Megacode: Unstable Ventricular Tachycardia Part 3

After administering the patient an analgesic and appropriate conscious sedate, synchronized cardioversion is performed on the patient. The patient remains in refractory ventricular tachycardia. Blood pressure: 90/48. Heart rate: 182. Respiratory rate: 12. Oxygen saturation: 95% on 2L/min via nasal cannula. The patient is sedate from versed and fentanyl. IV fluids are infusing.

11.  The initial cardioversion attempt is unsuccessful.  What is the next appropriate step?

a.  Deliver an unsynchronized shock at 200 Joule for refractory VT

b.  Place the monitor back in the synch mode and deliver another synchronized shock

c.  Administer adensosine 6mg rapid IV push

d.  Immediately perform bilateral carotid sinus massage on the patient

12.  How long should you wait before delivering another synchronized shock to a patient with unstable VT?

a.  Long enough to reassess the rhythm

b.  At least a minute to allow the AV node to resynchronize itself

c.  2 minutes as this allows the suppression of all ectopic ventricular activity

d.  For refractory unstable VT, the next shock should be unsynchronzied

13. Cardioversion has been shown to be ineffective in the treatment of what three rhythms?

a.
b.
c.

14.   What are three potential technical problems associated with the use of synchronized cardioversion?

a. 

b. 

c. 

15. When using a monophasic defibrillator, what is the initial joule setting used to cardiovert an adult with wide complex tachycardia?

a. 100 joules

b. 200 joules

c. 300 joules

d. 360 joules

Answers

11. The initial cardioversion attempt is unsuccessful. What is the next appropriate step?  

b. Place the monitor back in the synch mode and deliver another synchronized shock

12. How long should you wait before delivering another synchronized shock to a patient with unstable VT?

a. Long enough to reassess the rhythm

13. Cardioversion has been shown to be ineffective in the treatment of what three rhythms?

a. polymorphic ventricular tachycardia

b. junctional tachycardia

c. multifocal atrial tachycardia.

14. What are three potential technical problems associated with the use of synchronized cardioversion?
a. If the R waves are low in amplitude or the rhythm irregular, the monitor may not be able to identify and synchronize with the R wave peaks
b. Synchronization can take extra time to complete as the operator is required to apply both the adhesive pads and the monitor electrodes.
c. Many cardioverters will not synchronize through hand held, quick-look, paddles. An unwary rescuer may attempt to synchronize using that machine.

15. When using a monophasic defibrillator, what is the initial joule setting used to cardiovert an adult with wide complex tachycardia?
b. 200 joules