NREMT Paramedic Cognitive ExamCardiology & ResuscitationHard
A 28-year-old male collapses during a basketball game. CPR is initiated immediately by bystanders. Upon paramedic arrival, the patient is pulseless, and the monitor shows a wide, regular tachycardia at 200 bpm. What is the MOST appropriate immediate action?
- ADefibrillate immediately with a biphasic device at 200 J.
- BAdminister amiodarone 300 mg IV.
- CPerform synchronized cardioversion at 100 J.
- DAdminister adenosine 6 mg IV rapid push.
Show answer & explanationAnswer & explanation
Correct answer: A. Defibrillate immediately with a biphasic device at 200 J.
The patient is pulseless with a wide, regular tachycardia. This is considered pulseless ventricular tachycardia (pVT), which is treated identically to ventricular fibrillation (VF) in cardiac arrest. Both are shockable rhythms, and immediate defibrillation is the highest priority intervention.
Why the other options are wrong
- B. Amiodarone is given after the first shock and CPR cycle for refractory VF/pVT.
- C. Synchronized cardioversion is for unstable but *pulseless* tachycardias; this patient is pulseless, making defibrillation the correct intervention.
- D. Adenosine is for narrow-complex tachycardias or diagnostic for wide-complex, but not for pulseless wide-complex tachycardia.
Pulseless Ventricular Tachycardia (pVT)
A wide, regular, fast heart rhythm originating in the ventricles, where the patient has no palpable pulse. It is a form of cardiac arrest and is treated as a shockable rhythm.
- Treated identically to ventricular fibrillation (VF).
- Immediate defibrillation is the priority.
- High-quality CPR should continue between shocks.
Memory trick: Pulseless VT: 'Shock' it 'Strong' and 'Soon'!