MedicRN151

true enough swtooth, although i have to say that I couldn't tell that it was afib/flutter with RVR until after the rate was slowed down. All I could tell you was that it was fast, (in the neighborhood of 160), narrow, and at that time the R to R was regular. BTW I really appreciate all of the feedback that I am getting. It really helps to listen and learn from other, experienced emergency health care providers.

Her BP remained around 140/90 pretty much the whole time.

Swtooth, I agree, I think sync cardioversion shoul have been initiated in this case, I wonder why the MD didn't do it. Also, as for the betablocker, and calcium channel blocker at the same time, I was pretty wary about that as well, and had the ER Doc in the room when it was given.

ICU floater, actually, adenosine is used to treat SVT, it is in the ACLS narrow complex tachycardia algorhythm. I have used it in the field with a fair amount of effect. It is known as a chemical cardioverter for the fact that it causes a transient blockage in the cardiac conduction, which lets the sino-atrial node take over at its normal intrinsic firing rate of 60-100. That is of course, if the patient doesn't have any underlying pathologies like sepsis, electrolyte imbalance, or hypovolemia. In an ambulance, you do not have access to labs, all you can do is bolus to r/o hypovolemia, (that is of course if you don't have a patient drowning in her own fluids) and follow the protocols given by your medical director. Usually they parallel AHA standards. I do agree that there had to be an underlying problem though, in which case adenosine won't do anything at all.

mmtuk, sorry I was posting in the hypothetical mindset that she would have coded. She didn't, at least not before shift change. But I always think about the "What might have beens". And no, she didn't have any peripheral edema, which lead me to think she was going into left sided heart failure.

When I worked the ER in Indiana, Paramedics were able to do everything a nurse could except for initial assessments, patient education, and discharge. The ER I work in now, in Texas, only allows paramedics to act as tech's. Being an RN and having 10 years experience as a street medic myself, I view this as a horrible waste of a very valuable resource. BTW, I have seen some pretty d*** useless medics and RNs. I have also seen some very amazing individuals in both fields. I think making generalizations about either profession is childish, useless, and worst of all, it makes me want to group that person in the first category. Our purpose is the same. So lets stop whinning, work together, save some patients, and laugh our butts off while we are doing it! The job is way too serious if we don't.

Gila, I agree, I think it was a pump problem as well. I think one of the things that bothered me the most was that if this patient didn't receive the amio, she wasn't going to do too well. I didn't want to have a nagging question in my mind about whether taking that risk might have saved the patient's life or not.

In one of the very brief moments her heart rate dropped below 140, I could see fib/flutter. EMS gave adenosine in the field with limited effect. And I also wonder why a central line wasn't started. If I had this patient on my truck when I was a paramedic, I would have started an EJ or a femoral line in a heartbeat....or in her case, in 30 heartbeats.:wink2:

I had an elderly patient a few nights ago that was in sustained SVT with a heart rate in the 160's. It wouldn't respond to two diltiazem boluses or a metoprolol bolus. (I had Glucagon and Calcium at bedside...ya never know!) Anyway, the admitting doc ordered a cardizem titration drip. I spent a little time upping the rate until I hit the max of 15 mg/hr. That d*** heart rate still wouldn't go down. I got new orders for a Amiodarone drip, but I only had one line. She was an extremely hard stick and the whole ER was taking turns. As she was starting to deteriorate, I called the pharmacy to find out if I could piggyback it while looking for another line and was told I couldn't because the was not enough information on the compatiblities. While this patient was CTD, a new hire RN orientee said that she used to do it in the ICU she worked at all the time, and that it should be okay. Would you guys have taken the chance on piggybacking those meds because of the pt's condition? (A little more information: BNP 2200, Elevated cardiac enzymes, WBC 24, lungs filling, and sats out at 92% on NRB. Doc wouldn't order for a central line to be placed by the ED physician.) I have been tossing this one around in my head for the past couple of days trying to figure out what I could have done to improve on the patient's care.

Hello, Help me! I'm a paramedic with one semester left on his associate's RN degree and I am stumped on a research assignment. I am trying to find a website that lists how many nurse practitioners are in each state. So far I've only found the national amount and the Indiana statistics. Please help me.