“You can get past the dead end. You can break through the ceiling. I did and so have countless others.”

Clinical Pearl Wednesday #10

Merry Christmas! I hope all the Elite NP readers are having an amazing holiday with friends and family!

Lets get right to it.

Have a patient complaining of hiccups? Check their pulse!

An atypical symptom of atrial fibrillation and atrial flutter can be hiccups!

I have seen this 2 times in my career. Once working in the ER and another time in an urgent care. The patients presented with unrelenting hiccups for 2-3 days. They tried everything imaginable to stop them with no relief. I checked their pulse and listened to their heart and sure enough, it was very irregular. We put them on a monitor and one patient was in a-fib and the other a-flutter. They were not complaining of any other symptoms.

So remember: if you see hiccups, check that pulse!

2 Responses

    1. Certain neurological conditions, GI conditions, pneumonia, and multiple others. The differential is large. The a-fib and a-flutter have been ones that I have personally seen.

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