I work on a Progressive Care Unit and recently we had a cardiologist perform a cardioversion on an 80 y/o man who is a DNR. The patient came in with NSTEMI, and due to his age and other diagnosis of Cancer (I wasn't his nurse so I am not sure where primary source is but has mets to brain) a heart cath was declined by family.
The patient went into atrial fibrillation, but rate was controlled with a beta-blocker, the cardiologist on day 3 decided to do a cardioversion and family agreed. The nurse taking care of him told me that when she asked the doc what sedation he wanted so she could send to pharmacy for the drug, the doctor said that the patient didn't need any because the nurse had just given the patient Dilaudid 1mg IV a half an hour prior and he was concerned with giving the patient anything else. The cardioversion was performed successfully at 50j and the nurse said that the pt moaned prior, during, and after the procedure.
I am appalled that the doctor performed this procedure, because the patient was due to be evaluated by a LTC facility the next day and, the plan of care was for hospice at the LTC facility. I am completely irate that only Dilaudid was used to perform the procedure. And, finally, I am upset that the nurse wasn't being an advocate for the patient whether he could speak or not, especially since he couldn't communicate!
So, anyway, my question is...am I the only one who thinks this is wrong on all levels?
Just a side note, the pt went back into a-fib that night.
The range of views on what is required for sedation in elective cardioversion ranges from moderate sedation to general anesthesia. Even then, there are conflicting views as to whether or not even moderate sedation is enough.
Why didn't the nurse caring for the patient speak up? Nurses are first & foremost patient advocates.
Cardiacfreak, I love your shoe picture!
Thanks, I am also a shoe freak
I am not sure why the nurse didn't speak up. She is a good nurse, however, I think she dropped the ball on this one. I can't really speak for her, but when I asked why she didn't demand something, she stated, "It was Dr. Idiot, what would you have done?" To which I replied, "We would still be in the room and I would probably be draped over the patient."
I know she feels bad about the incident and hopefully in the future she will be a better advocate.
Obviously, there are untold bazillions of variables going on here (each patient/situation is unique). The patient is DNR, has brain mets, and a host of other issues we are not privy to. But, a cardioversion on 1 measly mg of dilaudid?
I wonder why the MD was, as the OP stated, "concerned with giving the patient anything else."
That MD was wrong, wrong, wrong. You can view the DNR how you like, one could argue for or against but a cardioversion without some type of sedation is cruel and you should write that doc up. Dilaudid is not a sedative. I'm angry with you. Wrong, wrong, wrong.
That MD was wrong, wrong, wrong. You can view the DNR how you like, one could argue for or against but a cardioversion without some type of sedation is cruel and you should write that doc up. Dilaudid is not a sedative. I'm angry with you. Wrong, wrong, wrong.
Hold up! I was at home in bed when this happened. This was told to me by another nurse. I plan on taking this to the ethics committee.
Please find out why before you go to the Ethics committee.
What does the doc say when you express your confusion to him/her?
If I were disturbed enough by this incident to consider an ethics committee, I'd just go without discussing it with the MD.
Where I work, as a night shift nurse, I wouldn't consider questioning an MDs decision. I did once. The response was "Are you questioning my assessment skills?" In an icy, threatening tone. I backed down, and shut up
cardiacfreak, ADN
742 Posts
I will, and thanks for the support. I'm amazed that the other nurses, including my manager, don't seem to be as concerned about it as I am.