SOTALOL WORKSHEET (Please Copy and paste into Word Document)

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IV SOTALOL DISCHARGE SUMMARY  (Copy and Paste into EMR)

The patient underwent a successful DCCV on ______ back to sinus rhythm, and was subsequently admitted under observation status.  The patient underwent sotalol loading as per the IV Sotalol Protocol, which is summarized below.  

    CrCl (Cockcroft-Gault Equation) = ____ ml/min 

    Patient underwent successful DCCV back to sinus rhythm

    Post DCCV ECG QTc = ____ msec 

(1)  SOTALOL IV DOSE

  Sotalol ____ mg IV x 1 given at ______  AM (time zero)

  During IV Sotalol infusion, serial ECGs were obtained q 15 minutes:

        15 minute  QTc =  ________
      30 minute  QTc =  ________
      45 minute  QTc =  ________
      60 minute  QTc =  ________

(2) SOTALOL PO Dose (1st po dose, to be given 5 hours after time zero)

    Sotalol ____ mg po x 1 given at ______ PM  

    ECG QTc (after 1st po sotalol dose) =  _______ msec 

(3) SOTALOL PO Dose (2nd po dose, to be given 17 hrs after time zero)

    Sotalol _____ mg po x 1 given at _____ PM 

    ECG QTc (after 2nd po dose) = ______ msec 

Hour 20-23: ECG QTc = ______ msec 

Serial ECGs did not demonstrate any QTc prolongation > 500 msec or increase of > 20% over baseline QTc.  

Upon discharge, the patient did not have any evidence of active CHF.