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No, the amio was not controlling this patient's rate sufficiently, his heart rate went down to 120 at times but was still up to 130's the night he was on it. He was in rapid afib before surgery as I also had him as a preop patient. At that time he was on metoprolol 100mg BID and his HR was still around 120 preop. He was not in heart failure or at least not showing clinical symptoms and I think the only reason why is that he was only around 56 years old. There was no significant indicator of fluid balance being off so I don't think it was a major factor. In the end, the patient ended up being taken off amio AGAIN, and placed on a calcium channel blocker on top of increasing metoprolol which did control his rate. This patient had been cardioverted a few years ago and then went back into afib after a few months so I guess this was a pretty stubborn case of afib. We don't use digoxin very much at all on our unit but when we do it is in afib/heart failure patients.

Thanks for the reply! The patient stopped taking his coumadin for a couple years so he was not anticoagulated and that is why I was mostly worried and trying to understand the different doctors' rationales, I am a new nurse on a stepdown unit and frequently find different doctors contradicting eachother. I am not sure if the patient had a TEE but since he was post CABG I know he had a regular echo preop. For this patient the afib was a problem since he was about 130-150bpm at rest and that was on 100mg metoprolol bid. Anyhow, thanks again for the insite to this situation, I am definitely going to ask my educator about this one!

I had a patient today who has a history of uncontrolled afib/flutter for about 6 years , 53 year old post op day 2 from CABG. He received iv amio in csicu and did not convert, he was on oral amio when admitted to our unit but remained with HR 120-150 at rest, metoprolol was increased to 100mg BID and the ward doc discontinued the oral amio with rational that we would try rate control. Several hours after first dose of metoprolol heart rate was essentially unchanged so I spoke with the surgeon on call. He asked why the amio was discontinued and ordered the IV amio protocol to be started. I let him know that he had already received IV amio in CSICU but he did not seem to think this was relevant. SOOOOOO my questions are....1) is there a risk of toxic levels of amio building up? 2) Is it safe to run IV amio with a chronic afib patient who has not been on coumadin? I have read that if pt. converts to RSR there is risk for emboli... 3) what are the chances of this pt even converting after being in afib for so many years? Thanks for any help....

I am a new grad on a cardiac stepdown unit and have many days when I feel the same. I cried on my way home today! I have also woken up panicking imagining myself programming a pump wrong or hanging the wrong med ect. (none of which I have done), I have many dreams where I am at work running around, which is the worst! I almost always feel run off my feet and frequently miss dinner break. What has helped me is making checklists for what I need to do that day and also general checklists for night duties/discharging/admitting ect. I think it is normal to miss things for at least the first 6 months as long as what you are missing is not a safety issue. Everyone is human. I try to to tell myself that I did my best and that there is no point thinking about it when you leave (although I often do). I think this is how many new grads get burnt out. I also try to confide in nurses who have been on the unit for a few years to hear about their experience as a new grad. I am not sure what your personality is like but I am a bit of a worrier and like to be very organized so when I feel like this is somewhat out of my control it does make me anxious. Most of the things I miss, I didn't even know I was supposed to do, so I try to tell myself this is just part of the learning experience. I also always tell nurses who I report off to, to tell me if I miss something so I can learn from my mistakes. 3 months on a tele unit is not enough to get into the flow of things. Try to hang in there and don't be too hard on yourself. You aren't the only one who feels this way!