ACLS review: Wide Complex Tachycardia (WCT) Review Questions Part 3

21.  Explain the technique for performing a Valsalva maneuverer.

22.  What are some contraindications for performing carotid sinus massage?

23.  Cardioversion has been shown to be ineffective in the treatment of what two rhythms?

24.  What is synchronized cardioversion? 

25.  What are some examples of wide complex tachycardia (QRS >0.12 second)?

26.  Explain how vagal maneuvers and adenosine may aid in the correct identification of a tachyarrhythmia.

27. What should the health care provider do if the patient fails to respond to an initial dose of adenosine? 

28. If a patient in symptomatic wide complex tachycardia fails to respond to adenosine, what beta blocker can be used?

29. What are some signs and symptoms of unstable wide complex tachycardia?

30.  What are four initial interventions that are used in the treatment of symptomatic wide complex tachycardia?

Answers

21.  Explain the technique for performing a Valsalva maneuverer.

Document the dysrhythmia before treating

Explain the procedure to the patient

Instruct the patient to inhale and hold their breath and

Bear down as if to have a bowel movement, and to hold this position for 20-30 seconds

Document any rhythm changes on the monitor.

22.  What are some contraindications for performing carotid sinus massage?

Avoid in elderly

Carotid bruits

History of CVA

Recent MI or myocardial ischemia

23.  Cardioversion has been shown to be ineffective in the treatment of what two rhythms?

Cardioversion is not effective for treatment of junctional tachycardia or multifocal atrial tachycardia.

24.  What is synchronized cardioversion? 

It is a shock delivery that is timed (synchronized) with the QRS complex. This synchronization avoids shock delivery during the relative refractory portion of the cardiac cycle, when a shock could produce VF.

25.  What are some examples of wide complex tachycardia (QRS 0.12 second)?

Ventricular tachycardia (VT)

SVT with aberrancy

Pre-excited tachycardias (Wolff-Parkinson-White [WPW] syndrome)

26.  Explain how vagal maneuvers and adenosine may aid in the correct identification of a tachyarrhythmia.

The diagnostic value of vagal maneuvers and adenosine is to transiently slow ventricular rate so that the arrhythmia can accurately be identified

27. What should the health care provider do if the patient fails to respond to an initial dose of adenosine? 

If the rhythm does not convert within 1 to 2 minutes, the health care provider should give 12mg of adenosine rapid IV push.

28. If a patient in symptomatic wide complex tachycardia fails to respond to adenosine, what beta blocker can be used?

Sotalol 1.5 mg/kg over 5 minutes

29. What are some signs and symptoms of unstable wide complex tachycardia?

Shortness of breath

Chest pain

Altered mental status

Weakness

Hypotension

Ischemic ECG changes

Pulmonary edema

Poor peripheral perfusion

30.  What are four initial interventions that are used in the treatment of symptomatic wide complex tachycardia?

Mnemonic for Treating WCT:  PREVADE

Primary Survey- ABCs

Recognize if the patient is stable or unstable

Evaluate rhythm- EKG

Vagal Maneuvers

Then try-

Adenosine & Antiarrhythmics

Direct cardioversion

Expert consultation


Reviewed on 2/28/16