Question

Your patient is a 58-year-old female who is confused and dyspneic. Her daughter called EMS because the patient complained of a fluttering sensation in her chest, followed a few minutes later by chest pain and an acute onset of confusion. She is pale and diaphoretic without a palpable radial pulse. The monitor shows a narrow complex rhythm at a rate of 180. Which of the following is most appropriate?

A) Valsalva maneuver
B) IV adenosine
C) Immediate synchronized cardioversion
D) IV diltiazem

Answer 1

Immediate synchronized cardioversion is the most appropriate action for this patient's symptoms and presentation as it can quickly restore normal heart rhythm and is necessary in this emergency situation.

Step-by-step explanation:

The most appropriate action for a 58-year-old female patient who is confused, dyspneic, pale, diaphoretic, and exhibiting a fluttering sensation in her chest with a narrow complex rhythm at 180 bpm, and without a palpable radial pulse, would be C) Immediate synchronized cardioversion. This patient is likely experiencing a serious tachyarrhythmia that is compromising her hemodynamic stability given the presence of acute confusion, absence of palpable pulse, and rapid heart rate. Immediate synchronized cardioversion is crucial in this emergency to restore a normal rhythm and prevent further deterioration. While IV adenosine and IV diltiazem may be appropriate for stable patients, and the Valsalva maneuver could be an initial attempt in a very stable patient with supraventricular tachycardia, this patient's condition warrants more immediate intervention with cardioversion.