NREMT Emergency Medical Technician (EMT) Cognitive ExamCardiology & ResuscitationHard
A 30-year-old male is experiencing palpitations, lightheadedness, and shortness of breath. His ECG shows a regular rhythm with a heart rate of 180 bpm, narrow QRS complexes, and no discernible P waves. He is alert and oriented, but his blood pressure is 90/60 mmHg. What is the MOST appropriate initial intervention?
- AAdminister 0.5 mg Atropine intravenously.
- BPrepare for synchronized cardioversion.
- CAdminister 6 mg Adenosine intravenously.
- DPerform vagal maneuvers.
Show answer & explanationAnswer & explanation
Correct answer: B. Prepare for synchronized cardioversion.
The patient's ECG findings (narrow QRS, HR 180 bpm, no P waves) are consistent with Supraventricular Tachycardia (SVT). While vagal maneuvers or adenosine might be considered for stable SVT, the patient is symptomatic with hypotension (BP 90/60 mmHg), indicating instability. Unstable SVT requires immediate synchronized cardioversion.
Why the other options are wrong
- A. Atropine is used for symptomatic bradycardia, not tachycardia.
- C. Adenosine is used for stable SVT, but due to the patient's instability (hypotension), cardioversion is preferred and more rapid.
- D. Vagal maneuvers are appropriate for stable SVT, but this patient is unstable due to hypotension.
Unstable Tachycardia Management
Immediate intervention for rapid heart rhythms causing signs of instability (e.g., hypotension, altered mental status, signs of shock, acute heart failure, ischemic chest discomfort).
- Identify unstable tachycardia (HR >150 bpm with symptoms of instability).
- Prioritize synchronized cardioversion.
- Sedation may be considered before cardioversion if time and patient condition allow.
- Do not delay cardioversion for unstable patients.
Memory trick: Fast heart, unstable signs? Shock 'em quick, no time for lines!