A 65-year-old man is admitted to the cardiac intensive care unit following a myocardial infarction. While he is resting in bed, the telemetry monitor suddenly alarms, showing a wide-complex tachycardia at a rate of 180/min. The nurse rushes into the room and finds the patient completely unresponsive. Arrange the following critical next steps in the correct chronological sequence according to standard Advanced Cardiovascular Life Support (ACLS) protocols.
- 1Verify the absence of a central pulse
- 2Initiate high-quality cardiopulmonary resuscitation (CPR)
- 3Deliver an unsynchronized defibrillation shock
- 4Administer intravenous epinephrine
Cevap
The correct sequence is to first verify the absence of a pulse, immediately initiate CPR, deliver a defibrillation shock, and then administer epinephrine.
In an unresponsive patient with a concerning rhythm on telemetry, the first step is to rapidly assess for a pulse (checking for 5 to 10 seconds). Once pulseless ventricular tachycardia is confirmed, high-quality CPR must be initiated immediately while the defibrillator is charging. Defibrillation (unsynchronized shock) is the primary treatment for pulseless ventricular tachycardia and should be delivered as soon as possible. Epinephrine is administered later in the algorithm to maintain coronary and cerebral perfusion pressures, typically after the first or second shock fails to achieve the return of spontaneous circulation.
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Anahtar Kavram
The ACLS cardiac arrest algorithm for shockable rhythms (pulseless ventricular tachycardia and ventricular fibrillation) prioritizes a rapid pulse check, immediate CPR, early defibrillation, and subsequent pharmacotherapy with epinephrine.