Almost every podiatric inpatient service has their classic diabetic foot ulcer patient on their service at some point. This patient had a fairly unremarkable medical history other than diabetes and being mildly overweight. The ulcer was inspected in the ED, and the patient was admitted for IV antibiotics for cellulitis and an infected diabetic foot ulcer.
Later that night, we received a page at midnight that the patient’s heart rate was 180. The nurse was asked if the patient was experiencing any symptoms (headache, altered mental status, etc), which she stated he was not. The nurse was told to check the pulse with another machine in 3-5 minutes while the resident came into the hospital. The nurse called and stated the heart rate was still the same. The resident ordered an EKG, troponin levels, a chest x-ray, a stat medicine consult, and a BMP.
Later that night, we received a page at midnight that the patient’s heart rate was 180.
Once the resident got to the hospital, the internal medicine resident met the podiatry resident at the patient’s room. The ulcer was inspected, and nothing had changed from the ED evaluation. The internal medicine resident had the patient try to bare down and breathe through a straw to try and normalize the heart rate. Unfortunately, this didn’t work. The internal medicine resident administered Adenosine IV starting at 6mg. This slowed the heart rate for a couple minutes, but then the heart rate increased to 180 BPM again. A 12mg and 18mg dose of Adenosine were administered with only short-term success. Ultimately, the patient had to be transferred to ICU.
Story by Dr. E.S.
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