diltiazem drip

What you did was .right, and what he said was right. Call if the pt goes below those parameters, but maintain a watchful eye on him. Their HRs can drop like a rock lickity split.

5mg/hr isn't a very big dosage of Cardizem. A systolic in the 80's is low, but you shouldn't be symptomatic. Watch to make sure the patient is still making urine. It's all good. :)

Yes the patient remained asymptomatic and UO was good :) I just get worried! Especially since that was my first time managing a diltiazem drip. And when I see a MAP

You did fine. In this case the physician was right. You are lucky. In my hospital it is very, very unlikely that a physician (resident) would have the slightest idea what to do with any sort of drip. Also we never, never, never get parameters for titrating drips. We get an order to (let's say) keep SPB >90 and the drug they want us to use. Never would a physician write how high or low we could titrate a drip. We of course have hospital and unit policy for all drips that the nurses all know and the physicians do not (usually). It is also the nurse that will be able to tell first of the therapy is working or not and how well.

This doctor is a cardiologist so I would hope he would have knowledge on a diltiazem drip

Most of the time doctors do not write parameters. If I have a drip and I have to call them about it, I ALWAYS ask them for parameters and modify the order to include them. I wish all of the nurses did that, it would just make things so much easier.

this doctor is a cardiologist so i would hope he would have knowledge on a diltiazem drip

*** maybe, maybe not. i doubt he has ever personally titrated a cardizem drip.

most of the time doctors do not write parameters. if i have a drip and i have to call them about it, i always ask them for parameters and modify the order to include them. i wish all of the nurses did that, it would just make things so much easier.

*** why would you want parameters? the physician you are asking likely knows far less about managing any sort of drip than an experienced icu nurse does. just ask the physician what they want for a goal (hr 90, map >65, etc) and manage the drip accordingly. your unit/hospital almost for sure already has max drip rates in a policy someplace and the starting minimum can be found in any good reference book.

if i were to ask one of my docs for paramaters i would most likely hear "hmmm, well how do you usually titrate it?".

this doctor is a cardiologist so i would hope he would have knowledge on a diltiazem drip

*** maybe, maybe not. i doubt he has ever personally titrated a cardizem drip.

most of the time doctors do not write parameters. if i have a drip and i have to call them about it, i always ask them for parameters and modify the order to include them. i wish all of the nurses did that, it would just make things so much easier.

*** why would you want parameters? the physician you are asking likely knows far less about managing any sort of drip than an experienced icu nurse does. just ask the physician what they want for a goal (hr 90, map >65, etc) and manage the drip accordingly. your unit/hospital almost for sure already has max drip rates in a policy someplace and the starting minimum can be found in any good reference book.

if i were to ask one of my docs for paramaters i would most likely hear "hmmm, well how do you usually titrate it?".

i meant vital sign parameters. we have policies stating max dosage rates and how often to titrate, etc. unfortunately on my floor (progressive care), we are technically not allowed to titrate drips. the only drip we are allowed to titrate is ntg for chest pain only, not for bp. i just wanted the doc to give me some vs parameters that way i didn't end up calling him at 0300 for a sbp of 82 when really he would rather have me call when it reaches

I work in an ER. I have noticed that Cardizem may not always drop an afib pt's b/p. I have 1 pt. prior and a pt today who had rapid afib (150s HR) with a low bp (80s/50s). the Cardizem drip actually raised the B/P due to slowing the heart and allowing it to more efficiently push blood into systemic circulation.

I work on an intermediate cardiac unit (similar to step-down or progressive care.). Our cardizem is pretty much always titrateable (5-15mg) to maintain a hr90. I don't really worry if they are a little above or below unless their MAP sustains below 60- then I start looking more closely at their urine output (not always easy, lately, as I seem to have lots of super-old incontinent women on cardizem drips and strict i&o is no longer a valid reason for a foley.). Generally when they are taching along at 150+, upping the cardizem will bring that hr down for me and bp up, thankfully.