Hey Doc, Mr. Jones in R4 is starting to sundown and keeps trying to get out of bed, do you have anything to sedate him? You look into R4 and Mr. Jones is pulling off his pulse ox and yelling at the tech, he definitely needs something to calm him down. However, Mr. Jones is 83 and is being admitted for CHF exacerbation on 5L NC, you also remember his ECG looking funny so you pull it up again. Oh yeah, he has a QTc of 509…that makes sedating him a bit more difficult. You think through your go-to list of medications…he is already on oxygen and hypoxic so you want to be careful about causing too much CNS depression with benzos, and his QTc is long so can you safely give him an antipsychotic?  You vaguely remember that haldol seemed to be safe-ish, but haven’t we all heard a horror story of someone going into torsades? Are there any other options?

Taylor Wahrenbrock MD, Joanne Rutsolias PharmD, & Eric Leser MD