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glen430

glen430

Posts by glen430

  1. New nurse here looking for help. Has anyone pushed amiodarone 300mg for a patient in VTACH with a pulse. Pt was unresponsive and post cardiopulmonary arrest. HR was over 130 and BP was 180's/90's (i know hypotension is an issue) No medications administered prior to this order. Only a shock at 200j per EMS prior to arrival. I have given amiodarone bolus of 150mg over 10 minutes then 1mg/min after that. I have pushed amiodarone 300mg for a pulseless patient. I work in a small hospital with no interventional cardiology services. Just wondering if its a standard I'm missing. If so' date=' can someone recommend a resource or reference?[/quote']

    Was it Polymorphic VT or Monomorphic VT? If it is stable Monomorphic VT,I would go ahead with Amio 150mg IV push and start infusion at 1mg x 6hr then 0.5mg x 16 as recommended by ACLS. IMHO I would consider Magnesium Sulphate for Polymorphic VT because most polymorphic VT occurring in the context of a prolonged resting QT interval or hypomagnesemia. One of the adverse reactions of amio is prolonged QT interval so It wouldn't be my drug of choice for Polymorphic VT like in torsades. This is only my humble opinion and I could be wrong.

  2. Hello! The other night I had a pt with end stage renal failure, anuria, hemodialysis. He was on a vent, doing fine, and then his SaO2 dropped very fast and we had hard time to bring it back. He also had extensive cardiac history, including CHF. STAT CXR was mostly whited out. Weird, because he didn't even had any fluids going. I even stopped his sedation with KVO because we planned to extubate him in the morning. He also had dialysis that day. The doc gave a bunch of orders, including morphine (to calm him down and stop air hunger? the pt was somewhat awake by then), nitro drip (do dilate blood vessels in the lungs?) and Lasix IV push. With Lasix I was puzzled. I read that Lasix is contraindicated to pt with anuria. Besides, how would we get read of the fluids from the lungs if all the fluids are going to stay in his system anyway? He is not going to produce urine to get rid of his pulmonary edema. I asked the doc about it, but he only gave me the look as he is one of those who are too good to answer some nurse. I cannot find anything on-line and other nurses didn't know why either. My only guess is that Lasix would shift fluids from lungs into blood vessels and maybe the doc was planning to send request for a dialysis next day? Anybody has more clear understanding of it?

    I appreciate any reply!

    Was it cardiogenic or non cardiogenic pulmonary edema? You dont think the pt was fluid overload and The SaO2 dropped very fast? My guess is pt might have a bad mucus plug and developed non cardiogenic pulmonary edema but I could be wrong. Breathing through closed airway can create negative pressure inside the lungs and thus draw fluids inside the lungs and eventually pt develop non cardiogenic pulmonary edema. It's like pulmonary edema secondary to bronchospasm post extubation.

    "The doc gave a bunch of orders, including morphine (to calm him down and stop air hunger? the pt was somewhat awake by then), nitro drip (do dilate blood vessels in the lungs?) and Lasix IV push. With Lasix I was puzzled. I read that Lasix is contraindicated to pt with anuria."

    They normally give morphine primarily to decrease preload (it can also decrease the afterload) and to alleviate anxiety (decrease O2 demand). IMHO,Nitro drip is to decrease preload by venous dilation and not to dilate blood vessels in the lungs. I agree with you on the Lasix order,it doesn't make sense because the pt is anuric secondary to ESRD. But some nephrologists believe that Lasix causes a rapid venodilatory response (starts before an effect on diuresis). They believe that rapid venodilatory response has significant effect on preload.

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