Cardizem

[ark-two]

Just a question. I'm usually in charge at night. I'm also a new grad and worked our floor out of orientation since Sept. I want your opinion. I am familiar with cardizem and have bolused and managed gtts a lot. I recieved a 93 yoa pt from er who was @ home had cp and squad called. Hr 170 adenosine in squad- down for 1 sec or so and up 170. Er 20 mg cardizem bolus and 10 ml gtt. Hr 140 uped to 15 ml gtt. ER reports hr jumping from 80 up 140 and so on. I get her and doing admit, hr 150 and down 31 up to 140 down 40. Sustaining one extreme to another for a few min at a time. Called cardiology told story, told them I thought she might need to go to unit for cardizem tritration. Packed her up and finished orders and admit, took her to CCU with hr stable in 60's. Did I make the right decision? Also, She was having cp with high hr and cp gone with low hr. Oh, yeah, bp fine and asyptomatic with hr flutuations other than cp.

[HappyNurse2005, RN]

Sounds like she has tachy/brady syndrome and needs a pacer!

OT, but you are a new grad and already doing charge?

Her HR was uncontrolled by the meds you were allowed to give. I gather you aren't allowed to titrate Cardizem on your floor-if so, then yes you did the right thing.

YOu did what you thought was best at the time. Thats all any of us can do.

[Rio, ASN, RN]

nice job ark-two. curious though... how were the nurses on CCU ? Receptive, critical, supportive, offer suggestions ?

[ark-two]

I was placed in charge my first day out of orientation as a new grad. I work nights so charge pretty much means I give ER beds and call md's and help my other nurses. I was placed in charge because of lack of RN's on night, but usually had 1 good TCU LPN. CCU is right across the hall and was on call when I worked. They are my support and shoulder to cry on and I cried quite a bit when I started! Now I'm pretty comfortable and utilize other staff, including our rapid response team.

The Cardiologist did not want to move the patient, but I was pretty insistent. We are not to titrate and once her HR went to 30 I was actually supposed to pull the gtt, but she really needed it. She was d/c'd the next day, but I'm sure she'll be back with the same thing soon. Oh yeah, no pacer was placed, she was fine after I transferred her. For the time being anyway. No cardiac workup done other than triponins!