Neostigmine Toxicity
Report:
Sinus rhythm
3:2 sino-atrial exit block
Nonspecific T wave changes
Comment:
The patient was paralysed by vecuronium for a CAT scan after a traffic accident; she was brought back to Casualty and the relaxant was reversed with 5 mg neostigmine and 0.3 mg atropine. She became bradycardic and hypotensive and remained intubated. The reasons for twice the usual dose of neostigmine and economy on atropine remains unknown, but Dr. Johnson’s famous formulation68 comes to mind.
The bigeminal rhythm is produced by 3:2 sino-atrial exit block, second degree, type 1: the long cycles are less than twice as long as the short cycles.
Her previous ECG is shown below (Fig 105a).
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