A 49-year-old Woman with Multiple Episodes of Ventricular Fibrillation, Ventricular Tachycardia, and Torsades de Pointes, Requiring 211 Defibrillatory Shocks

摘要

A 49-year-old black woman presents to the emergency department at 5:00 AM complaining of nausea, vomiting, and epigastric pain that began suddenly 3(1/2) hours earlier, along with fever, chills, and cough. The patient reports to the triage nurse that she had been drinking whiskey and had eaten some crab salad, chicken salad, and deviled eggs at a party the previous evening. The patient is a noncompliant diabetic with no other significant medical history. The patient's vital signs at triage are as follows: blood pressure, 133/91 mm Hg; heart rate, 86 beats per minute; respiratory rate, 1/8 breaths per minute; oxygen saturation, 97% on room air; oral temperature, 35.8degC (96.4degF); pain score, 9/10 on a 0-10 scale; and fingerstick blood glucose, 419 mg/dL (normal range, 70-110 mg/dL). The triage nurse reports that the patient's abdomen is soft but tender to palpation in the epigastric area. The patient is vomiting in triage, so the nurse brings her to a minor medical bed in the treatment area.