NREMT Paramedic Cognitive ExamCardiology & ResuscitationEasy
A 45-year-old male presents with sudden onset of severe palpitations. He denies chest pain or shortness of breath. His vital signs are BP 128/84 mmHg, HR 180 bpm, RR 16 bpm, SpO2 98%. The ECG shows a regular, narrow-complex tachycardia. He is alert and oriented with no signs of hypoperfusion. What is the MOST appropriate initial treatment for this patient?
- AAdenosine 6 mg rapid IV push
- BSynchronized cardioversion
- CAmiodarone 150 mg IV over 10 minutes
- DPerform vagal maneuvers
Show answer & explanationAnswer & explanation
Correct answer: D. Perform vagal maneuvers
For stable patients with regular, narrow-complex tachycardia, the initial treatment step is to attempt vagal maneuvers. These non-invasive techniques can often terminate supraventricular tachycardia (SVT) by increasing vagal tone.
Why the other options are wrong
- A. Adenosine is the next step if vagal maneuvers are unsuccessful, but not the initial intervention.
- B. Synchronized cardioversion is reserved for unstable tachycardias.
- C. Amiodarone is typically used for refractory ventricular or some supraventricular tachycardias, not as a first-line for stable narrow-complex tachycardia.
Stable Narrow-Complex Tachycardia Initial Treatment
For a stable patient with regular, narrow-complex tachycardia, the initial intervention should be vagal maneuvers to attempt to terminate the dysrhythmia.
- Patient must be stable (no signs of shock, acute altered mental status, ongoing ischemic chest discomfort, acute heart failure).
- ECG must show regular, narrow-complex rhythm.
- Vagal maneuvers (e.g., Valsalva, carotid sinus massage) increase vagal tone to slow heart rate.
Memory trick: Start with Vagal, then Zap with Meds!