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15 Posts

bax
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Topics: 16
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01/18/08 - 09:56 PM

A 45-year-old male suddenly loses consciousness and falls to the ground. He has been previously healthy and has been on no medications. There is no obvious evidence of trauma. An electrocardiogram reveals wide complex tachycardia at a rate of 300 beats per minute. Which of the following is the most appropriate intervention?

A. Obtain vital signs
B. Administer a bolus of intravenous lidocaine
C. Administer a thrombolytic agent
D. Perform asynchronous cardioversion
E. Perform synchronous cardioversion

anuba
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Topics: 6
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01/19/08 - 06:45 AM

If no hx. of medical problem... IV Lidocaine

From my other readings..Mgt for wide complex tachycardia:
IV Amiodarone
Class 1C agents
...............

bax
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01/19/08 - 08:56 AM

i am afraid u missed imp clue from q stem..

Ivonne
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01/19/08 - 09:46 AM

VTAC or Vfib most likely-------------->D

Could u explain the difference between asynchronous vs synchronous i think it is related if it goes with the HR of the patient or not but not sure

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Aashi
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01/19/08 - 10:18 AM

Ivonne wrote:
VTAC or Vfib most likely-------------->D

Could u explain the difference between asynchronous vs synchronous i think it is related if it goes with the HR of the patient or not but not sure

Synchronized cardioversion is used when there is a PULSE present usually >150 with +VE ominous S/S present (chest pain, pulmonary edema, lightheadedness, hypotension) ---------> shock will be given by the machine together (synchronized) with the pulse

Defibrilation (UNSYCNHRONIZED) there is NO pulse present ------>Pt is in V-FIB or PULSELESS VT
so the shock is given unsynchronized because there is NO pulse

This pt is clearly UNSTABLE, he is unconscious-------------->VT------>Shock him-------->D

Edited by Aashi on 01/19/08 - 10:29 AM

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Ivonne
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01/19/08 - 10:27 AM

Thanks Aashi smiling face

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smalley
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01/19/08 - 06:00 PM

d.... wide ventricular tachycardia with no pulse so mgt is same as vfibv.as person is unstable do asynchronous cardioversion

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bax
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01/19/08 - 08:27 PM

drduck
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01/19/08 - 11:52 PM

RX 135
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01/20/08 - 01:11 AM

#10

syncronou...cv at p wave used for afib afl..if done at t wave will presipitate vf

asychr for vf vt...no done woth refernce to ekg

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dr19
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03/09/08 - 07:12 AM

#11

sustained VT------->synchronous cardioversion

farnsworth
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Posts: 165

03/09/08 - 10:05 AM

#12

wide complex VT: asynchronous cardioversion (this patient is pulseless, so B and C are complete non-sense: how could IV agents get to the 'site of action', i. e. the heart, if the heart is not pumping any blood? -> arterial and venous stasis. To get the IV agents to the heart, blood flow has to be established, either by CPR or by restoration of spontaneous circulation).

synchronous cardioversion is reserved for pts w/ AFib/AFlut (synchronized to R-spike)

farnsworth
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03/09/08 - 10:13 AM

#13

@RX135: in AFib there is by definition no P wave, so the shock is synchronized to R-spike on the EKG tracing.
If you 'accidentally' shocked during the ascent of the T-wave trace, you indeed could provoke VFib. In that case: shock again (asynchronous mode), this usually solves the problem. I understand, that cardioversion seems scary when doing this for the first time... Anyway, if you do not act fast in an unstable patient, he/she will be dead anyway (you can't kill an already dead person, so it is a win-win situation, if you succeed in restoration of spontaneous circulation, ROSC).
Most defibrillators are in 'async mode' by default, which makes sense when using them in an emergency situation, like pulseless VT. When cardioverting a patient w/ AFib/AFlut you should not forget to switch to 'sync mode'.

liliaeliz
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03/16/08 - 08:32 PM

#14

THANKSSSSSSSSSSSSSSS

zaidsuror
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03/21/08 - 04:12 AM

#15

Why are you assuming this patient has Vfib? all that is mentioned is that the patient has lost consciousness.It is not said that he is pulseless or that he is not breathing!!! he could have a hemodynamicaly unstable ventricular tachycardia which would merit a synchronized cardioversion.Besides Ventricular fib shows significant electric activity with no signs of an organized pattern.
The bottom line is that it is imperitive to mention that the patient dropped dead with no pulse and no breathing!!! without that the patient may simply have lost consciousness and could have anything from neurological structural or infectious problem or drug or metabolic problem. If cardiac arrhythmia is the cause , it could be unstable atrial arrhythmia or ventricular. So specify.

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