Question

"Your adult patient is experiencing lightheadedness and shortness of breath. He is found to be bradycardic with a second-degree type II AV heart block on the electrocardiogram. His heart rate is 44 beats per minute, and he is breathing 20 times per minute, and has a blood pressure of 90 systolic. He is cool and pale but denies chest pain.

Which of the following would be most appropriate if the patient fails to respond to atropine?

A) Administer 1 milligram of epinephrine
B) Synchronized cardioversion at 10 joules
C) Transcutaneous pacing
D) Administer a 500-milliliter IV bolus of normal saline"

Answer 1

For a bradycardic patient with second-degree type II AV block not responding to atropine, transcutaneous pacing is the most suitable intervention to restore an adequate heart rate and ensure sufficient blood flow.

Step-by-step explanation:

The question pertains to the appropriate medical intervention for an adult patient with a second-degree type II AV block who is symptomatic and has failed to respond to atropine. With a resting heart rate of 60-100 bpm considered normal, this patient is experiencing bradycardia, with a rate below the expected threshold, and is displaying symptoms such as lightheadedness and shortness of breath, indicating insufficient oxygenated blood flow to body tissues.

Should atropine fail to improve the patient's condition, the most appropriate next step would be transcutaneous pacing. This method serves to normalize heart rhythm by providing electrical stimulation to maintain an adequate heart rate. Other options, like administering epinephrine, may be necessary in different contexts but are secondary to pacing in this specific scenario where immediate, direct intervention in the heart's rhythm is needed.