I had an elderly patient a few nights ago that was in sustained SVT with a heart rate in the 160's. It wouldn't respond to two diltiazem boluses or a metoprolol bolus. (I had Glucagon and Calcium at bedside...ya never know!)
Anyway, the admitting doc ordered a cardizem titration drip. I spent a little time upping the rate until I hit the max of 15 mg/hr. That d*** heart rate still wouldn't go down. I got new orders for a Amiodarone drip, but I only had one line. She was an extremely hard stick and the whole ER was taking turns. As she was starting to deteriorate, I called the pharmacy to find out if I could piggyback it while looking for another line and was told I couldn't because the was not enough information on the compatiblities. While this patient was CTD, a new hire RN orientee said that she used to do it in the ICU she worked at all the time, and that it should be okay.
Would you guys have taken the chance on piggybacking those meds because of the pt's condition?
(A little more information: BNP 2200, Elevated cardiac enzymes, WBC 24, lungs filling, and sats out at 92% on NRB. Doc wouldn't order for a central line to be placed by the ED physician.)
I have been tossing this one around in my head for the past couple of days trying to figure out what I could have done to improve on the patient's care.
