Caso clínico: Torsades de Pointes secundaria al uso de haloperidol intravenoso

Resumen

Torsade de Pointes (TdP) is a type of ventricular tachycardia that is generally related to a QT interval prolongation due to congenital/ acquired causes or is associated to drugs. It is usually observed in the presence of corrected QT (cQT) above 440 milliseconds. It can also appear in patients without prolongation of this interval. TdP is usually characterized by a less disorganized rhythm than ventricular fibrillation (VF), appearing as paroxysmal episodes. The relevance of this case arises from the customary use of haloperidol in emergency services in agitated or aggressive patients or in patients with some kind of psychopathy. According to the literature, there are numerous investigations that have described a direct relationship in the appearance of TdP during intravenous administration of haloperidol. The objective of the case is to know the possible appearance of this arrhythmia in connection with the use of intravenous haloperidol and the development of a care plan focused on the patient. In order to carry out the study, an individualized care plan and a bibliographic search in different nursing methodology databases were performed. We present the case of a 28-year-old male with a psychiatric history who, after sedation with intravenous haloperidol, presented several self-limited TdP episodes. Following Virginia Henderson‘s conceptual model and the NANDA taxonomy by which we highlight the main diagnoses (00151) Self-mutilation, (00240) Risk of decreased cardiac output and (00062) Risk of exhaustion from the caregiver‘s role, and the results and interventions according to NOC and NIC taxonomies.