Scenario data: A 58-year-old male enters your clinic today. He complains that he feels very weak and states that he occasionally has the sensation of his heart beating heavily in his chest. He states he has no chest pain or discomfort.

Skin: Pale and dry
Cardio: HR 150; BP 120/80
Resp: Lungs CTA in all fields
CNS: Alert and oriented
Monitor: (see rhythm strip below)

What is the patient's rhythm?

As you begin your assessment, the patient has a 10 second run of ventricular tachycardia which spontaneously converts back to normal sinus rhythm. During the 10 second run, the patient complained that he had some shortness of air which subsided after the episode. What is the most important intervention you should complete at this time?

You attach a monitor/defibrillator and call for an IV to be started on the patient. As you call for the IV, the patient begins to complain of a “fluttering feeling” in his chest and slight weakness. This is what you see on the monitor.

What is the rhythm?

Besides slight weakness, the patient does not seem to be unstable at this time and the QRS Complex is narrow. The patient now has oxygen on and an IV in place. What would be your first intervention?

Several attempts at vagal maneuvers are not successful. What would be your next intervention?

The 6 mg of adenosine does not convert the rhythm. What will be your next intervention?

You give the 12 mg of adenosine rapid IV push, and it does not convert the rhythm. After you give the 12 mg of adenosine, how many times can you repeat the 12mg of adenosine.

As you prepare for synchronized cardioversion, the patient’s rhythm changes and he becomes unresponsive. This is what you see on the monitor:

What is the rhythm?

You recognize the rhythm as ventricular tachycardia, and the patient does not have a pulse. What will be your first intervention?

You shock the patient at 120 J. What do you do now?

After you deliver 5 cycles of CPR, you perform a rhythm/pulse check and this is what you see on the monitor:

The patient has a faint pulse (180’s), is unresponsive, has a BP of 80/20 and is not breathing spontaneously. You are supporting ventilation with BVM. What should be your next intervention?

For synchronized cardioversion, what is the initial recommended dosage of electricity?

You perform the synchronized cardioversion and the rhythm does not convert. The patient still has a pulse. What is your next intervention?

You perform synchronized cardioversion at 200 J and the patient converts to the following rhythm:

After cardioversion, the patient has a good pulse and is breathing spontaneously (RR 8). What is the patient’s rhythm?

Great Job! The patient is stabilized and sent to the critical care unit. If the cardioversion machine would not have been able to synchronize with the patient’s rhythm when he was unstable, what would have been the best intervention?