We have a dual source CT scanner and still use IV Beta Blockers. The cardiologists say the images are so much clearer.
1. We hope if pt is on oral Beta Blockers or Calcium Channel Blockers that they will take them the am of their test but sometimes they get confused and forget.
2. If Heart Rate is >70 or irregular we give up to 40mg IV Metoprolol
if initial BP is >90-100sys.
3. We treat each pt individually making a nursing judgment depending on their size, VS, how they are feeling, meds they are on etc. I usually start with 5-10mg given over 2-5min. We do not have to get them less than 60 HR. 65 is a good heart rate for younger or obese people, they can use a min dose radiation protocol, and on obese people the images are clearer the slower they are.
4. If the above doesn't work we keep going until the max of 40mg.
In a few rare cases we have consulted with the ct MD and they have had us give some cardizem in addition, see case below.
5. If they have asthma we give Cardizem IV up to 25mg given over 2-5min adjusting to their response. If the heart rate does not come down with the full dose, we can give 20mg Metoprolol in addition (even though they have asthma).
6. If they have more than 2 pvc's in a 10sec tele strip we give 1mg/kg lidocaine up to 100mg, or 150mg in an obese pt.
7. If they have PAC's we are to try the max of Metoprolol that they can tolerate.
8. New this week if they still have freq PVC's or PAC's we call to see if the CT Dr wants to cancel the test. I guess they lose a lot of the images during those premature beats.
Surprisingly most of our pt's have done well but it is scary giving all those medications then they go home. We have had a pt faint recently with a low bp and hr in the 30's after a full dose of metoprolol, cardizem and his nitro, he was a difficult case because of afib, but we got great pictures
and they did find a lesion so I guess it was worth it.
It seems like pt's already on beta blockers do not respond to the 40 of Metoprolol.
Many days I feel like we medicate the scanner though, not the patient. The goal is always for optimal pictures, but as nurses we have to constantly advocate for our patients and stop with the meds when we feel they are at their max.