A patient presents with palpitations. O/E the patient was conscious, pulse was fast with BP of 80/50 mmHg. He was subjected to Vagal maneuver and was given intravenous adenosine. The rhythm remains refractory to maximum dose of adenosine. What is the next step in management of this patient?
Correct Answer: Cardioversion
Description: Question about Hemodynamic instability. Vagal maneuver and IV adenosine hints about PSVT/ AVN. And Pt. is refractory to Adenosine as max. dose is already given. So, next best step would be repeat adenosine according to new ACC guidelines, Only for those patients who are hemodynamically Stable > 90 mm Hg- brains tends to switch on auto regulation Question mentions about unstable patient therefore rules out repeat adenosine. Amiodarone -mainly used in treatment of broad complex VT - H/o AVN, narrow QRS complex Therefore rules out Amiodarone Defibrillation: Done for patient with ventricular fibrillation. It is basically a non-synchronized DC shock. It is given in: a. PVT Broad QRS b. Ventricular fibrillation Therefore, ruled out. Cardioversion is synchronized DC shock used for management of patients with any tachyarrhythmia for hemodynamic unstability. RR interval constant HR =300/min Narrow QRS Global ST segment depression in all leads Subendocardial ischemia, which is usually demonstrated in patients of PSVT. In both Harrisons and ACC guidelines
Category:
Medicine
Get More
Subject Mock Tests
Practice with over 200,000 questions from various medical subjects and improve your knowledge.
Attempt a mock test nowMock Exam
Take an exam with 100 random questions selected from all subjects to test your knowledge.
Coming SoonGet More
Subject Mock Tests
Try practicing mock tests with over 200,000 questions from various medical subjects.
Attempt a mock test now