Rapid Afib

Hey all,


Last night was the busiest shift I've had in in several months. I've had busy shifts but this one was downright crazy!!! I didn't have a break ever and was constantly on the move. The night did go by fast...but then I was so worried I'd never get done.
I had two admits and a transfer, but let me discuss just one admit. He comes in with N/V and rapid afib with wide complex. They hook him up to NGT to LIS in ER and his belly starts feeling better. He comes up and I see that he's to go on a diltiazem gtt. It takes forever (well like a 1/2 hour) for pharmacy to send up the bag. I finally find a pump (the hospital was like out of pumps) and give him 10mg dilt (bolus). I start the gtt at 5gtt and his BP holds great, get it up to 10. I wait a while and his HR is like 150 with occasional bursts to 180. He's asymptomatic. After like 45 min to an hour I turn it up to 15. His blood pressure holds but I want to wait to see if this works. Sometimes his rate would go down to 140 but then it hang at 150-160. Almost an hour later, I am not seeing any improvement so I give him IV Dig 250 mcgs as ordered by doc originally if Dilt didn't get HR <130. By this time my shift is over almost. Before I left he had slightly come down to 130s to 140s but then he would go to 150s. I explained all this to the day shift round and of course the docs would round but what is the next step? Amio? He's had afib for years.
Should I have gone through the dilt titration faster? I didn't want to bottom out his BP and he was asymptomatic. Does dilt IV work pretty fast?
Thanks for reading. I'm gonna try to get some sleep LOL.