Diltiazem/Cardizem for AFIB RVR

[lafmedic1]

Had my first useage of this drug a week ago. The patients initial complaint was Shortness of Breath with no respiratory comprimise. I found his pulse/conduction rate to be 170-200 per min and 12 lead ekg confirmed Afib RVR. His lung sounds were clear and his pressure stable. I had the patient for an extended period of time (30 min)and decided to call for orders to use this drug. The doctor ordered half of our standing doseage. One application of the drug and within 30 seconds his rate slowed and his complaint of SOB resolved. I was very nervous using this as few others in my area have applied cardizem.Has anyone else used this drug yet and had any problems ?

Oh and by he way the rubber insert likes to fly out from the pressure build up so watch out .

 

[vquintessence]

What are your standing orders/guidelines regarding dosage?

I'm also confused, are you asking what the side effects to anticipate are?

 

[lafmedic1]

Standing orders state direct consultation with med control in administration of this rug. The inital dose is suggested at 2 mg with a 10mg/ml concentration. I was just curious if anyone else has had succsess in converting Afib RVR with Cardizem or have seen any problems encoutered with its usage.

 

[Flight-LP]

Cardizem has been safely used in EMS for over a decade. The standard dose for the first bolus is 0.25mg/kg over 2 minutes, followed by a 0.35mg/kg bolus also over 2 minutes. A 2mg bolus is sub-therapeutic in an adult. Conversion should be followed by a 10mg/hr infusion of a 1:1 concentration (125mg in 125ml NS or D5w).

Its a good drug when used appropriately.

 

[redcrossemt]

If I understand you correctly, you got resolution of symptoms with 1 mg?

 

[lafmedic1]

Thats my fault redcross. Our protocol states 2 Ml not 2 mg. The initial for us would be 20 mg/2mL and I administered 10mg/1ml which is where the half came from. The patient weighed approx 80 Kg so if I use Flight LPs inital suggested dose my company's comes out to the same. So I did administer half (10mg/1Ml) And got a conversion in less than 30 seconds. Im pretty impressed to say the least as I usually dont have luck with the drugs as Cajuns are a diferent breed around here . 40 Years of Boudin and Cracklins with bud light does strange things to the cardio system.