ACLS review: Wide Complex Tachycardia (WCT) Review Questions Part 2
11. What are 5 vagal maneuvers that can be used in the initial treatment of wide complex tachycardia?
12. What is the initial dose Adenosine when treating an adult in wide complex tachycardia?
13. When using a monophasic defibrillator, what is the initial joule setting used to cardiovert an adult with wide complex tachycardia?
14. During the treatment of refractory wide complex tachycardia, what is the second dose of adenosine?
15. What are some conditions that may predispose a patient to torsades de pointes?
16. Name three antiarrhythmics that can be used to treat stable VT?
17. What are the therapeutic endpoints for the administration of Procainamide for VT with a pulse?
18. Name 5 precautions that should be considered prior to performing carotid sinus massage?
19. An adult patient in unstable wide complex tachycardia does not respond to an initial cardioversion attempt at 100 J. What would the next step be in the treatment of this patient?
20. What signs and symptoms might be observed in an unstable patient with wide complex tachycardia that would require synchronized cardioversion?
12. What is the initial dose Adenosine when treating an adult in wide complex tachycardia?
13. When using a monophasic defibrillator, what is the initial joule setting used to cardiovert an adult with wide complex tachycardia?
14. During the treatment of refractory wide complex tachycardia, what is the second dose of adenosine?
15. What are some conditions that may predispose a patient to torsades de pointes?
Long QT syndrome
Hypomagnesaemia
Antiarrhythmic drug toxicity
Other drug toxicities: phenothiazines, tricyclic antidepressants. Calcium channel blockers
16. Name three antiarrhythmics that can be used to treat stable VT?
Procainamide
Amiodarone
Lidocaine
18. Name 5 precautions that should be considered prior to performing carotid sinus massage?
Answers
11. What are 5 vagal maneuvers that can be used in the initial treatment of wide complex tachycardia?
Valsalva maneuver
Blowing through a straw
Ice water to the face
Coughing
Carotid sinus massage
12. What is the initial dose Adenosine when treating an adult in wide complex tachycardia?
6mg IV using fast flush technique
200 J
12mg IV using fast flush technique
Long QT syndrome
Hypomagnesaemia
Antiarrhythmic drug toxicity
Other drug toxicities: phenothiazines, tricyclic antidepressants. Calcium channel blockers
Procainamide
Amiodarone
Lidocaine
17. What are the therapeutic endpoints for the administration of Procainamide for VT with a pulse?
The patient receives the maximum dose of 17mg/kg
The rhythm is suppressed
The patient becomes hypotensive
The QRS complex widens over 50% from baseline.
Avoid carotid massage in older adults
Never perform bilateral carotid massage
Listen for bruits before carotid massage- contraindicated if bruits are present
It should not be continued for more than 10 sec.
Patient should be on cardiac monitor
Should have IV access before attempting vagal maneuvers
19. An adult patient in unstable wide complex tachycardia does not respond to an initial cardioversion attempt at 100 J. What would the next step be in the treatment of this patient?
Depress the synchronized button on the monitor again
Increase the joule setting to 200 J and cardiovert the patient again
20. What signs and symptoms might be observed in an unstable patient with wide complex tachycardia that would require synchronized cardioversion?
Chest pain
Syncope
Shortness of breath
Cold and clammy skin
Decreased level of consciousness
Hypotension
Pulmonary congestion
Reviewed 2/28/16
Reviewed 2/28/16
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