WebQuest
Managing Medication History in Emergency Department
A 67-year-old female patient with a regular physician was prescribed several medications, including Atenolol 50mg daily, after a myocardial infarction. She present to an ED 6 months later for complaints of racing heart. Her vital signs are as follows on presentation;
BP 142/92, HR 118, RR 18, SPO2 96%, Temp 36.8 degrees. ECG shows A-Fib. ED RN documented medications as stated by patient. Cardiac work up is unremarkable. The ED physician consults the internist to see the patient. The Internist prescribes Metoprolol 10 mg IV push stat. 30 minutes after Metoprolol IV dose, patient's heart rate is down to 84 bpm and repeat ECG is now NSR.
Patient is discharged to home with a prescription of Metoprolol 50mg orally twice daily. No medication teaching done on discharge. Patient is back in ED 2 days later with symptomatic bradycardia.
Questions:
What are the problems with this scenario?
Would taking a BPMH prevent this adverse drug event as patient was now on two beta blockers?
What role does the ED nurse have in this case particularly on patient's discharge to home?
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