A 91-year-old woman presented to the emergency department by ambulance after her family found her minimally responsive. Telemetry monitoring demonstrated episodes of non-sustained polymorphic ventricular tachycardia (PMVT) associated with significantly prolonged repolarization. Her medical history revealed that she was taking quinine or a derivative in three different forms: hydroxychloroquine, quinine sulfate (for leg cramps), and her gin mixed with tonic water (containing quinine). The present case is illustrative of classic etiologies and findings of acquired long QT syndrome, and serves as an important reminder for providers to take a complete medication history, including use of duplicative and alternative medicines and type of alcohol consumption.KEY WORDS: cardiac arrhythmia; prolonged QT; quinine; gin and tonic.

Introduction Diagnosis of lung cancer often results in tremendous stress for most patients, especially in patients with underlying psychological illness. Psychosocial support (consultation with psychologist, psychotherapist, or social worker) referral is considered standard for quality cancer care; however, which patients utilize these resources and how these resources affect patient outcomes remain unclear. Objectives We aimed to identify which newly diagnosed lung cancer patients accessed available psychosocial resources and assessed how utilization of these resources correlated with treatment and survival outcomes. Methods Data were collected from National Cancer Institute‐designated cancer center at the University of New Mexico. We analyzed lung cancer registry and mortality data at the cancer center and bronchoscopy suite data to retrospectively identify patients diagnosed with lung cancer between 2012 and 2017. We used a logistic regression model to compare psychological support utilization at the cancer center between patients with and without history of psychiatric illness. We used a Cox proportional hazards model to identify individual risk factors for mortality. Results Patients with a previous psychological diagnosis were 2.4 times more likely (odds ratio = 2.443; confidence interval [CI], 1.130–5.284) to utilize psychological resources than patients without a pre‐cancer psychological diagnosis. Patients who received psychosocial intervention had a 120.4% higher hazard of dying than those who did not (hazard ratio = 2.204; 95% CI, 1.240–3.917). One‐year survival probability among those who did not utilize resources was 62.65% (95% CI, 55.24%–71.06%) and 43.0% (95% CI, 31.61%–58.50%) among those who did. Patients with a previous psychiatric diagnosis were more likely to utilize psychosocial resources within 1 year of lung cancer diagnosis. Conclusions Patients with previous psychiatric illness are more likely to utilize psychosocial resources at the cancer center after a new diagnosis of lung cancer. Patients who utilize psychosocial interventions have higher 1‐year mortality than those who do not.

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Targeted temperature management is known to improve neurologic outcomes and provide survival benefit. The American Heart Association recommends that post-cardiac arrest care include TTM for all comatose patients who achieve return of spontaneous circulation. The aim of this project was to assess the efficiency and effectiveness of TTM protocol in the University of New Mexico Hospital (UNMH) medical ICU (MICU).METHODS: A retrospective chart review was conducted which identified 128 patients who were admitted to the UNMH MICU from February 1, 2017 through January 31, 2019 for the diagnosis of cardiac arrest. Data collected included patient demographics (age/sex), type of cooling device, temperature on arrival, type of cardiac arrest, time to target temperature, and mortality at 72 hours. Our protocol recommends initiation of TTM in all adults (age $ 18) cardiac arrest patients with a GCS < 8. Patients who did not meet cooling criteria were excluded. Data was analyzed using Kruskal-Wallis one-way ANOVA. RESULTS:We found that three factors significantly influenced the likelihood of reaching our target temperature of 36 o C. These were age, starting temperature, and total cooling time with adjusted odds ratios (95% C.I.) of 1.1, 4.7, and 1.3 with associated pvalues of 0.05, 0.01, and 0.02, respectively. Of patients who were cooled, 71% (64/90) died within the first 72hrs following arrival, compared to 100% (22/22) of patients who were not cooled. Cooling improved mortality by 29% (p value 0.0045). CONCLUSIONS:Components of TTM including temperature goals and length of cooling are well defined, and the UNMH MICU TTM protocol aligns with the current medical literature with a targeted temperature of less than or equal to 36 degrees Celsius for 24 hours following cardiac arrest. However, the factors that affect reaching target temperature are rarely discussed. We found that the factors of age, starting temperature, and total cooling time are independent predictors in reaching our target temperature goal.CLINICAL IMPLICATIONS: Medical ICUs should consider the factors of age, starting temperature, and total cooling time as potential barriers in achieving target temperature management in patients following cardiac arrest.