Quiz Questions

A 90-year-old woman is brought into the hospital outpatient clinic. She says that she feels weak and slightly dizzy. Her blood pressure is 77/34, and her heart rate is between 132 and 159 bpm. The ECG shows atrial fibrillation.

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1. What is the most appropriate treatment for her?

1. Digoxin
2. Defibrillation
3. Diltiazem
4. Synchronized cardioversion
5. Amiodarone

2. List three arrhythmias associated with unstable tachycardia, excluding atrial fibrillation.

3. Which of the following sequences for cardioversion is most appropriate for a patient in atrial fibrillation? (You are using a monophasic device.)

1. 50 J, 100 J, 200 J, 300 J, 360 J
2. 100 to 120 J, 200 J, 300 J, 360 J
3. 100 J, 200 J, 300 J, 360 J
4. 360 J 360 J 360 J 260 J

4. What is the initial finding you need to guide your assessment and treatment of the patient?

5. What are the next three questions that guide an emergency team in the management of a patient with tachycardia?

6. The patient has the same rhythm on the monitor but is now unstable. Which treatment would you select?

An elderly man is brought into the ED by his grandson. He is not responding, but he does have a faint carotid pulse. His heart rate is estimated to be about 150 and his blood pressure is 50/24. His skin is cool, pale, and damp. You request an ECG, which shows the following rhythm:

7. What is the rhythm?

8. What is the recommended next step?

1. Sedation
2. Amiodarone 150 mg IV
3. Synchronized cardioversion
4. Cardiology consult

A co-worker comes in with 48-year-old man who is complaining of chest pain. His heart rate is >176. He is light-headed and worried about fainting. You assess the patient's ABCDs using the primary and secondary surveys, and request an ECG.

Here is what appears on the ECG:

You are unsure what the rhythm is, but the patient is deteriorating and his rate is irregular and fast. You request a cardiology consult. You alert the team.

9. Do you administer an unsynchronized shock or a synchronized shock?

10. With help from the team, you identify the rhythm as

1. monomorphic VT.
2. atrial flutter.
3. atrial fibrillation.
4. polymorphic VT.
5. supraventricular VT.

Quiz Questions

1. Answer: D. Synchronized cardioversion
2. Answers: These are the arrhythmias associated with unstable tachycardia, excluding atrial fibrillation:
   1. Monomorphic VT
   2. Polymorphic VT
   3. Wide-complex tachycardia
   4. Supraventricular tachycardia
   5. Atrial flutter
3. Answer: B. 100 to 120 J, 200 J, 300J, 360 J
4. Answer: D. Administer adenosine.
5. Answer:
   1. Is the patient stable or unstable?
   2. Is the QRS wide or narrow?
   3. Is the ventricular rhythm regular or irregular?
6. Answer:
   1. When the patient has no pulse
   2. When the patient is deteriorating clinically (severe shock, in polymorphic VT, or when a delay in converting the rhythm may result in pulseless arrest)
   3. When you are unsure whether the unstable patient's rhythm is monomorphic or polymorphic VT.
7. Answer: Monomorphic VT
8. Answer: C. Synchronized cardioversion
9. Answer: Unsynchronized
10. Answer: D. polymorphic VT