Hi,
I work on a tele/med unit, and have had several pts on Cardizem gtt's since my first day.
Yesterday, I received report on a pt who originally was admitted for "sepsis" and was stable when I left the previous night.
My report today was that the day shift called a "MRT" on her because she suddenly converted to A-Fib from NSR, and was flushed and "not quite right." Keep in mind in my facility a "MRT" stands for "Medical Response Team" and is made up of a team of nurses, respiratory therapists, the PCS, and if needed, an MD and an anesthesiologist. It's for when a pt is "not OK" but not coding.
The MRT team, after calling the pts MD and consult with cardiology put her on a Cardizem drip at 10mg/hr.
Previous to my shift the pt had an 8.8 second pause, then converted to sinus brady, then back to a-fib.
When I got report, the pt had actually converted back to sustained sinus brady, but was having pauses, and was also bradying down to the 30-40's briefly at times.
I called the MD first thing to tell him what the pt was showing on the monitor, because I have always been taught that side effects of a Cardizem drip can include bradycardia, and AV block (which could account for the pauses), but the other nurses did not seem that concerned even though I looked it up in our units IV drug reference to confirm.
When I talked to the MD, he had me decrease the drip to 5mg/hr for 1 hour, then D/C the drip.
I talked with the tele monitor to aske them to watch this pt closely (since I had 6 pts and could not watch the tele all the time), and explained to them that the pt was on Cardizem, and was now off of it, and I wanted to know if the pt continued to have the pauses and brady after the drip was D/C'd.
Turns out I was right, and after a few hours off the drip, the pt maintained a HR in the 60's and no pauses. I was surprised at how much my tele monitors knew about drugs, etc.
The pt remained asymptomatic, and at my offgoing report, I was able to tell the nurse that the pt was stable, but that the monitors would be on the lookout for anything abnormal.
Sorry this is so long, I guess the bottom line question is do you other cardiac nurses see reactions to Cardizem often similar to my experience? Most pts I have had on this drip do fine, and convert to a NSR, without these side effects.
Is this frequent? Or rare?
Amy