I recently had a situation at work that I feel was handled correctly, but was told that the House MD and the critical care intensivist thought I handled badly. What would you guys have done differently? Little background - I work nights on a post-op/telemetry floor with an average of 6-7 patients. Recently we've been having patients that are admitted to our floor from the ICU that are unstable and are transferred back to the ICU within hours.
I had a 64 year old male patient 4 days post-op from a lap hemicolectomy. He had a normal recovery and was to be discharged the next day. Vitals were stable all night. Heartrate in the 80's. At around 3:30am his heartrate jumped to 165. He was asymptomatic except for c/o lightheadedness and dizziness. I called a rapid response and had the patient assessed by the house MD. EKG showed a new onset of atrial flutter. Patient was given one dose of adenosine, then given Cardizem 10mg IV push and started on a Cardizem drip at 10mg/hr. Patient remained on our floor. After 1 hour pt's heartrate hadn't changed so I called the House MD again and got an order to give another Cardizem 10mg IV push and increase patient's drip to 15mg/hr. After about another 45 minutes the patient's heartrate was still 160. Paged house MD, got no answer, so I called another rapid response. (House MD has to respond to this call). When House MD arrives, he orders a third Cardizem 10mg and increases patients drip to 20mg/hr. In the meantime, I also called the patient's attending physician. Attending physician wants patient transferred down to ICU immediately and also orders cardiology consult. House MD then makes a comment to me that "If you're going to call a rapid response on the patient every 5 minutes I guess we'll have to take him downstairs." Critical care intensivist is in the room telling the House MD that I overreacted and didn't want to wait for the Cardizem to work. (This was overheard by our CNA.) I did give the Cardizem time to work, it just didn't! We are not a cardiac unit, and the patient was symptomatic.
I feel like the only thing I could have done differently was call the attending physician sooner to get the patient transferred. When I went back to work a few days later, I found out that the patient had spent 3 days in the ICU on a Cardizem drip prior to being transferred back to our floor, then discharged. Sorry this is so long, I'm just frustrated by the whole situation.
