Arrhythmias Flashcard 11
Rationale
C. Rationale: A systolic blood pressure of 70 mm Hg is a sign of shock. This indicates that the patient has unstable bradyarrhythmia, which means that cardiac arrest is imminent.
Question
Which one of the following symptoms of bradyarrhythmia is a danger sign that cardiac arrest is imminent?
a. Oxygen saturation of 94%
b. Heart rate of 50 bpm
c. Systolic blood pressure of 70 mm Hg
d. ECG findings of complete heart block
Answer
c. Systolic blood pressure
Rationale
C. Rationale: Heart transplant patients cannot be treated with atropine due to the lack of vagal innervation. The vagal nerve is essential for the antimuscarinic effects of atropine, but it is resected in surgery. Thus, to effectively treat heart transplant patients in symptomatic bradyarrhythmia, transcutaneous pacing is more suitable.
Question
Why is atropine ineffective in heart transplant patients, causing these patients to need transcutaneous pacing instead?
a. Stimulates the immune system to reject the heart
b. Depressed central venous circulation
c. No vagal innervation
d. All of the above
Answer
c. No vagal innervation
Rationale
E. Rationale: Wide complex tachycardias, if monomorphic and stable, may be treated with adenosine. Antiarrhythmic infusions for stable wide QRS tachycardias include procainamide, amiodarone, and sotalol. Synchronized cardioversion can be used if the complexes are wide and regular and if the patient is stable.
Question
Wide QRS complex tachycardias can be treated with:
a. Adenosine 6 mg IV
b. Synchronized cardioversion
c. Sotalol 100 mg over 5 minutes
d. B and C
e. All of the above
Answer
e. All of the above
Rationale
A. Rationale: This patient has an unstable tachycardia (hypotensive, altered mental status, tachypneic, and decreased perfusion to the extremities). According to the tachycardia algorithm, the treatment for this patient is immediate synchronized cardioversion. (ACLS Case: Adult Tachycardia with a pulse)
Question
You are caring for a patient who complains of chest pain and is slow to respond. His vital signs reflect a heart rate of 165 bpm, blood pressure of 78/49 mm Hg, and respiratory rate of 28 breaths/min. The patient’s skin is cool and clammy. On ECG, you determine that he is in SVT. The appropriate intervention for this patient is:
a. Immediate synchronized cardioversion
b. High-quality CPR
c. Intubation
d. Immediate defibrillation
Answer
a. Immediate synchronized cardioversion
Rationale
B. Rationale: Hypotension and bradycardia are side effects of amiodarone. Increasing amiodarone infusion to 2 mg/minute will exacerbate the problem. The other choices are remedies to counteract these side effects.
Question
You are monitoring a patient who has recently been stabilized 2 hours after having a wide complex tachyarrhythmia with a pulse. He is on a maintenance infusion of amiodarone 1 mg/minute. His blood pressure was 140/80 mm Hg 15 minutes ago but is now 100/60 mm Hg. Which of the following will NOT remedy the problem?
a. Bolus administration of intravenous fluids
b. Adjust infusion rate to 2 mg/minute
c. Chronotropic drugs
d. Temporary pacing
Answer
b. Adjust infusion rate to 2 mg/minute