Malnutrition, Weight Loss and Eating Disorders — Guidelines for Telemetry — Clinical Pathway: ICU and Inpatient

Malnutrition, Weight Loss and Eating Disorders Clinical Pathway — ICU and Inpatient

Guidelines for Telemetry and ICU when Admitting Patients with Malnutrition

Admit to Telemetry after discussion with Cardiology

Severe Bradycardia
  • HR ≤ 30 bpm with no ventricular ectopic beats (no PVC's)
  • HR ≤ 35 bpm with simple ventricular ectopy (single PVC's)
Complex Ventricular Ectopy or ECG Abnormalities
  • Ventricular couplets or triplets, V-tach or atrioventricular block with any type of baseline heart rate
  • On baseline ECG QTc or QT interval:
    • 500 ms if heart rate is normal or elevated, or with a known history of purging or hypokalemia
    • > 550 ms if bradycardic (HR < 60)
Electrolyte Abnormalities
  • K < 2.5 mmol/L, Phos < 2.5 mg/dL, Mag < 1.5 mg/dL
    • Note: severe abnormalities such as K < 1.5 mmol/L, Phos < 1.5 mg/dL, or Mag < 1.0 mg/dL may require admission to ICU depending on clinical status
Recent Unexplained Syncope  

In typical situations, patients will be admitted to a telemetry bed under Adolescent Medicine Attending with either Adolescent residents or APPs in the FLOC role. Typically, patients should be transferred to the adolescent unit after 48 hours of observation if there is no complex ventricular ectopy, patients are stable with asymptomatic bradycardia, and the patient is making clinical progress.

Patients admitted to tele/6E may need a cardiology consult and this can be discussed via EPIC secure chat. After clinic hours, the cardiology fellow can be called. If the patient is clinically stable and is admitted at night, the cardiology fellow will approve the tele bed.

These guidelines were developed to assist with decisions about where patients with severe bradycardia who are admitted for Nutritional Rehabilitation should be admitted. Heart rate criteria are generally based on assessments when the patient is awake and at rest. In some circumstances, the assessment can be based on trends of severe bradycardia that may only be evident at night and discrepant from higher heart rates while awake.

Admit to ICU after discussion and formally consulting Cardiology for:

  • Hemodynamic instability/signs of shock:
    • Chest pain
    • Weakness
    • Dyspnea
  • Life-threatening arrhythmia/ECG changes
  • Patient without vascular access who may have arrhythmias
  • Severe electrolyte abnormalities:
    • K < 1.5 mmol/L, Phos < 1.5 mg/dL, or Mag < 1.0 mg/dL

Note

This document is a revision of Policy and Procedures from 2022. This version has been agreed upon by Adolescent Medicine and Cardiology in 2017.