February 2005 
Volume 35  Number 2
Pages 18 - 18
  PDF Version Available!


  • Figure. No caption a...

    When an ED physician prescribed the alpha-beta-adrenergic blocker labetalol, 20 mg I.V. push, for a patient in hypertensive crisis, the nurse quickly administered it. The patient immediately went into cardiac arrest and died.

    When administered to treat hypertensive crisis, the initial dose of labetalol should be administered over 2 minutes to prevent a sudden, severe drop in blood pressure. In cases like this, when the recommended drug administration time is longer than 1 minute, terms in the order such as “I.V. push” or “bolus” are inappropriate because they imply that the drug should be given more quickly.

    Figure. No caption available. Following these guidelines can prevent similar errors:

    * Clarify any order with inappropriate terms, such as I.V. push for labetalol.

    * Ask the pharmacy for I.V. push guidelines, including a safe injection time frame for various drugs. Post the ...

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