Here is a rhythm strip from a patient who had a lap chole. Some ST changes were noted in surgery so the patient came to ICU. I took care of this patient the next day. Fentanyl drip had been started the day before. The heart rate kept getting slower over the coarse of the day. Until the patient started having pauses as you can see--lots of them, up to 3 a minute. If I count right, it is over 8 seconds long. Totally asymptomatic, so I didn't treat. You can be sure that my atropine was on hand. The internist got worked up, even though I had stopped the Fentanyl drip, and he had her shipped out to a cardiologist. After a few more hours the pauses stopped. I figured it was due to the Fentanyl which is lipophilic. What do you think?
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