Am I having an acute BF (Brain Fart)????

  1. Okay,..maybe I'm just loosing my mind,...been on a cardiac/step down unit almost 8 years,..recently transfered to ER (which I love BTW),.every shift I learn something that I couldn't do on my unit that I will now do alot in the ER or many things that are just done way different in ER than on my unit,..this is good,....but Adenocard,...I've pushed Adenocard probably 100's of times on the unit,..not really even afraid of it anymore,.BUT,..unless I've gone crazy and am mixing up my meds here,..we ALWAYS check a Mg level,..or many times just give a 1gm mg bolus then push the Adenocard,...to prevent Torsades,....when I questioned other ER nurses about this they all looked at me like I was crazy,..might see not waiting for the Mg w/"unstable" pt,..but this guy was healthy,.BP 140/60, no SOB, O2 sats 98% ORA,.his heart rate was 200ish,...have I lost my mind??
    •  
  2. 12 Comments

  3. by   AnnieOaklyRN
    Um I have never done that with adenosine. If a patient is in SVT they need to be converted ASAP to prevent myocardial injury or infarction, which can and will happen even in an otherwise healthy person if you wait long enough. No time for mag level check. I am a paramedic and a nursing student, and I push it in the feild fairly often and have never had someone convert to torsades or any other arrythmia after they have that initial asystole with ventricular escape beats. Never heard of a mag level or giving mag in the E.D. either.

    Swtooth
  4. by   babynurselsa
    Never seen the mag level on a pt that I have given adenocard. At least not until we ran labs AFTER the fact.
    I am amazed the rest of the VS were stable with a HR over 200.
  5. by   ritarunningfeet
    I have been in ER for 1.5 years and my experiance has been the same as above, we usually don't have time to check and wait for a mg level to come back. When they are in SVT we give the adenosine, asap. I have had pts come in already converted because the Medics are able to give it in the field with the ok of medical direction, and they obviously can't check a mg level while on the rig.
  6. by   gonzo1
    2 years in ER, have never seen mag level checked until after the fact. Probably one of your doctors started doing that a long time ago and it just kind of became the norm. Torsades is really rare and we don't wait.
  7. by   NicoleRN07
    I have given Adenocard many times, and never checked a Mg level, until afterwards, and in cases, not at all.
  8. by   chip193
    Not in 17 years have I seen a Mg checked before adenosine.
  9. by   bill4745
    Ditto, both in ICU and ER.
  10. by   Altra
    Quote from swtooth
    Um I have never done that with adenosine. If a patient is in SVT they need to be converted ASAP to prevent myocardial injury or infarction, which can and will happen even in an otherwise healthy person if you wait long enough. No time for mag level check.
    Agree - the out of control rate/rhythm is the emergency. Labs will be checked after adenosine/cardioversion.
  11. by   neneRN
    Nope, give .the adenosine, worry about Mag later
  12. by   TazziRN
    A rate of 200 is not a stable pt. There is a potential for the rhythm to deteriorate into a fatal one, so you want to correct it asap. If my doc wanted to wait for a mag level first I'd be calling the pt's PCP and asking him to come in and take over.
  13. by   nuangel1
    nope no mag med 1st then labs .not in icu oer ed
  14. by   Jennifer, RN
    I worked on tele prior to coming to the ER, never saw a mag checked prior to pushing adenisine. Adenisine is an emergency medication with no time to check labs. A cardiologist once explained that the longer you wait to give adenisine for SVT, the less responsive the heart is to the medication. Something to look up.

close