Question

You are called to assist a 55-year-old male who complains of sudden onset chest pain, dyspnea, and palpitations. On arrival, he is found semi-conscious with a pulse rate too fast to palpate and a blood pressure of 80 systolic. Once on the monitor, he is exhibiting an irregularly wide complex tachycardia, with a polymorphic QRS appearance, at nearly 200 per minute. Which of the following would be the most effective intervention for this patient?

A) Administer procainamide at 20 mg/min IV infusion, per protocol

B) Administer 6 mg of adenosine IVP, followed by 12 mg, twice for a total of 30 mg, per protocol

C) Administer defibrillation per protocol

D) Administer synchronized electrical cardioversion at 50-100 joules, per protocol

Answer 1

Administering synchronized electrical cardioversion at 50-100 joules, per protocol is the most effective intervention for a 55-year-old male experiencing a irregularly wide complex tachycardia with hemodynamic instability.

Step-by-step explanation:

A 55-year-old male presenting with sudden onset chest pain, dyspnea, palpitations, semi-conscious state, a rapid pulse that is too fast to palpate, and low blood pressure is indicative of a cardiac emergency. The description of the electrocardiogram shows an irregularly wide complex tachycardia with a polymorphic QRS appearance at a rate of nearly 200 beats per minute. Considering the severity of the condition with hemodynamic instability and the rhythm described, the most effective intervention for this patient would be administering synchronized electrical cardioversion at 50-100 joules, per protocol. This procedure is essential in delivering a timed electrical shock to the heart to restore a normal rhythm when a patient is experiencing a dangerous arrhythmia with pulses.