Patient was a 30-something year old white female admitted for pancreatitis. History of alcohol and illegal drug abuse and yes, pancreatitis. Currently undergoing fluid resuscitation with normal saline infusing at 250ml/hr.
Medications of note include a dilaudid (hydromorphone) PCA device with dosing of 0.2mg/dose with time lock out of 10minutes and verapamil 80mg PO twice daily.
Telemetry tracing shows normal sinus rhythm in the 70’s with a prolonged QT around 620ms (calcuated QTc of 650ms). QT had increased since start of shift from around 360ms to current.
The following 12-lead is captured:
QT/QTc is measured at 622/671ms by the machine. Quick manual calculation confirms this.
Patient is still asymptomatic and vital signs are stable. She is just pissed you woke her up.
What is the probable diagnosis? What needs to be done? Should we call cardiology? Call and wake up the EP doc? Pacer pads? Let her sleep? Do nothing and pray she doesn’t have a R-on-T PVC?
Answers and discussion to follow in a day or two…