ACLS Review Questions

6.  Three hours after admission to your unit a 67 year old who was admitted to the telemetry unit with bradycardia begins to complain of weakness and dizziness.  At the same time the telemetry tech calls you to report that although she remains in a heart block, her rate is now in the 30s.  As you assess the patient you find that she is mildly confused and anxious.  She now has mild chest pain and shortness of breath.  Her BP is 92/40 with a heart rate of 34.  The hospitalist is called and he determines that the patient needs to be prepared for transcutaneous pacing.   After applying the pacing pads and electrodes you slowly increase the mA on the defibrillator monitor and observe the monitor and note the following rhythm:

How should this rhythm be treated?

A.      The patient should be given 1mg of Atropine IV stat

B.      The patient should be given epinephrine (1:10,000) 1mg IV over 3-5 minutes

C.      The rhythm and rate is appropriate for the patient since the pacer is in the demand mode

D.       The mA should be slowly increased. 

Answer  D.          The mA should be slowly increased. 

The patient has developed unstable 2^nd degree heart block type II.   She is exhibiting signs and symptoms of instability that include hypotension, chest pain, shortness of breath, and mild confusion.  Transcutaneous pacing may be attempted or a chronotrophic  infusion such as epinephrine or dopamine can be started.  However, the MD has elected to try pacing with the goal of obtaining electrical and mechanical capture of the myocardium.   This is achieved by slowly increasing the mAs on the transcutaneous pacer until a QRS complex immediately follows a pacer spike.  After gaining electrical capture then palpate the femoral artery to determine if there is a pulse.  The pulse rate should match the pacemaker rate.   Afterwards other hemodynamic improvements should be noted.   On this rhythm strip, electrical capture has not been achieved because there are pacer spikes that are not immediately followed by QRS complexes.  Answer A is incorrect because atropine is given to a patient with symptomatic bradycardia and the dosage would be 0.5mg.  Answer B provides the right medication but the wrong means of giving it.  In unstable bradycardia epinephrine is given as and infusion rather than IV push.  Answer C is incorrect because the patient’s heart is not being paced.  On this rhythm strip, electrical capture has not been achieved because there are pacer spikes that are not followed by QRS complexes and she still presents with 2^nd degree heart block type II.



Reviewed 3/1/16