GIM Question 12 Instructor

You are called to the ward at night because a patient has a heart rate of 120 on routine vitals. Previous readings showed a rate of 80-90. Outline your initial steps.

  • Pain (chest or other), dyspnea, anxiety, recent bleeding (stool, rectal, hematemesis), vomiting, diarrhea
  • New medications (i.e. anticholinergics – especially in the elderly)
  • Medication changes (i.e. stopping β-blockers/digoxin/diltiazem)
  • Endocrinopathy (i.e. hyperthyroid, addisonian crisis)

Review patient chart

Physical exam

  • Repeat vitals (Temp, HR, RR, Sp02, BP – orthostatic vitals if suspect hypovolemic)
  • JVP, precordial, respiratory
  • Look for source of infection if febrile

Investigate cause

  • ECG, Troponin, CK, lytes, CR – if ACS
  • CXR – if Resp
  • CBC, lytes, Cr, urine C&S, CXR – if febrile
  • CBC, lytes, Cr, urine C&S, CXR, blood cultures x2, lactate – if suspect sepsis

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