Scenario: This electrocardiogram is from a 28-year-old woman who came to an emergency department with generalized edema and shortness of breath. She had been in a motor vehicle accident 8 years prior, leading to a traumatic brain injury (TBI) causing seizures and a spinal cord injury (SCI) with spastic quadriplegia. Current comorbidities included obesity (body mass index [calculated as weight in kilograms divided by height in meters squared], 38), diabetes, and non-ischemic myocardial injury. She was nonverbal and bedbound, and her parents made all of her medical decisions. She was often admitted to the hospital because of inappropriate thermoregulation, anasarca, bradycardia, and respiratory failure, all consequences of the TBI and SCI. On arrival, her blood pressure was 102/65 mm Hg, respiratory rate 18/min, oxygen saturation 93% on room air, and temperature 36.4 °C. Atropine and a dopamine infusion did not improve her heart rate, so she was transferred to...

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