tommyk
05-16-2006, 07:21 PM
Hy 2217 Know how to read an EKG in its most basic, I had a question on that myself...
Now, a 40-year-old male marathon runner suddenly loses consciousness and falls to the ground. He has been previously healthy and has been on no medications. There is no obvious evidence of trauma. An electrocardiogram reveals wide complex tachycardia at a rate of 330 beats per minute. Which of the following is the most appropriate thing to do?
1-Get Vitals and call paramedics
2-Give a bolus of IV lidocaine
3-Tap him on the back and say he made a great attempt at the marathon and go home.
4-Perform asynchronous cardioversion
5-Perform synchronous cardioversion
7-Give him a PO challenge (small sips of water underneath, away from direct sunlight)
8-Give him an IV bolus of 5% D ½ normal saline over 24 hours.
9-Put on a 24 hour telemetry monitor.
ans) #4. The patient is in ventricular tachycardia (Know how this looks on an EKG) and is hemodynamically unstable as apparent from the loss of consciousness. He should be emergently cardioverted asynchronously with 200 joules of energy initially. He is hemodynamically unstable, as apparent from his loss of consciousness. Precious time will be lost by obtaining vital signs if cardioversion can be done now. A lidocaine bolus should be given once a pulse and sinus rhythm is obtained to keep him out of ventricular tachycardia. This is especially beneficial if the event is ischemic in origin. He may be having an infarct, and this may be the cause of his ventricular tachycardia. Emergently, the physician needs to restore sinus rhythm and then the man will be treated for myocardial infarction, if indicated. If the patient were stable, synchronous cardioversion could be attempted, as well as the IV boluses. The telemetry answer is completely bogus, it is usually used inpatient when a pt has a syncope episode and you cannot figure out why...
Now, a 40-year-old male marathon runner suddenly loses consciousness and falls to the ground. He has been previously healthy and has been on no medications. There is no obvious evidence of trauma. An electrocardiogram reveals wide complex tachycardia at a rate of 330 beats per minute. Which of the following is the most appropriate thing to do?
1-Get Vitals and call paramedics
2-Give a bolus of IV lidocaine
3-Tap him on the back and say he made a great attempt at the marathon and go home.
4-Perform asynchronous cardioversion
5-Perform synchronous cardioversion
7-Give him a PO challenge (small sips of water underneath, away from direct sunlight)
8-Give him an IV bolus of 5% D ½ normal saline over 24 hours.
9-Put on a 24 hour telemetry monitor.
ans) #4. The patient is in ventricular tachycardia (Know how this looks on an EKG) and is hemodynamically unstable as apparent from the loss of consciousness. He should be emergently cardioverted asynchronously with 200 joules of energy initially. He is hemodynamically unstable, as apparent from his loss of consciousness. Precious time will be lost by obtaining vital signs if cardioversion can be done now. A lidocaine bolus should be given once a pulse and sinus rhythm is obtained to keep him out of ventricular tachycardia. This is especially beneficial if the event is ischemic in origin. He may be having an infarct, and this may be the cause of his ventricular tachycardia. Emergently, the physician needs to restore sinus rhythm and then the man will be treated for myocardial infarction, if indicated. If the patient were stable, synchronous cardioversion could be attempted, as well as the IV boluses. The telemetry answer is completely bogus, it is usually used inpatient when a pt has a syncope episode and you cannot figure out why...