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Teachable Moment
Less Is More
June 2015

Behind the Monitor—The Trouble With Telemetry: A Teachable Moment

Author Affiliations
  • 1Department of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, Maryland
JAMA Intern Med. 2015;175(6):894. doi:10.1001/jamainternmed.2015.0837

A man in his 80s with a history of atrial fibrillation (AF), dementia, and delirium during prior hospitalizations was admitted for treatment of a hip fracture after a mechanical fall. He was noted to have an irregular pulse and was placed on telemetry to monitor for arrhythmias prior to surgery. He had no history of ischemic heart disease, vital signs were within normal limits, and an electrocardiogram revealed AF with a heart rate between 60 and 70 beats/min. Overnight, he became agitated and confused, pulling off the telemetry monitor wires attached to his chest. The telemetry alarm sounded, and hospital staff restrained him and reapplied the telemetry leads. Disliking the extra wires, he again yanked them off. He ended up requiring intramuscular lorazepam and soft wrist restraints to prevent him from removing his telemetry monitor. His delirium persisted for the rest of the night, and a sitter was called in to watch him more closely.

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