Hello. I am a rapid response nurse and I had a patient yesterday who was on a stepdown unit. She was having runs of a wide-complex tachycardia in the 120s-130s. She was awake, slightly confused at baseline, just reporting "feeling lousy." They were treating her for VTach and ordered a Amiodarone bolus and drip. Despite the Amiodarone drip, she was still having the episodes of VTach. The doctor wanted to start a Lidocaine bolus and drip, in addition to the Amiodarone drip already running for the past 2-3 hours. Has anyone ever run Lidocaine and Amiodarone drips concurrently?
I looked on our online Micromedex system and it said there were major drug-drug interactions causing cardiotoxicity, but only had "fair" documentation. I spoke with the pharmacists who did not have a concrete answer as to whether or not it was okay. One of them even said, "Well the computer system did not flag it so its probably not severely harmful." I spoke with the nursing supervisor who said that she has done it in code situations. I have given both lidocaine and amiodarone boluses in code situations, but usually it is a last ditch effort. I even spoke with the CCU nurses who have not done it before. When I called the doctor back to clarify the order, he was yelling and wanted to know why his orders were not followed without question.
I ended up documenting everything and starting the drip. What would you have done? Has anyone done this? Should I have done something differently?