Examkin

Question

Difficulty: EasyInitial Stabilization and Triage

During a routine morning round on the telemetry unit, a hospitalized patient suddenly loses consciousness, and the central monitor instantly displays coarse ventricular fibrillation. No carotid pulse is palpable. Arrange the following emergency interventions in the correct chronological sequence according to standard Advanced Cardiac Life Support (ACLS) protocols for this specific presentation.

  1. 1Initiate continuous high-quality chest compressions
  2. 2Deliver a biphasic electrical defibrillation shock
  3. 3Administer 1 mg of intravenous epinephrine
  4. 4Administer 300 mg of intravenous amiodarone

Answer

The correct sequence begins with immediate chest compressions, followed by early defibrillation, then epinephrine if the rhythm is refractory, and finally amiodarone for persistent ventricular fibrillation.
In the ACLS algorithm for ventricular fibrillation or pulseless ventricular tachycardia, immediate high-quality CPR is the foundational first step. As soon as a defibrillator is available, the patient should receive an electrical shock. If the shockable rhythm persists after another 2-minute cycle of CPR, epinephrine is administered. If the rhythm still does not convert after a subsequent shock, an antiarrhythmic such as amiodarone is given.

Step-by-Step Solution

1
Recognize cardiac arrest and immediately start CPR.
Maintains minimal coronary and cerebral perfusion.
Chest compressions are the fundamental first step in any pulseless patient while awaiting further equipment.
2
Perform electrical defibrillation.
Attempts to reset the electrical activity of the heart.
Ventricular fibrillation is a shockable rhythm, and early defibrillation is the only definitive treatment to restore an organized rhythm.
3
Administer epinephrine.
Causes peripheral vasoconstriction, increasing aortic diastolic pressure.
Given if the rhythm does not convert after the initial shock and subsequent CPR, to help improve perfusion during ongoing compressions.
4
Administer amiodarone.
Alters the myocardial action potential and refractory period.
Used as a second-line pharmacological agent when the patient remains in shock-refractory ventricular fibrillation despite early defibrillation and epinephrine.

Key Concept

Advanced Cardiac Life Support (ACLS) Pulseless Arrest Algorithm for Shockable Rhythms
Estimated Time:1m 0s
Rate this question

Topics

Initial Stabilization and Triage

More questions from this topic