Quote:
Originally Posted by PedOncoDoc
My first question is why you would take an adult patient with a complicated PMHx when assigned to the pediatric side... 
My item for the differential:
Long QT syndrome - I didn't get out my calipers, but on eyeball it looks to be borderline at best, and the QT interval can be worsened by both methadone and proton pump inhibitor medications. Myocardial ischemia can also contribute, and his history of diabetes and Hypertrophic cardiomyopathy put him at risk for cardiac ischemia - the neuropathies suggest his diabetes has not been very well controlled. Data suggests effexor is not likely contributing, but case reports suggest it might. |
The most important teaching point of this case is: NEVER BE HELPFUL.
He was in an adult acute (non-critical) room and his history was not in the EMR and had not been solicited by triage. He was just around the corner close to the peds side though and we had just had a string of code blues and traumas swamping the adult team. I figured this would likely be a simple vaso-vagal case given his age and that he was in an acute room.
Differential:
Long QT (QTc = 652)