Clinical Question: Mannitol Use in the ED – How to dose and Where it Is Kept?
Mariam Isa, PharmD and Joanne Routsolias, ED Clinical PharmD
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Figure 1. Initial arrhythmia detected on telemetry
Heart of the Matter: Non-Sustained Wide Complex Tachycardia
A 74 year old male with history of STEMI s/p PCI with DES of LAD and RI, HFrEF (EF 20-25%), sick sinus syndrome s/p DC-PPM, atrial flutter, hypertension, insulin-dependent diabetes, severe PAD s/p right IR SFA stent, and pancreatic insufficiency presenting for hypotension from general surgery clinic. The patient is brought to the resuscitation bay and while you are waiting for your work-up the monitor alarms and shows the following (Figure 1).
Michael Hohl MD and Ari Edelheit MD
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Figure 1. Index EKG
Heart of the Matter: Challenging (A) Visual Diagnosis
A 38 year old male with a history of asthma presents to the emergency department with chest pain. He complains of intermittent left side chest pain ongoing for months, worsening over last week. Chest pain is not exertional or positional. He also complains of palpitations with occasional “pauses.” During these episodes the patient complains of lightheadedness. He denies shortness of breath or syncope. Patient endorses history of sudden cardiac death in his cousin at age 35. Initial vitals are notable for BP 133/88, HR 51, RR14 and O2 saturation of 98% on room air. The patient’s initial EKG (Figure 1) is shown.
Abish Kharel MD and Ari Edelheit MD
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