-Quick rundown. patient used to be on 120mg of cardizem ER.
-patient was running brady and possible syncope on admittance
-doctor dc cardizem.
-pt is running afib/aflutter in the 130s-150s over the past few days, asymptomatic.
-I wasnt worried about it and the tele monitor is calling em and harassing me over something that has been unchanged.
-The hospitalist has known about this for the past few days.
-I get a call from their charge nurse asking em if the hospitalist knows about this. The day hospitalist knew about this and I felt that this can wait. She paged the night hospitalist to come over to my floor, the hospitalist wasnt worried, neither were any nurse on my floor.
So did I do the right thing? For something that has been unchanged over the past few days, is it necessary to call the hospitalist if the patient is asymptomatic? Day hospitalist even charted it in his progress notes.
side note: This telemonitor has overstepped her boundaries in the past and trying to get me to give an oncology patient fluids because her admitting diagnosis was for dehydration(The lady was on her last leg and she was changed to a palliative care the next day because of the metastasis of her cancer). She has also told her charge nurse to call me and even at a point told me that her charge nurse recommended me push adenosine on someone that had orthostatic tachycardia.
Just thinking out loud here…did the a fib cause the incontinence or vice versa? For example, did the patient suddenly convert into a fib, had a syncopal episode, and lose bladder control? Or, for example, does the pt have a UTI, is incontinent as a result of urgency, and this is an early manifestation of sepsis? Did the ER do a UA? Most do with new onset incontinence.
The normal QTc for men is 0.44 seconds, 0.46 for women. The recommendation for decreasing an amiodarone dose is for QTc greater than 0.5
MunoRN, could you direct me to a reference for this. All the references I have found, including my own IV drug guide, which is a good one, mention QTc prolongation, but I have not been able to find a reference that specifically recommends decreasing the dose for greater than 0.5 seconds.
MunoRN, could you direct me to a reference for this. All the references I have found, including my own IV drug guide, which is a good one, mention QTc prolongation, but I have not been able to find a reference that specifically recommends decreasing the dose for greater than 0.5 seconds.
"the dose of amiodarone should be decreased or the drug should be discontinued if the length of the QTc closely approaches or exceeds 500 msec(9)."
The risk of throwing a clot is well under 1%, and usually happens when a patient goes from AF to sinus (ie post-cardioversion).
Which is why a TOE should be done prior to cardioversion. And what about HF? I don't understand how you think it's okay for a patient to have a sustained rhythm of 150, especially for hours.
No crackles. BP was stable. If you look further down the cardiologist knew about it. I already stated the metoprolol was within the parameters, we do not do cardiac drips on my floor. Ill be sure to ask for a transfer next time it comes around.
I think I need to take some cardiac classes. I dont think it ever hurts to do that, regardless of what unit you are on.
The presence or absence of crackles a not true indicator of CHF. Crackles on auscultation could be caused by atelecstasis, or any type of infiltrate.
The most common early symptoms of congestive heart failure are shortness of breath and fatigue, or more vague symptoms such as sleepiness.
A prolonged period of heart rate > 130... can put an otherwise healthy patient into heart failure.
I do not give a rat's pattoti if the almighty cardiologist "KNEW ABOUT IT". The nurse must find a way to to take action to control the rate.
The presence or absence of crackles a not true indicator of CHF.
But the presence of crackles is strongly correlated with poor outcomes. If the nurse called me win report in this patient asking for a medication change I would absolutely want to know of physical exam findings indicative of R and/or L sided congestion.
I also wouldn't let a patient stay in RVR for that long. After 5 days at 130-150 I bet the pt had a positive trop.
But the presence of crackles is strongly correlated with poor outcomes. If the nurse called me win report in this patient asking for a medication change I would absolutely want to know of physical exam findings indicative of R and/or L sided congestion.
I also wouldn't let a patient stay in RVR for that long. After 5 days at 130-150 I bet the pt had a positive trop.
Sent from my iPhone.
Again, I appreciate everyone's input. I am taking alot of it of what you nurses are saying.
kysmommyrn, BSN
15 Posts
When new to nursing, I was taught QT prolongation was anything greater than 0.4 secs. My ekg book now states norm is