In the ED, their vitals/exam are as above. Patient with AICD firing likely due to ventricular tachydysrhythmia (including rapid VT/VF) most likely due to electrolyte abnormality vs. volume abnormality (such as hypervolemia/hypovolemia) but we will evaluate for inappropriate ICD function and acute cardiopulmonary etiologies (such as infection, ACS, CAD, valvular disease, myo/pericarditis, endocarditis, DVT/PE) as they are on the differential given acute on chronic exacerbation of sxs. Hyperthyroidism, excessive exercise, high anxiety, anemia, toxin (such as alcohol/caffeine/cocaine), and medication side effect (especially with theophylline, adenosine, digitalis) are always on the differential but less likely.
– Labs/Tests: CBC, CMP, lipase, coags, troponins, BNP, TSH w/ reflex T4, UA w/ reflex UCx
– Imaging: CXR, BSUS to assess IVC to assess fluid status, TTE as inpatient
– Treatments: IVF vs. diuresis based on fluid status, IV magnesium 4g as indicated, IV calcium gluconate as indicated, Low threshold for IV amiodarone, Synchronized cardioversion if unstable (hypotension, AMS)
– Consults: Cardiologist, EP for possibility of antitachycardia pacing (ATP)
– Dispo: Likely admission to cardiology