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This patient was admitted to the general medical ward with a history of alcoholism. A code is in progress, and he has recurrent episodes of this rhythm. You review his chart, which notes that the baseline QT interval is high normal to slightly prolonged. He has received 2 doses of epinephrine 1 mg and 1 dose of amiodarone 300 mg IV so far.

What would you order for his next medication?

1. Lidocaine 1 to 1.5 mg IV and start infusion 2 mg/min.
2. Repeat amiodarone 300 mg IV.
3. Repeat amiodarone 150 mg IV.
4. Give sodium bicarbonate 50 mEq IV.
5. Give magnesium sulfate 1 to 2 g IV diluted in 10 mL D5W given over 5 to 20 minutes.

Answer :

Final answer:

Given the patient's history and the presented symptoms, magnesium sulfate is the recommended next medication to administer for potential QT prolongation and associated arrhythmia, which can be exacerbated by alcoholism.

Explanation:

This patient, admitted with a history of alcoholism and experiencing recurrent episodes of arrhythmia, has a baseline QT interval that is high normal to slightly prolonged, as indicated on the 12-lead ECG. In the situation where the patient has received doses of epinephrine and amiodarone without satisfactory rhythm conversion or stabilization, the best next step considering the current information would be to administer magnesium sulfate. Given the description, there's a possibility the patient may be experiencing torsades de pointes, a type of ventricular tachycardia associated with a prolonged QT interval, a situation for which magnesium sulfate, given IV, is a first-line treatment. This choice is based on its effectiveness in addressing the underlying electrolyte disturbances that can contribute to QT prolongation.

Therefore, the appropriate order from the options given would be to give magnesium sulfate 1 to 2 g IV diluted in 10 mL D5W given over 5 to 20 minutes. This intervention aims at correcting potential magnesium deficiency, often seen in patients with a history of alcoholism, and can help stabilize the heart rhythm.

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