The other night, I had a patient with gastritis, puking their heart out. Doc orders 25 mg Phenergan IV and 0.5 Dilaudid IV. We usually use Zofran, but the patient had a long list of allergies that included Zofran and Compazine. Also ordered was a liter bolus of NS, due to the dehydration with a HR of around 100.
So, being the smart little new nurse I am, I put the Phen in a 50 ml bag of saline, and ran it in through the main NS line (wasn't bolusing yet, just a fast KVO). I ran the Phen in over about 5 minutes. Because of all the other allergies, I confirmed before I gave it that the patient had had it before.
So, as it's finishing up, I'm in the room charting a few things, getting ready to give the Dilaudid (after the Phen...I was tired of the puking as I'm sure they were too!). The patient asks me if it's normal to feel their heart racing with this med. I figured that it was a little anxiety (very anxious patient), and turned around to see the pulse ox reading 190! And yeah, it really was that. Dang it.
Anyway, the Phen was already infused. I turned up the liter to start running in. BP was still WNL, pt denied anything other than "racing", didn't get diaphoretic. We all kind of stood around and watched, and it slowed down to about 140 after 4-5 minutes. It took about 30 minutes to get back to around 100. (However during that first 5 minutes, when questioned further pt restated that they had had it before...but that it had made their heart "race" then too. Thanks. The first time I asked would have been the optimal time to share that tidbit.)
So, this was my wordy way of asking if anyone has ever seen this before, or what I may have done differently (besides grilling the patient on any other fun experiences they had ever had with meds that they failed to mention). I called the pharmacy to ask if I needed to report the reaction, and they said no, since tachycardia was already in the literature ("Yeah, but this more than just your average tachycardia!")
I do have to say though, at least it didn't burn them.
"Wow...I can't imagine taking the time for this...I work in a busy ED where 30 min is a long time and plenty of time to see if the antiemetic worked or if we need to try something else."
I work in a very busy ER also,..we are no longer allowed to give phenergan IV push,.they completely took it away from us for awhile,,..we usually use Zofran,.but of course there is always someone who is allergic or for whom Zofran isn't working.
If not fluids then mix 12.5 mg with 10 cc nss and push slowly over 2-3 min then if the other 12.5 is needed give it, but my experience is usually 12.5 will do the trick, I usually do try to use at least a 50 cc bag Nss with phenergan it it and run w.o if possible.
Specializes in ER,Neurology, Endocrinology, Pulmonology.
maybe it was one of those idiosyncratic reactions. You just never know what can happen of this was her first dose, but chances are it wasn't.
In my area we are no longer allowed to give anything more that 6.25 mg with first dose, because of all the problems we've had. You should see how mad our dilaudid/phenergan patients are!!
i too have never seen a reaction like that to phenergan .we do use it in my ed.but we start with 12.5 and i dilute in 10 cc ns and give slow ivp thru running saline line .i've not had a problem .but we also use zofran ,anzimet ,compazine ,reglan etc .it depends on whose ordering it.
BrnEyedGirl, BSN, MSN, RN, APRN
1,236 Posts
"Wow...I can't imagine taking the time for this...I work in a busy ED where 30 min is a long time and plenty of time to see if the antiemetic worked or if we need to try something else."
I work in a very busy ER also,..we are no longer allowed to give phenergan IV push,.they completely took it away from us for awhile,,..we usually use Zofran,.but of course there is always someone who is allergic or for whom Zofran isn't working.