of starting a nursing podcast because everything I'm subscribed to either falls super flat or is for student nurses. I want to essentially interview a nurse where the goal is to share or teach me something that they've learned. I feel like a lot of nurse oriented stuff is about the emotional side of things and focuses on mercy but nothing really highlights how smart and disciplined we are in medicine. Like, some of my most intense moments have been in a yelling match over amio vs cardizem bolus on a tanking patient, or assisting in placing a central line because there's no other staff. Do you think there's interest in that? What are things that you'd like to see or you'd lose interest in?

I'm a new grad on an adult medicine unit and I was genuinely feeling pretty positive about how I was doing until a couple days ago when one of my patients started going down hill. He was a 80 something year old male, s/p abdominal surgery, stable BP with a HR sustaining in the 50s. I was going about my shift until PT called me, saying that he became orthostatic when he stood up. I checked his BP and it was 60s/40s, HR 100. Paged the docs, they wanted to bolus him with 1L LR wide open. Up until this point, it all felt pretty straight forward. He hadn't been eating/drinking much because he didn't like the clear liquid diet foods we were offering him. I thought we were going to be fine after the bolus.
I come back after the bolus was done. His pressures were 110s/70s, but now his HR was 140-160, and he was complaining of chest pain and headache. At this point I started getting anxious. My preceptor basically carried me and it all seems like a blur; everything happened so fast that I felt like I didn't have time to think. We did an ECG and he was in afib, rapid response came, and they were talking about giving metop/cardizem, and after several pages, the surgery resident finally came. Long story short he converted back to NSR without any meds (and then he continued to have episodes of afib 2 days in a row, eventually transferred to TCU).
I felt like everything was moving at 100 miles an hour and I didn't even have time to think before my preceptor started doing things. This was my first experience with a patient declining this quickly and I felt almost useless. Any advice on how to be better? I know it takes experience but I'd like to be more prepared for situations like these when they happen again.. How long did it take you to feel comfortable on your unit?

I’ve been a nurse since December and am still on orientation in the ED. I had a patient yesterday with new onset a-fib. It was the end of my shift and my preceptor handed me the meds to go admin. I gave a bolus dose of cardizem as well as set up a titration. Within 15 minutes, my pt showed to be in SR and her rate dropped from 140 to 110. Today, the house super tells my preceptor that the patient didn’t get any of their drip for 4 hrs because I hadn’t entered the bottle. My patient got 5ml an hour of saline! I am so mad at myself. I hadn’t ever administered it before and should have made sure I knew how to set it up correctly! I just wanted to vent somewhere. This is so embarrassing. Hopefully nothing like this ever happens again.
TL;DR I didn’t know I couldn’t just spike the bag of cardizem and my pt got only saline for 4 hrs and now I just want to crawl into a hole.

I had the sweetest guy who worked as a tech at a local rehab come in to my ER after passing out at work. He had complained of chest pain then went down like a tree in front of some of the nurses; they checked his vitals and found him in a fib at 120 and hypertensive at 200/100. They roused him and gave him three nitro before EMS arrived. All symptoms resolved before he got to the ER, heart rate 100, BP 130/80, guy's feeling fine he says.
After we got a portable chest the doctor pulled up his films and pulled me aside. "Either there's artifact on this x-ray or his aorta is about to blow." Sure enough she shows me the picture and it looked like a HUGE dissection. She said it was large enough to be anatomically implausible so she ordered a repeat CXR. She immediately looked at the film and called me over. "It looks the same. I don't think that's artifact."
"If this blows he dies." She says.
"Should I be doing anything differently to help prevent that?" I ask (I'm a fairly new nurse and haven't dealt with much of this)
"No, just know if this ruptures he's going to die. Immediately." She says.
Good talk.
She ordered a stat CTA and ran in with the ultrasound while I threw an 18 g in, and before she'd even gotten set up for the echo, CT was ready for him. The patient had started asking questions and figured out we were worried, so of course he's getting anxious, and his pressures are back up into the 190s. I'm literally running down the hall with lopressor, Ativan, and a cardizem bolus hoping I can get his pressures down before he ruptures. He started getting panicky and pale when he had to be supine for the scan. As I'm rushing him back down the hall after his scan he says, "uhhh I feel funny... I feel something funny in my chest... Like a rush of hot fluid from my chest into my belly all of a sudden... Is that bad?" I relay this to the doctor and she runs to look at his scan.
It was artifact. No dissection. Normal aorta.
Turned out he was having an NSTEMI but that seemed like NBD after over half an hour of sheer panic at a rural hospital with no plan for treating a dissection.
I clock in at 0800. Patient was transferred and this was all over by 0930. Don't you love those mornings?

