? for CVICU Nurses!

Hello,
For our post-op hearts we normally use MSo4 for first 24 hours then use toradol if their creat is <1.8 for 48 hours rotating with oxyIR 5-10mg tablets. Within 24 hours our heart are usually out of bed in the chair and transferred to stepdown unit. Now if they remain intubated they stay on MSO4 but we will switch from IV to SQ. Also if someone has an allergy to Morphine Sulfate we go to fentanyl usually. Hope this helps-

LCRN

We also use Morphine 2-4mg IV Q1hr prn until they transfer to the floor. But, we have them take PO as soon as they are extubated and safe to do so. We have Percocet, Vicodin, and sometimes Valium helps them too, all of these are on our standing orders. We can also do Tordol if they continue to c/o pain without much relief from any/all of the above. The biggest thing we also use is a Precedex gtt. They all come back from the OR on it, extubate on it, and if they are having pain issues, can stay on the precedex gtt until they transfer out.

We use morphine also. Usually 2mg-8mg depending on Doc. Most are extubated within 4-8 hrs postop and in a chair2-6 hrs post extubation. When they are extubated we give percocet x2 and lose dose morphine for breakthrough pain.
We have a 15 bed CVICU and to up to 5 open hearts or thoracotomies per day. It gets pretty hectic at times.

We use Morphine as well, higher doses while intubated, and lower doses after extubation, then T3s or Darvocet. We have a 52-bed unit, hectic indeed.

Fent gtt with bolus orders on all patients, generally weaned off by morning if extubated, taking PO etc.

Dilaudid while intubated

Morphine 2-4mg IV q1hr
Vicodin 1-2 tabs q4hr
Oxycontin 5-10mg q2hr

Torodol generally if pt is young, creat normal, has to be approved by surgeon though, all others listed above are all protocol. With the exception of younger male patients, and those with chronic pain or drug addicts, we can get pretty decent pain control with what's listed above.

Pre-extubation, we immediately use paracetemol 6 hourly and use either 2mg boluses of morphine, or 20 mcg boluses of fentanyl (depending on the pt's age, kidney function, allergies etc) PRN. Once extubated, the pt has a PCI that delivers either 0.5mg morphine every 5 mins, or fentanyl...unfortunately if the patient is in acute pain after a turn, the PCI is not particularly effective.

If we recover the non intubated patient, PACU orders of Dilaudid 0.2-1.0 q5mins. If we get them after PACU Dilaudid 0.2 q1hr and 2 norco's q4. Direct pts are my fav. Prop + fent