Adenosine vs. Cardizem in tachy med/surg pt.

[RaziRN]

I have a question. I have one year of experience in med/surg( woo hoo!) and the other PM I had a pt. who was s/p MI from the night before who became tachycardic. He was maintaining a HR anywhere from 130's to 150's and c/o palpitations. Now this pt. is a hot mess to begin with...trach, PEG tube, all sorts of nasties in his sputum and now he's had an MI during this hospitalization for other issues. The pt. had become tachy the night before and Adenosine was pushed by the house supervisor with ICU nurses present and of course the pt. attached to the code cart. I paged the MD and he ordered the same thing again. So we pushed the Adenosine and his rhythm immediately changed to SR, no pause whatsoever. First off, it is my belief that this pt. should have been in the ICU but apparently the MDs ratianale is that he wanted to tx the MI medically with Plavix and ASA. But he was continually having these tachy episodes. But that's another topic. My question is: why Adenosine? I've had tachy pts. before and I was ordered to push cardizem and that brought them back to SR. So, is there something I'm missing here? Why would the MD choose a drug that we are not allowed to push on the M/S floor and have to pull resources from the ICU to administer?

[RaziRN]

Forgive me if I sound like an idiot. I just woke up. Anyway, of course the pt. was on tele. My floor is a catch all. It's a small hospital and we are the neuro unit, renal unit, step down unit and cardiac unit, etc. This was not A-fib or A-flutter. The tele tech was just calling it a Sinus tach which is what it looked like to me on the monitor. The pt.'s other VSS. I agree this pt. should be a DNR if they're not going to be in the ICU. But as you can see the pt. has a trach and a PEG and family has not made the pt. a DNR which leads me to believe they're reluctant to. But the pt is A+O x 2 at least. The house supervisor is a part of the RRT and is required to have critical care experience so she and an ICU nurse were present and pushed the adenosine. Charge nurse was also present as I had never done this before and I was just there to get primary fluids started and to prepare 20 ml NS for the house sup. and to learn of course. Thanks for all the replies. Some of them are going over my head right now...possibly because I just woke up or because I'm not a specifically cardiac nurse...

[surferbettycrocker]

lets not overcomplicate things here with j points and various and sundry EP terms although knowledge is a wonderful thing.

for M/S, 'trainwreck' pt and adenosine= MD present- as the previous posted typed it is to slow down the Hr to see what in sam hell is going on not to 'treat' per se. now if the pt doesnt respond (still tachy) MD should be reviewing EKG,vs, ordering What Next.

now if the pt doesn't respond (asystole) now you have many MD's at bedside running a code. how would you answer the question "so whats the situation" when the 'code master' sr resident comes a-callin'? i dunno we just pushed some adenosine...

i agree with tele bed for sure and maybe sepsis, or maybe hypoxia-the situation the OP gives needs to be flushed out more sorry to ramble just my:anbd::gift:

[Jennerizer, ASN, RN]

It could be something as simple as that particular MD prefers Adenosine over Cardizem. I've been a PCU nurse and have yet to see Adenosine used on the floor. Perhaps it is because at my hospital, md's do not ever come to code situations. The charge nurse runs the code and the floor nurses do all the work.

If you ever get the chance, just ask the md himself. Hopefully he's one that enjoys the opportunity to teach and then you'll have your answer.

[lkwashington]

It was stated in a previous post about the patient should have been monitored more closely. My response was saying a Tele floor is all that is needed at that particular moment. I am a PCU nurse. I will props to PCU nurses that can handle this type of patient for the situation. No reason for me to down anyone, as nurses we want to learn as much as we can.

[BCRNA]

A lot of times its just prescribers choice, no particular reason for one drug over another. Each drug has its different benefits/risks, mode of action, etc. When I decide what vasopressor to use or antiarrythmic, alot of the time its just what I feel like at the moment. Many ways to do the same thing.

[JulieCVICURN, BSN, RN]

Adenosine is used to see the underlying rhythm. To slow the heart rate down to see exactly what is going with the heart. I think this drug was great drug of choice. Any floor that has Telemetry would have a good choice.

Agreed. In some cases docs will use it because they can't tell if the rhythm is SVT or Afib, and the adenosine will slow it down long enough for them to get a good look. Depending on what the rhythm is determined to be, the treatment plan may change.