Cardiac Monitoring on PCU 7A

Unit

7A (Medicine patients)

Admission/cardiac monitoring  Criteria

• Patients who are stable following drug overdose
• Patients requiring non-acute monitoring (e.g. hypokalemia, pneumonia, COPD).
• Patients who have experienced syncope, palpitations.
• Patients with GI bleeding, hemodynamically stable.
• Patients with new onset atrial fibrillation, hemodynamically stable.
• Patients with stable congestive heart failure.
• Low probability R/O MI
• Reversible hypoxemia
• Patients with hypertensive urgency

Infusion Medications

• Atropine (bolus)
• Digoxin (bolus)
• Magnesium sulfate (infusion)
• Fosphenytoin load (see UMMC policy)
• Amiodarone (infusion, loading dose)* 

* MD and /or ACLS certified RN must be present during administration

Exclusion Criteria

• Patients with chest pain, cardiac ischemia, high probability r/o MI:
• Patients requiring continuous vasopressors vasodilators
• Patients requiring arterial line or pulmonary artery monitoring; CVP.
• Patients requiring placement of a pacemaker or with a pacer malfunction.
• Patients requiring EP studies or AICD/PCD implantation
• Patients requiring transvenous or epicardial pacing.
• Ongoing/persistent hemodynamically unstable.
• Hypertensive emergency—(see definition in education resources)**
• Esmolol bolus or initiation of drip 

** Add definition to 7A education resources for cardiac monitoring).

Criteria for Discontinuation of Cardiac Monitoring

• Absence for >48 hours of an addition, deletion or change in antiarrhythmic therapy.
• Absence for  > 48 hours of an addition, deletion or change in drug therapy with cardiovascular effects.
• Absence for >48 hours of hemodynamically or clinically significant alteration in blood pressure, heart rate,RR, ECG or arrhythmia trend analysis
• Comfort care status
• Withdrawal of life support