A Cook County Hospital Emergency Medicine Blog for up-to-date medicine and more.
Figure 1. Index EKG
The patient is a 52-year-old female, with a past medical history of hypertension, congestive heart failure, atrial fibrillation on rivaroxaban, and type 2 diabetes who is presenting with palpitations and shortness of breath for two days. Episodes last 1-3 minutes at a time before resolving. She has a history of similar symptoms the month prior, for which her cardiologist recommended an ablation in the future.
Emily Bovasso MD and Ari Edelheit MD
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Figure 1. Index EKG
A 59-year-old male with no known medical history presents to the emergency department with complaints of chest pain and shortness of breath for one week. The chest pain and shortness of breath is exertional and acutely worsened on the day of presentation which prompted the ED visit. Initial vital signs notable for BP 106/87, HR 45, RR 18 and oxygen saturation 98% on room air. The patient’s initial EKG (Figure 1) is shown.
Abish Kharel MD and Ari Edelheit MD
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Figure 1. Action potential with QT prolongation
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
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