Critical Care Medicine-Neurologic Disorders>>>>>Life Support and Resuscitation
Question 1#

A patient presents to the emergency department (ED) with acuteonset chest pain radiating to his jaw and down his left arm. During evaluation he becomes unresponsive and pulseless. His ECG demonstrated wide complex tachycardia.

Which of the following answer choices is most correct regarding the underlying rhythm and coinciding appropriate treatment for this patient?

A. Pulseless electrical activity (PEA), synchronized cardioversion with biphasic 120 J
B. Pulseless ventricular tachycardia, synchronized cardioversion with monophasic 360 J
C. Ventricular fibrillation, unsynchronized cardioversion with biphasic 120 J
D. PEA, unsynchronized cardioversion with biphasic 200 J
E. Pulseless ventricular tachycardia, unsynchronized cardioversion with biphasic 120 J

Correct Answer is E

Comment:

Correct Answer: E

A successful resuscitation effort is determined by high-quality CPR in addition to timely defibrillation, if amenable. Recognizing the difference between shockable and nonshockable rhythms is key to resuscitation efforts. The patient in this question has pulseless ventricular tachycardia, which should be treated with biphasic unsynchronized cardioversion starting at 120 J. This cardioversion continues during the process of advanced cardiac life support (ACLS) until ROSC occurs or the patient becomes asystolic or develops PEA. If using a monophasic defibrillator, then a single unsynchronized 360-Joule dose should be administered.

Reference:

  1. Link MS, Berkow LC, Kudenchuk PJ, et al. Part 7: adult advanced cardiovascular life support: 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2015;132(18 suppl 2):S444-S464.