So here's what happened last night to my patient....
I work night shift so I came on at 1900 and received report on this patient. She was in for s/p fall d/t hypotension and afib with RVR. The nurse replied that they were giving amiodarone and metoprolol po. Pt's HR 120s and BP 130's systolic. Denies any chest pain.
I go into the room around 2000 and check her BP and now it's in the 80's systolic. (side note, RN said she gave Lasix earlier per MD) I informed the MD and she ordered to give a bolus. Bolus given and pressure came back up high 120's systolic. Around 2200 I administer her night meds which consist of Metoprolol 50 mg PO. With her current pressure back up and her A fib HR 120s I feel it's safe to give.
2220 I recheck her BP and she's down in the 80s. MD aware. MD orders another bolus. Pt does respond to the fluids but pressure at 2300 80's-70s. Now she converted to SR 90s. Then she started to brady into the high 50s. Pt alert. Positive pulses. MD orders ANOTHER bolus. Pt doesn't respond to...End up starting her on a dopamine gtt.
Come to find out, MD wrote an incident report on me saying that since I gave the metoprolol, that caused her to become hypotensive and brady. After the fact that she said that she agreed to give the metoprolol saying that it was indicated at the time.
What is your advice? Do you think that the metoprolol would have worked so quickly?? PO? I feel responsible in a way for what happened. I'm willing to learn from my mistakes. Just feel thrown under the bus abit.
On a sidenote....pt is doing fine. This AM, her BP 120s but she converted back to A fib c RVR.......
