Vinit Sawhney MRCP a, Dr Vivienne A Ezzat PhD a , Andrew SP Sharp MD b, Richard J Schilling MD a. The Lancet, Volume 376, Issue 9736, Page 204, 17 July 2010
In November, 2009, a 61-year-old man was admitted to our intensive therapy unit (ITU) after extensive abdominal surgery to treat multiple gunshot wounds. Two days into his stay in ITU, he developed septicaemia, which necessitated treatment with antibiotics and ventilatory and inotropic support.
After a week, a percutaneous tracheostomy was done for continuation of ventilatory support. Whilst intubated our patient had a witnessed syncopal episode lasting 10 s, associated with sinus arrest and subsequent sinus bradycardia of 30 bpm. This episode quickly resolved and subsequent ECG, echocardiography, and blood tests, including those of thyroid function, were all normal. Over the next 10 days he had six further asystolic episodes, each lasting about 10 s with no obvious precipitant. Between events he was haemodynamically stable. Pacemaker insertion was not undertaken because of continuing sepsis.

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