The message <[log in to unmask]>
from Taj Hassan <[log in to unmask]> contains these words:
> Would then have considered an anti-arrhythmic, but not
> necessarily lignocaine. Evidence seems to be mounting
> against it (other players...amiodarone or even
> sotatlol...popular with the Americans). I would have
> considered magnesium if he was on diuretics or a renal
> patient or history of alcohol abuse. Otherwise
> not....no evidence to suggest it has a significant
> effect in any other circumstance except dropping BP
> further.
Ummm... having seen someone get Torsade de Pointes from long term
sotalol use, I'm a bit scared of it!
My case was a real pitfall for the unwary.
An 84 year old lady was brought in after a family dispute and had
apparently then collapsed at home. She appeared to be
hyperventilating on arrival and blood gases showed a low pCO2.
Understandably, it was thought she had a 'panic attack'.
Her medication included sotalol and thyroxine.
Her ECG intermittently showed ventricular bigeminy and trigeminy then
episodes of Torsade. When she was in sinus rhythm a *very* long QT
interval became apparent.
U&E, Ca++ and Mg++ were normal.
I did *not* send her home with a cup of tea...
--
Helen D. Vecht
[log in to unmask]
Somewhere around North-West London
%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%
|