So this situation actually happened well over a month ago. Details will be alerted to protect patient privacy.
Patient presents to ED with c/o shortness of breath. I wheel them back and set them in the bed while I start getting vitals. O2% is fine... HR 76.. Then 114, 106, 90, 104, etc. "Shit.. They're in a-fib". Ask regarding same, no history. Cardiac monitor and 12 lead confirm, new onset with no history of a-fib or any other cardiac anomaly.
Standard treatment, anti-arrhythmic and heparinize, yadda yadda. Heparin is ready, waiting on pharmacy to send my Cardizem drip. Finally get all my meds ready and a nurse for witness, bolus of Cardizem goes in the line, immediately hook up the drip to 0.9 at like 50/hr.
Patient almost immediately complains of itching, and begins itching on the infusing arm more intensely than a " regular itchiness". Gave it a couple more seconds, noticed it was not transient, immediately stopped the infusion, cleared the line, and notified the MD. Reaction was limited to local itching and hives.
TL;DR my question is, how often have any of you seen acute allergic reaction to Cardizem in your practice? I know that any drug can cause an allergic reaction, but I'd given Cardizem numerous times and never seen it cause it. Also, the patient was perfectly stable after this event, which is the most important :)

So yesterday was the busiest shift I have worked in my 4 years as a med/surg RN. I want to lay it all out there so that maybe you all can tell me what I could have done differently from the beginning to avoid such a hot mess of a shift. I'll try to be as clear and succinct as possible because there was a lot going on, the entire 12 hours.
I began the shift with 6 patients.
Patient 1: in pain, on a PCA, sort of a psych case. Had kicked out 3 prior roommates because of "excessive noise and visitors." Was currently in a power struggle with her roommate over the room temperature and had already called house several times.
Patient 2: young dude, on ABX, would be discharged later that shift.
Patient 3: wants Dilaudid Q2, on the dot. Docs can't find anything wrong with him.
Patient 4: Had just been through a rapid response at 0600, and was PCU/ICU status, but we had no beds. Not. One. So she was mine, with ICU nurses "checking in" every hour or so. ON BiPap, cardizem drip, HR in the 150's. Skin gray, diaphoretic.
Patient 5: Total care, new PEG, aphasic, prior GI bleed, suspected stroke, feedings not restarted at 0600 because we had none of the ordered milk for her. Otherwise seems stable (but not for long, woo hoo!).
Patient 6: Newly dx'd DM, anemic, had orders for 1 unit of PRBC's to be transfused during my shift. Otherwise walky-talky.
After report, I spent a lot of time with Patient 4 because I was obviously worried about her. Got a late start on morning med pass, so I didn't finish with that until about 11:30. During that time, the ICU nurse was in and out, titrating the drip and getting the patient from BiPap to non-rebreather to eventually nasal cannula. She tolerated everything well and converted back to NSR about 11:30, at which point the drip was stopped. I was busy with normal morning tasks up until this point.
During 1100 vitals/BS checks, Patient 5's blood sugar was in the 50's and BP was 70s over 30s. She's pale, but otherwise unchanged in appearance. I call doc, place patient in Trendelenburg (yes I know this has been proven to be ineffective) and gave fluid bolus. Also gave 1/2 amp of d50. Rechecks of BS and BP were within normal limits an hour later.
I continue passing 1200/1300 meds and putting out small fires here and there (You get Dilaudid! You get Phenergan! You get a new roommate! You get a new Duoderm!) I manage to take a short lunch around 1400. Still have not charted a single thing at this point. I had my CNA checking Patient 5's BP every 30 minutes. Patient 4 is now downgraded back to medical status. I discharge Patient 2, get my blood started with Patient 6, and come back to check on Patient 4 and 5.
1600: Patient 5's BP is 80/50 and now she looks bad. Using all accessory muscles to breathe, RR 30, pale as a ghost, diaphoretic. I call the doc, get orders, then call critical care doc. I go back to Patient 6 to check her vitals, temp has gone up. Shit. Stop transfusion, page doc. Clock is ticking. Back to Patient 5.
Meanwhile, ER has brought up an admission (someone else's, thank jeebus) who was "A/OX3" but is now unresponsive, even during transport. (WTF??) A rapid is called on this patient. I'm waiting on critical care and Patient 6's doc to call back, and I know I need to call a rapid on my patient, too. I pull a couple ICU nurses and an RT into my room for assistance.
We do our thing, and they call the rapid. We get Patient 5 on Bipap (already in the room - thanks, Patient 4!) and we get orders for meds and transfer at this point from critical care. Still no ICU beds. Still haven't documented a thing. During all this mess, Patient 6's doc calls back and my charge takes the call, gives the patient Tylenol and restarts the transfusion. Whew.
Finally an ICU bed is open and I give report and transfer Patient 5 at 1745. I start doing 1800 med pass and restart an IV for Patient 3. This brings us right up to 1845 and its time for report. I stay until after 2100 charting.
How could I have streamlined things? I feel like I ran myself ragged, but still didn't get to do everything, or even most things. I don't know. Thoughts? My mind is still spinning.

So I had a patient in the CVICU s/p Convergent procedure (fancy ablation on the inside and outside of the heart) who remained in Afib with RVR 140-150s. Pt. was restarted on her home medication of Sotalol 80mg yet remained in AF-RVR. Amio 150mg bolus was given and a gtt started at 1mg. The electrophysiology attending had a major problem with this order. While I understand his issue with the potential for a complete heart block or asystole, Amio is often given in tandem with beta blockers for refractory Afib in our setting. My question is: is Amio a defensible option for uncontrolled AF in this patient and why; if not, what would be some better options given that the patient was also 'allergic' to cardizem?