CPR and defibrillation should be initiated in which of the arrhythmias?

AIIMS Raipur lecturer 2021

Medical & Surgical Nursing

Easy

Appeared in: AIIMS Raipur lecturer 2021

Explanation

Ventricular Fibrillation (VF) is a life-threatening arrhythmia where the ventricles quiver chaotically instead of pumping blood.
This rhythm results in no cardiac output, no pulse, and immediate cardiac arrest.
VF is a 'shockable' rhythm, meaning the definitive treatment is an immediate unsynchronized electrical shock (defibrillation) to reset the heart's electrical activity.
High-quality CPR must be performed concurrently to circulate blood to vital organs until defibrillation can be successfully administered.

Option A: Atrial flutter is an arrhythmia originating in the atria. While it can cause a rapid heart rate and may require treatment (like synchronized cardioversion if unstable), it does not inherently cause cardiac arrest and is not treated with defibrillation.
Option B: Premature ventricular contractions (PVCs) are extra, isolated beats and are typically benign. They do not cause cardiac arrest or require CPR/defibrillation.
Option C: Sinus tachycardia is a fast but regular heart rhythm, usually a normal response to stress, fever, or hypovolemia. The heart is still pumping effectively, and treatment focuses on the underlying cause, not defibrillation.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Identification of shockable cardiac rhythms requiring immediate CPR and defibrillation as background academic context rather than a clinical decision trigger.
Rapid identification of shockable versus non-shockable rhythms is a critical skill for nurses in emergency and critical care settings. The ACLS algorithm depends on this initial assessment.
For Ventricular Fibrillation, every minute of delay in defibrillation decreases the chance of survival by approximately 10%. This highlights the urgency of initiating the 'chain of survival': early recognition, early CPR, and early defibrillation.
What if? If the patient had a pulse with a very fast, wide-complex tachycardia, the rhythm would be Ventricular Tachycardia (VT). The immediate action would change. Instead of defibrillation (unsynchronized shock), the nurse would prepare for synchronized cardioversion if the patient is unstable, or administer anti-arrhythmic medications if stable.

How to Approach the Question

First, understand the question's core concept: it's asking for a condition that causes immediate cardiac arrest and is treated with both CPR and defibrillation.
Analyze the term 'defibrillation'. This refers to an unsynchronized electrical shock used to terminate a chaotic, life-threatening rhythm without a pulse.
Review the options: Think about the pathophysiology of each arrhythmia.
Atrial flutter, PVCs, and sinus tachycardia are rhythms that do not, by themselves, represent a complete cessation of cardiac output. They can be precursors or symptoms, but are not the same as pulseless cardiac arrest.
Identify Ventricular Fibrillation as the rhythm characterized by chaotic ventricular quivering, no pulse, and no cardiac output.
Conclude that only Ventricular Fibrillation fits the criteria of requiring immediate CPR (to circulate blood) and defibrillation (to correct the lethal rhythm).

Concept Tested & Keywords

Concept Tested: Identification of shockable cardiac rhythms requiring immediate CPR and defibrillation.
Stem keywords: CPR, defibrillation, arrhythmias
Lead-in keywords: initiated in which