RUHS, Jaipur, PB B.Sc Nursing Entrance-2019
Medical & Surgical Nursing
Easy
If a patient is in pulseless Ventricular Tachycardia, which one of the following is the first choice of treatment?
Appeared in: RUHS, Jaipur, PB B.Sc Nursing Entrance-2019
Explanation
- Pulseless Ventricular Tachycardia (VT) is a non-perfusing, life-threatening cardiac arrest rhythm.
- The definitive and primary treatment is immediate high-energy, unsynchronized electrical shock, known as defibrillation.
- Defibrillation works by depolarizing a critical mass of myocardial cells at once, which terminates the chaotic electrical activity and allows the heart's natural pacemaker to potentially resume a normal rhythm.
- According to ACLS guidelines, early defibrillation is the most critical factor in improving survival rates for patients with pulsel-ess VT or Ventricular Fibrillation (VF).
Why Other Options Were Wrong
- Option A: Synchronized cardioversion delivers a shock timed to the R-wave. In a pulseless patient, there is no organized cardiac output, making synchronization impossible and delaying the necessary unsynchronized shock.
- Option B: A pacemaker is a device used to generate electrical impulses to treat slow heart rates (bradyarrhythmias) or heart blocks. It is not effective for terminating a rapid, chaotic rhythm like VT.
- Option D: While antiarrhythmic drugs like amiodarone or lidocaine are part of the ACLS algorithm for pulseless VT, they are administered only after initial attempts at defibrillation and CPR have been made. They are not the first-line intervention.
Related Visual
Clinical Relevance
- Nursing practice connection: Prioritize focused assessment, early escalation, and real-time monitoring when managing Management of Pulseless Ventricular Tachycardia in acute care settings.
- Nurses must be able to rapidly recognize pulseless VT on a cardiac monitor, confirm the absence of a pulse and breathing, and immediately initiate the 'Code Blue' or emergency response protocol.
- A key nursing responsibility during a cardiac arrest is ensuring high-quality CPR with minimal interruptions and safe, effective operation of the defibrillator.
- Documentation is critical. The nurse must accurately record the time of events, including rhythm changes, shocks delivered (and energy level), and medications administered.
How to Approach the Question
- First, identify the key clinical condition presented in the question: 'pulseless Ventricular Tachycardia'.
- Recognize that the word 'pulseless' is the critical determinant. This signifies a state of cardiac arrest, not just a rhythm disturbance.
- Recall the fundamental principles of Advanced Cardiac Life Support (ACLS) for shockable cardiac arrest rhythms (pulseless VT and Ventricular Fibrillation).
- The ACLS algorithm prioritizes immediate, high-quality CPR and early defibrillation as the most crucial interventions for survival.
- Evaluate each option against this priority. Defibrillation is the only option that provides an immediate, unsynchronized electrical shock to terminate the lethal rhythm.
- Eliminate the other options by identifying their correct indications: synchronized cardioversion is for tachycardia with a pulse, a pacemaker is for bradycardia, and antiarrhythmic medications are secondary treatments used after initial shocks.
Concept Tested & Keywords
- Concept Tested: Management of Pulseless Ventricular Tachycardia
- Stem keywords: pulseless Ventricular Tachycardia, first choice of treatment
- Lead-in keywords: first choice
- Clinical cues: The term 'pulseless' is the most critical piece of information, as it defines the situation as a cardiac arrest.
- Negative lead-in flag: false
Question ID
QurKi831tYI8_Y4pRy6oql
Reference Book
E6 Medicine Davidson Principles Practice 24e p. 502-504
E6 Ghai Essential Pediatrics(pp 26-904 of 913) p. 767-769
E6 Nelson Textbook of Pediatrics(2024) — Volume 2 p. 642-644
Practise the full RUHS, Jaipur, PB B.Sc Nursing Entrance-2019
Attempt every question from this paper in a timed mock, then review the full solution for each one.
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