Figure 1. Action potential with QT prolongation

Pharm & Cheese: Antipsychotic Selection and Risk of QTc Prolongation

April 22, 2026

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

Heart of the Matter: LAD OMI

March 21, 2026

The patient is a 70-year-old female with a past medical history of hypertension, off of medications, who is presenting for concern of chest pain. The pain radiated to both her neck and back, started at 4 AM, and resolved just 10 minutes prior to arrival in the emergency department. The patient had an EKG (Figure 1) in triage that was immediately brought to the attending for review

Erica Dolph MD and Ari Edelheit MD

Heart of the Matter: Wide Complex SVT

March 7, 2026

A 74-year-old male with documented 95% stenosis of the LAD in 2021 status post catheterization, HIV well-controlled on Tivicay presents to the ED for intermittent non-exertional, non-pleuritic chest pain that started 2 days ago. The pain is described as non-radiating. He denies any fevers, cough, shortness of breath, lower extremity swelling, abdominal pain, vomiting, diarrhea. He denies prior history of DVT or PE, recent travel, or surgery. Initial vital signs were: BP 163/82, HR 160, RR 20, O2 97% on room air. His EKG (Figure 1) is shown.

Veda Ravishankar MD and Ari Edelheit MD

the County Consult