CCU BSN RN - Thanks. I was leaning toward 1. I am a newer nurse and was struggling between advocating and challenging someone else's expertise, especially in front of the patient (well 2 ppl if you incl the MD trying to have the convo). This was the first time this RT had treated patient; it was albuterol AND duoneb together; patient was also receiving IV Solu-medrol. Happened w/every previous treatment and patient was compliant w/ instuctions given to reduce s/e during treatments. Previous RT would continuously monitor and d/c immediately when HR got too high to balance benefit of the med w/the risk of the tachycardia. Another MD decreased frequency after this treatment due to these issues. But patient was so dumbfounded by RT's comments and in despair from being that distressed the 16 hours preceding, that she refused next treatment. Didn't sit well with me and wanted to know what you all thought. Thanks again!