Help with titration

Is there a policy on critical drips in your ED?

I would err on the side of caution and do blood pressures every 5 minutes while a patient is still considered critical.

I would speak to the provider as far as the max dose, and double check the timing of the BP's.

When faced with this, especially the first couple of times, I would ask for clarification from the provider, and your charge nurse for assistance.

I have never given a labetolol drip. Does your hospital have a drip policy that tells you how to properly titrate your medication.

I would find it more appropriate for this patient to have continuous blood pressure monitoring (arterial line) for more precise measuring. The order (goal) was to maintain the blood pressure between 180 - 200.

You stated that with each BP you went up 1mg/min up to the max of 3 mg/min. So within 45 minutes you maxed the patient on the labetolol?

I'm not am expert but I feel this was erroneous. The patients BP dropped below the goal of 180 into the 160s. To go from a sBP of 290s to the 160s seems like way to fast of a transition and I'd have been worried about rebound hypertension or any other number of problems depending on the patients clinical scenario.

Whether what you did was right or wrong, I don't know. I think you were wrong in administering a drip that you were unfamiliar with in terms of policy/guidelines. If no harm occurred to the patient great. But I feel in the future you should seek input or familiarize yourself with how to quickly look up policy and drip guides (I assume all hospitals have a drip guide?).

Also I understand the ED is it's own beast but safety should always be number 1.

I had a nightmare shift once where I had a lot going on and a patient on a drip I'd never managed before. I won't get in to details, but bottom line is I kept getting contradictory information and no useful guidance from my coworkers, the docs, and pharmacy. I tracked down the clin spec on the cardiac floor and ultimately got the answers I needed. Never do something without knowing how or why. I've been there, it's frustrating and nerve-wracking, but you have to persist for your patient.

It sounds like you needed more specific parameters, which should have come from the doctors. Asking a coworker was a good idea, but if her answer didn't help, you can ask her to clarify or ask another coworker. Better yet, your charge nurse or clin spec.