dimps
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Q--50 yr old man is admitted secondary to respiratory failure & tachycardia. His temp is 38.9c (102F), BP 110/60, RR 30/min, ECG shows P wave preeceding QRS complex .No two P waves have same morphology ,
most appropriate next step in management
a -administration of digitalis
b -administration of warfarin
c -electrical cardioversion
d -mechanical ventilation
e -placement of a defibrillator
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| dmnz
Forum Junior
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B
DMNZ :wink:
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| wetchin
Forum Junior
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cud yu explain why B is the answer?
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| dmnz
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I think c , d, e are not correct because first do not cardiovert unless anticoagulated, mechanical ventilation is not required (as no ABG analysis given) and placement of defibrilltor (AICD) is not indicated in this patient.
Now a and B - Note that no comment has been made regarding rhythm and hence take it to be regular ( sinus tachycardia or PAT ; cannot be atrial flutter as no block is mentioned or AF as P waves are present) ;
Note P wave morphology -it says 'no two P waves are egual' - it means EITHER there is filling problem of atria due to tachycardia (secondary to fever and respiratory problem) OR p is coinciding with T due to PAT.
In either case treat the cause (Fever or respiratory) ; and since patient has stable BP immediate digoxin may not be reguired, warfarin can help to anticoagulate and further open up chances to cardiovert later/add digoxin, though it takes 48 hrs to increase INR with warfarin .If tachycardia increases and BP falls ,load with Digoxin.
Well that's what I thought /
dmnz :|
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| daira
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D; multifocal atrial tachycardias are associated with respiratory diseases. Oxygenation would make it better.
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| dimps
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Qalander u r 100% correct
answer is D
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| cache
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excellent question, dimps
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