Just before cardiac arrest, which ECG abnormality is seen in the patient?

NORCET 2 - 2021 (shift-1)

Medical Surgical Nursing

Hard

Appeared in: NORCET 2 - 2021 (shift-1)

Explanation

The ECG shows Ventricular Tachycardia (VT), a life-threatening arrhythmia characterized by a fast rate (100-250 bpm) and wide QRS complexes (greater than 0.12s).
VT is a common precursor to cardiac arrest because it severely compromises cardiac output and can quickly degenerate into Ventricular Fibrillation (VF), a non-perfusing rhythm.
The rhythm in the image is rapid and regular with wide, bizarre QRS complexes, which are the hallmark signs of monomorphic VT.
Recognizing VT is critical because it is a 'shockable' rhythm in a pulseless patient, and immediate defibrillation can be lifesaving.

Option A: Atrial Fibrillation (AF) is a supraventricular arrhythmia. It is not typically an immediate precursor to cardiac arrest, unlike VT.
Option C: This term is too general. While VT is a type of dysrhythmia, the question requires the identification of the specific abnormality that precedes cardiac arrest.
Option D: This term is non-specific. While some life-threatening rhythms like Polymorphic VT or VF are irregular, the classic monomorphic VT shown in the image is regular.

Visual 1: Diagram - A comparative chart showing the ECG strips for Normal Sinus Rhythm, Ventricular Tachycardia, and Ventricular Fibrillation side-by-side to highlight the differences in rate, rhythm, and QRS morphology.
Visual 2: Flowchart - The ACLS (Advanced Cardiovascular Life Support) algorithm for managing a patient with pulseless Ventricular Tachycardia, showing the sequence of CPR, rhythm analysis, defibrillation, and medication administration.

Clinical Relevance

Nursing practice connection: Prioritize focused assessment, early escalation, and real-time monitoring when managing Identification of life-threatening cardiac arrhythmias on an ECG in acute care settings.
Rapid recognition of VT on an ECG monitor is a critical nursing skill. The immediate nursing action is to assess the patient's responsiveness and check for a pulse.
If the patient is pulseless, this is a medical emergency (Code Blue). The nurse must initiate high-quality CPR and call for the resuscitation team and defibrillator immediately.
VT is one of the two 'shockable' rhythms (along with VF). Early defibrillation is the most effective treatment for terminating pulseless VT and restoring a perfusing rhythm.

How to Approach the Question

First, analyze the provided ECG image systematically. Assess the rate (is it fast or slow?), the rhythm (is it regular or irregular?), and the QRS complex (is it narrow or wide?).
Based on the analysis, identify the specific arrhythmia. A fast rate, regular rhythm, and wide QRS complexes point directly to Ventricular Tachycardia (VT).
Next, consider the clinical context provided in the question: 'just before cardiac arrest'.
Recall the common pathways to cardiac arrest. Life-threatening ventricular arrhythmias like VT and VF are the most frequent immediate precursors.
Evaluate the options. Eliminate overly general terms like 'Dysrhythmia' and incorrect rhythms like 'AF'. Select the option that specifically and accurately identifies the arrhythmia shown and fits the clinical context.

Concept Tested & Keywords

Concept Tested: Identification of life-threatening cardiac arrhythmias on an ECG.
Stem keywords: cardiac arrest, ECG abnormality
Lead-in keywords: which
Clinical cues: The visual information from the ECG strip is the primary clue to identifying the specific arrhythmia.

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