Pushing IV Lopressor

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Has any one ever had a patient develop long pauses or asystole after giving lopressor IV. Yesterday I noticed my patients heart rate had gone up to 130 and was sinus tach after giving her a bath and giving her demerol 50 im for pain afterwards. She was post op day 2 from abd surgery and 87 years old. Since it was 1700 and she had lopressor due at 1800 I went ahead and give it to her then. I diluted it in 10cc ns and pushed it over 5 mintues

15 minutes after giving the med her alarm rang asystole and the showed a 5 sec pause- she was drowsy but arousable and bp 100/37 and resp 16 sat 95% While I was waiting for the cardilogist to call back she did it agian which was 30 minutes now after the med had been given. When I left my shift she was connected to out crash cart on the external pacer with atropine at bedside in sr 77 bp 113/70 resp fine and good sats. Was this from the lopressor? I've never seen this happen before. All night I dreamed of her ekg strip going asystole.

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Specializes in LTC, assisted living, med-surg, psych.

I've never personally seen it happen, and I've pushed a lot of Lopressor over the years. However, that doesn't mean it can't happen, especially since the drug both slows the heart rate and lowers BP. I wonder what the dosage was---5 mg? 10? You did the right thing in pushing it slowly; yes, it was a bit early, but with a HR of 130, she needed it........I myself have always given meds like Lopressor and Vasotec at a 1mg/min rate, better safe than sorry! But it sounds like this lady could have gotten into trouble anyway; she's 87 and just had abdominal surgery---those are some big risk factors right there.

I think you did a great job here; you were obviously right on top of things, and the patient made it through because of your quick response. Congratulations!

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I've only seen that once, when a new nurse pushed it too fast, but 5 minutes and diluted isn't too fast. Maybe she was just super-sensitive because of her age?

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I agree w/ Tazzi, Some people just cant handle betablockers, just as some cant handle calcium channel blockers........... However I think you did the right thing regardless of what response the pt. had.......... Ive seen pt.s go into complete heart block after getting a beta blocker......

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I agree as well. Our department policy, (an ER), is to administer 5mg over 2 minutes X 3, 5 minutes apart as tolerated. (ie, the vitals don't take a nose dive). I have never seen that happen that long after giving it.

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Specializes in aged -adolescent.

Zachary 211 and others, Because I am a new nurse, can you please tell me how soon after giving a beta blocker someone would go into complete heart block and other such examples please. If you've just given anything how long should you stick around for. If someone's going to have this happen is it pretty soon after like immediate? It's all these tips I have to learn because I am scared I might freak out but if I know something's risky or my gut instinct tells me that somethings not as should be? any help appreciated. Thanks

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Specializes in ICU.

Sounds like this patient might have sick sinus syndrome. 130 - asystole. sounds about right. I KNOW this sounds callous but lopressor is almost a diagnostic tool for sick sinus or tachy/brady syndrome. Sounds like she might have been heading for that pacemaker regradless.

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Sounds like this patient might have sick sinus syndrome. 130 - asystole. sounds about right. I KNOW this sounds callous but lopressor is almost a diagnostic tool for sick sinus or tachy/brady syndrome. Sounds like she might have been heading for that pacemaker regradless.

that is what my supervisor said too. This has given me a whole new respect for lopressor. Thanks for all the info and advice, I just didn't know for sure if I had screwed it up somehow or missed something in assessment.

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Zachary 211 and others, Because I am a new nurse, can you please tell me how soon after giving a beta blocker someone would go into complete heart block and other such examples please. If you've just given anything how long should you stick around for. If someone's going to have this happen is it pretty soon after like immediate? It's all these tips I have to learn because I am scared I might freak out but if I know something's risky or my gut instinct tells me that somethings not as should be? any help appreciated. Thanks

If you give them slowly you can almost see it happening before you finish pushing the med. If you don't see it right away you would see it within 5-15 minutes depending on the reaction. You should NEVER push beta blockers or any cardiac med unless the pt is on the monitor, and your alarms should be on.

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Specializes in Emergency, PACU, ICU,.

You didn't mention the BP prior to administration, just the rate... Did you check her BP prior?

A hot bath followed by Demerol seems to be a Rx for decreased BP, which "might" have accounted for her being tachy...

Regardless, sounds like things turned out well....

Kev

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Specializes in med surg.

We also have the lopresor 5 mg q 5 min x 3 protocol at our hospital, but I've learned to watch those vitals carefully (in addition to having tele on)... The drop in BP can be very rapid, so i do vitals before i start and before each dose to be sure the pt can tolerate it - often I only end up giving one dose because the heart rate and bp are affected so fast. When in doubt...wait! You can always give more later lol!

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