Figure 1
How would you manage this patient?
A 60-year-old female with a history of non-small cell lung cancer presents to the emergency department with a six-hour history of shoulder and neck pain. Her lung cancer was excised three years earlier with an excellent prognosis. An initial ECG demonstrates sinus tachycardia resembling atrial flutter. The patient receives 20 mg intravenous diltiazem and begins having sinus pauses lasting 2-4s multiple times each minute. Her blood pressure is 115/70 mmHg, and her heart rate between pauses is 90-120 bpm with intermittent P waves. Her chest X-ray demonstrates expected postoperative changes. The patient is alert and oriented and experiences intense anxiety with each pause. Which of the following management steps is most appropriate? Image credit: @FerarriMD.
- Observation
- Vasopressor infusion
- External pacing
- Insulin and glucose infusion
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