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JAMA Performance Improvement
February 6, 2018

Oversedation of a Patient With Obstructive Sleep Apnea Prior to Imaging

Author Affiliations
  • 1Northwestern Memorial Hospital, Chicago, Illinois
JAMA. 2018;319(5):495-496. doi:10.1001/jama.2017.22004

An elderly smoker with a body mass index of 39 presented to the emergency department (ED) with acute-onset dizziness. The patient had a history of stable coronary artery disease after bare-metal stent placement with medication (clopidogrel). Hypertension, hyperlipidemia, and carotid endarterectomy were also part of the patient’s history. The nurse’s communication notes included a history of obstructive sleep apnea (OSA), but this was absent from the physician’s history. In the ED, the patient received meclizine for dizziness and ondansetron for nausea. A neurologist was consulted and recommended magnetic resonance imaging (MRI)/magnetic resonance angiography. The patient indicated feeling claustrophobic and was given 1 mg of lorazepam to reduce anxiety prior to MRI. During the MRI, the patient had a gradual change in mental status over 15 minutes beginning with progressively incoherent answers to various prompts by the MRI technician. The patient eventually stopped responding to prompts, and soon after, a cardiac arrest code was called.

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