NREMT Paramedic Cognitive ExamCardiology & ResuscitationHard
A 40-year-old male collapses during a basketball game. Bystanders initiated CPR immediately. Upon arrival, you find the patient is unresponsive, pulseless, and apneic. The cardiac monitor shows a wide, irregular QRS complex rhythm with no discernible P waves, at a rate of 180 bpm. What is the most appropriate next intervention?
- AInitiate transcutaneous pacing
- BAdminister Adenosine 6 mg IV push
- CAdminister Amiodarone 300 mg IV
- DPerform immediate defibrillation at 200 J (biphasic)
Show answer & explanationAnswer & explanation
Correct answer: D. Perform immediate defibrillation at 200 J (biphasic)
The patient is in cardiac arrest, unresponsive, pulseless, and apneic, with a cardiac monitor showing a wide, irregular QRS complex rhythm consistent with Polymorphic Ventricular Tachycardia (PVT) or Ventricular Fibrillation (VF). Both are shockable rhythms, and immediate defibrillation is the priority intervention to terminate the life-threatening arrhythmia.
Why the other options are wrong
- A. Transcutaneous pacing is for symptomatic bradycardia, not pulseless tachyarrhythmias.
- B. Adenosine is used for stable narrow-complex tachycardias, not pulseless wide-complex rhythms.
- C. Amiodarone is an antiarrhythmic given after initial defibrillation and CPR, not as the primary first intervention for a shockable rhythm.
Pulseless Ventricular Tachycardia/Fibrillation Treatment
Pulseless Ventricular Tachycardia (pVT) and Ventricular Fibrillation (VF) are life-threatening cardiac arrest rhythms requiring immediate defibrillation.
- Both are 'shockable' rhythms.
- Defibrillation is the most critical intervention.
- CPR should be continuous between shocks.
Memory trick: Shock the v-fib, pace the slow, check the PEA, asystole's a no-go.