A 62-year-old man is evaluated in the cardiac intensive care unit following an acute anterior myocardial infarction. On hospital day 2, the telemetry monitor suddenly alarms, demonstrating a chaotic, irregular rhythm with an undulating baseline and no discernible P waves, QRS complexes, or T waves. The patient is found unresponsive, apneic, and pulseless. The emergency response team arrives immediately with a defibrillator, and chest compressions are initiated. Arrange the following subsequent interventions in the most appropriate chronological sequence according to standard Advanced Cardiovascular Life Support (ACLS) guidelines for this presentation.
- 1Deliver the initial unsynchronized defibrillation shock
- 2Resume continuous high-quality chest compressions for 2 minutes
- 3Perform a rhythm check and deliver a second unsynchronized shock
- 4Administer 1 mg of intravenous epinephrine during chest compressions
- 5Administer 300 mg of intravenous amiodarone following a third shock
Cevap
The correct sequence for managing persistent ventricular fibrillation is: 1) Initial defibrillation, 2) Two minutes of continuous chest compressions, 3) Second defibrillation, 4) Epinephrine administration, and 5) Amiodarone administration.
According to ACLS guidelines for shockable rhythms (ventricular fibrillation/pulseless ventricular tachycardia), the immediate priority is an unsynchronized shock. This is strictly followed by 2 minutes of uninterrupted chest compressions. After 2 minutes, the rhythm is re-checked, and a second shock is delivered if the rhythm remains shockable. Epinephrine (1 mg) is administered during the CPR cycle that follows the second shock. If the rhythm persists through a third shock, amiodarone (300 mg) is administered during the subsequent CPR cycle.
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Anahtar Kavram
Advanced Cardiovascular Life Support (ACLS) Pulseless Arrest Algorithm