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.
History
- 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
