Trust my own instincts?

Specialties Cardiac

Published

Specializes in ICU, MedSurg, Medical Telemetry.

I was trending the other night on a patient that I was informed had afib, but it didn't look quite right to me. I'm not amazing at reading tele -- I've only been a nurse since October -- but the occasional bursts of "afib" looked like a heart block to me b/c I thought I saw three distinct P waves that clocked out and a space where a Q wave should have been. I grabbed a more experienced nurse and she agreed with me, saying that she thought it was Mobitz Type I. I charted it as such even though the more experienced nurse before me had charted it as afib and the pt was being treated for afib with an amiodorone gtt.

Should I have just written down what the more experienced nurse had, since I'm still not very good at reading tele?

Also, would amiodorone hurt a pt if he actually has a heart block and not afib?

I discovered this right before report, so I passed on the two different tele readings to the nurse coming on. I'm just want to know to satisfy my own curiosity.

Oh, one last question. How low of a heart rate is "too low" with a patient on an amiodorone gtt when the MD already knows that the patient tends to stay in the 50s normally with occasional jumps into rates as high as the 150s? I must admit that the darn drug makes me really nervous, esp. since that night was the first night I ever started an amiodorone gtt on someone.

Up Vote Up Vote ×
Specializes in Cardiac.

Absoultely chart what you think is right! Your assessment is just that YOURS! You did the right thing by asking a more experienced nurse. You could have gotten an EKG to clarify. I too come across strips that are hard to decipher, sometimes we have to have the doc clarify for us, if its really hard.

Amiodarone is an antiarrythmic and I don't believe it to be used for heart blocks. There is no benefit of it.I know you do not give beta blockers for heart blocks and if I remember correctly for symptomatic bradycardias/heart blocks the only treatment is atropine or pacemaker.

If you are unsure or detect a change in rhythm you should call the doctor and say "I believe this pt is in a heart block can I fax you the EKG?" Especially if the pt is on a drip that can potentially cause the him to decompensate.

Up Vote Up Vote ×
Specializes in ICU, MedSurg, Medical Telemetry.

Thank you for responding so quickly. The on-coming nurse wanted a clarifying EKG, so I ordered one for her before I left.

Up Vote Up Vote ×
Specializes in Cardiac.

On my unit we dont really need a dr order for an EKG. It is understood that we can get one for any CP or EKG changes that we think need addressed.

Well good for you, you remembered something from you telemetry class obviously!

The one learning experience that has taken me a while to get used to as a new nurse is to trust my own nursing judgment. If you feel something is wrong or you feel that you are seeing a change in the pt status, go with it! Don't be afraid to call the Dr. they might be pissy about being paged at night, but you will earn more respect from them and they will trust you more because you are looking out for their pts. Good Luck!

Up Vote Up Vote ×

I work in a CVICU and we use Amio drips with nearly every open heart surgery pt we have in the immediate postop period. We always D/C the amio if a new heart block develops (I know, different protocols at different places). Amio does, however, have an exceptionally long half life, so the effects will still last even after you turn off the drip. I would not be surprised if the med was stopped on that pt.

Bradycardia becomes an issue when the pt gets symptomatic. If your pt is trucking along just fine with a rate in the 40-50's, generally it won't be treated. It may be in their plan to get a permanent pacemaker at some point in the near future, but you as their RN will most likely not be giving any atropine if your pt's BP remains stable and they don't become symptomatic.

Up Vote Up Vote ×
Specializes in Critical Care & ENT.

Definitely chart your own assessment. Many times I've seen several nurses charting pedal pulses for days on a patient with a missing limb. You can always look at a previous assessment to see if you pick up anything different. Getting a more experienced nurse or charge nurse is always a good thing to do if your unsure. Getting a new EKG, seeing if the patient had any old EKGs or a history of what your seeing would be all things I would have looked into. Comparing all these EKGs can help point you in the right direction.

Up Vote Up Vote ×
+ Add a Comment