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Recently overnight in the ICU, 70 y/o s/p LUL lobectomy for adenocarcinoma, a fib, HTN, HLD. Came out of surgery in a fib with RVR 2 days prior in the 140s, w/ steady pressures. Hard to rate control, but manageable the past 2 days. At 3AM get a call, hes a. fib in the 160-170s pressure 120/60, received 1 x metop push during the day, 25 mg atenolol BID that day. At bedside patient is extremely anxious, excessively worried about his heart rate, however not fidgety or agitated. Adminstered 1 x 5mg metop does not budge. Patient unable to be consoled verbally, states hes having a panic attack.
Weighing options (haldol, ativan, precedex), I went with low dose ativan x 1 in the setting of his very fast heart rate (higher than age predicted) and didn't want to give haldol or QTc prolonging medications. I did this knowing full well the stigma against benzos (however, dose dependent) in the ICU setting and having read the literature. 5 minutes afterwards, patient calmed down, heart rate at 115, gave another IV metop 5mg, which brought his HR down to 100.
Next morning post call got reemed with a text from the CT fellow saying how could you use lorazepam!?! Looking back on it I probably should have used low dose precedex to calm him down, but I didn't think what I did was necessarily that bad and in this setting was effective. Thoughts?
Weighing options (haldol, ativan, precedex), I went with low dose ativan x 1 in the setting of his very fast heart rate (higher than age predicted) and didn't want to give haldol or QTc prolonging medications. I did this knowing full well the stigma against benzos (however, dose dependent) in the ICU setting and having read the literature. 5 minutes afterwards, patient calmed down, heart rate at 115, gave another IV metop 5mg, which brought his HR down to 100.
Next morning post call got reemed with a text from the CT fellow saying how could you use lorazepam!?! Looking back on it I probably should have used low dose precedex to calm him down, but I didn't think what I did was necessarily that bad and in this setting was effective. Thoughts?