Question

First-line therapy for patients with torsades who are conscious and stable vs unconscious:

a) Conscious and stable: IV magnesium sulfate; Unconscious: Immediate defibrillation
b) Conscious and stable: IV amiodarone; Unconscious: IV epinephrine
c) Conscious and stable: IV lidocaine; Unconscious: Immediate cardioversion
d) Conscious and stable: IV adenosine; Unconscious: IV beta-blockers

Answer 1

For conscious and stable patients with Torsades de Pointes, IV magnesium sulfate is the first-line treatment, while unconscious patients require immediate defibrillation to restore normal heart rhythm.

Step-by-step explanation:

The appropriate first-line therapy for a patient with Torsades de Pointes (TdP), which is a form of ventricular fibrillation, depends on the patient's level of consciousness and hemodynamic stability. For conscious and stable patients, the recommended treatment is intravenous (IV) magnesium sulfate. In contrast, an unconscious patient exhibiting TdP requires immediate defibrillation to restore a normal cardiac rhythm.

This is consistent with standard emergency protocols for life-threatening arrhythmias where the rapid correction of the heart rhythm can be life-saving, particularly in the acute setting of TdP that leads to hemodynamic compromise or cardiac arrest. Therefore, the correct answer is a) Conscious and stable: IV magnesium sulfate; Unconscious: Immediate defibrillation.