A patient in their 50s presented to the emergency department within 30 minutes of ingestion of prawns at a restaurant with complaints of an itchy skin, rash, and generalized weakness. The patient’s pulse rate was 79 bpm, blood pressure was 50/30 mm Hg, and respiratory rate was 20 per minute. Findings on systemic examination were normal. The patient was initially treated with injections of hydrocortisone, chlorpheniramine, and a rapid infusion of 1000 mL of normal saline boluses. However, they continued to remain hypotensive (blood pressure, 70/50 mm Hg). The patient was then given adrenaline, 1 mg (1:10 000 dilution), intravenously. Immediately after the intravenous adrenaline injection, wide complex tachycardia was observed on the cardiac monitor. A 12-lead electrocardiogram (ECG) showed a wide complex tachycardia (WCT) at a rate of 105 beats per minute (bpm) (Figure, A). After 3 minutes, the WCT slowed and gradually returned to sinus rhythm. The subsequent ECG showed a 1-mm ST elevation in leads I, and aVL, and ST depression and T-wave inversion in leads II, III, aVF, and V3 to V6 (Figure, B).1
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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.
Corresponding Author: Vickram Vignesh Rangaswamy, MD, DM, Sri Ramakrishna Hospital, Coimbatore 641044, India (firstname.lastname@example.org).
Published Online: August 21, 2023. doi:10.1001/jamainternmed.2023.2259
Conflict of Interest Disclosures: None reported.
Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:
It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.
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