A Cook County Hospital Emergency Medicine Blog for up-to-date medicine and more.
Figure 1. Index EKG
A 49-year-old male with a history of hypertension, hyperlipidemia, and a history of opioid use disorder presents to the emergency department. The tech hands you this EKG (Figure 1) and says, “Hey doc, this patient states he has palpitations, they are going to R1.”
Taylor Wahrenbrock MD, Michael Hohl MD, Michael Nelson MD, and Ari Edelheit MD
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Figure 1. The four order set pathways for opioid and xylazine withdrawal. Based on severity of withdrawal, ability to gain IV access, and known or concern for prolonged QTc.
EMS brings in a patient who is reporting heroin withdrawal, so you reflexively give the patient an IV fluid bolus and Zofran, but he is now feeling worse. You try sublingual buprenorphine 8mg, and while the patient initially feels better, he is feeling even sicker a few hours later. What else may be going on? What other options are at your disposal to improve your patient’s symptoms?
Taylor Wahrenbrock, MD; Kathryn McGregor, MD; Eric Leser, MD; Michael Nelson, MD; Antonia Nemanich, MD
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EMS brings you a 38-year-old male patient from the street. He is obtunded, GCS 6, smells strongly of vodka, and was reportedly surrounded by liquor bottles at the scene. He is breathing comfortably with both stable and normal vital signs on assessment. What should be done?
Jorge Aceves, MD
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