aFib RVR

[gypsynurse]

A question please. Have you ever known of any reason why a patient would need to have pads place to receive Cardizem 10 mg IVP? I realize that placing hands free pads for cardioversion and cardiac monitoring make perfect sense but why would anyone need pads to give Cardizem if patient on CM? And isn't it pretty well established that Cardizem is given x2 and if RVR conts then drip? And why Cardizem over 5 mins instead of 2 minutes? And why would anyone give Adenosine if they suspected WPW? Am I'm crazy?? Thanks

[Ricu]

Seems like overkill to me and expensive at that. Is that your institutional policy? Not sure about Adenosine for WPW, either. Calcium channel blockers, yes, but ablation is the definitive treatment.

[gypsynurse]

Contract hospital said it was a safety issue. I had patient on cardiac monitor and crash cart was at bedside. I gave Cardizem over 5 minutes per order even though it always given over two minutes. Rate on ER arrival was 180's and decreased to 90's to 130's after bolus. Was given Adenosine per charge nurse previously and rate increased to 230's rather than slowing rate. I know that Adenosine will block impulse at AV node but if WPW the impulse will travel down accessory pathway worsening A Fib. However after researching extensively, I can't find a reason for increased HR immediately after Adenosine. Patient was allowed to remain in RVR for some time after Adenosine and before Cardizem even though I asked about giving Cardizem. I attempted to speak with physician but was just told "let me think about it" when I asked about rhythm. Does anyone know why HR increased immediately with Adenosine. And did I put patient at risk? Should Procanimide or Amiodarone been used?

[gypsynurse]

Also on another note cardioversion should not used before echo due to increased risk of dislodging clot if patient has possibly been in A Fib longer than 48 hrs. So what do you think the pads were suppose to be for? Could there be a possible heart block after Cardizem?