I’d like to preface this post by stating that all patients are different, all resident doctors are different, all cardiologists are different. If you are not in agreement with something you see here, let’s discuss rather than berate or belittle. We’re all medical professionals (or soon to be medical professionals), so let’s act like it. Let’s start a discussion

So in nursing school we’re all pretty much taught that the medication to treat new onset atrial fibrillation aka a-fib is cardizem (aka diltiazem). However in this case, I learned there are other things to consider and different ways to convert a-fib to normal sinus rhythm.

My patient comes in with a-fib with RVR, HR in 160s, sustained “low” systolic pressures but MAPs consistently > 65. As a novice RN, I expect the resident to order a cardizem ivp then a drip and heparin drip. Cardizem to slow control ventricular rate and hopefully convert patient back to NSR, heparin to prevent clots. And that’s what the 1st year resident ordered.

Not even 5 minutes later I get a call from the attending Cardiologist for updates on the patient. “Patient currently in a-fib with RVR, HR in 160s, low bp but map consistently > 65, new onset according to patient.” The Cardiologist said, “You’re not starting a cardizem drip with that blood pressure. You guys are going to drop his pressures lower. Give him 10mg Labetalol IV push then call me back if that doesn’t work. I’ll write an order for digoxin.”

Low and behold, after the slow IV push of labetalol ,the pt converted back to NSR, HR in high 80s to low 90s. I asked the cardiologist how he intends on maintaining sinus rhythm. The doctor ordered metoprolol 25mg BID.

And before I knew it, the night shift came walking in.