NREMT Paramedic Cognitive ExamCardiology & ResuscitationMedium
A 70-year-old female presents with sudden onset of dizziness, weakness, and lightheadedness. Her ECG shows a regular rhythm with a ventricular rate of 30 bpm, P waves present but not consistently followed by QRS complexes, and a variable PR interval. She is hypotensive and confused. Which of the following is the MOST appropriate initial intervention?
- APerform synchronized cardioversion
- BAdminister Amiodarone 150 mg IV over 10 minutes
- CAdminister Adenosine 6 mg IV push
- DInitiate transcutaneous pacing
Show answer & explanationAnswer & explanation
Correct answer: D. Initiate transcutaneous pacing
The patient's ECG findings (ventricular rate of 30 bpm, P waves not consistently followed by QRS, variable PR) are consistent with a symptomatic third-degree (complete) AV block. Given her hypotension and confusion, she is hemodynamically unstable. Transcutaneous pacing is the most appropriate initial intervention for symptomatic bradycardia that is causing hemodynamic instability.
Why the other options are wrong
- A. Synchronized cardioversion is used for unstable tachyarrhythmias, not bradycardia.
- B. Amiodarone is an antiarrhythmic used for tachyarrhythmias and would not be appropriate for symptomatic bradycardia.
- C. Adenosine is used for narrow-complex tachycardias and would worsen bradycardia, potentially causing asystole.
Symptomatic Bradycardia Management
Interventions for a slow heart rate causing signs of hypoperfusion, with transcutaneous pacing as the definitive immediate treatment.
- Assess for hemodynamic instability.
- Atropine is first-line for stable bradycardia.
- Transcutaneous pacing for unstable bradycardia.
Memory trick: Slow Heart, Slow Response: Pacing Prevails When Atropine Fails!