Which procedure involves giving a synchronised countershock to convert an undesirable rhythm to a stable rhyt… - DSSSB 13 August 2024

DSSSB 13 August 2024

Medical & Surgical Nursing

Easy

Appeared in: DSSSB 13 August 2024

Explanation

Cardioversion is a medical procedure that uses a timed or 'synchronized' electrical shock to convert an abnormal, fast heart rhythm back to a normal sinus rhythm.
The key feature is synchronization: the device monitors the patient's ECG and delivers the shock precisely on the R-wave.
This timing is a critical safety measure to avoid the T-wave, as a shock during this 'vulnerable period' can trigger ventricular fibrillation (R-on-T phenomenon).
It is used for patients who have a pulse but are hemodynamically unstable due to tachyarrhythmias like atrial fibrillation, atrial flutter, or supraventricular tachycardia (SVT).

Option A: Defibrillation delivers an unsynchronized shock, meaning it is not timed to any specific part of the cardiac cycle. The question specifically asks for a 'synchronised' procedure.
Option C: This is a broad, non-specific term. While a defibrillator or cardioverter could be considered a type of 'cardiac stimulator', it is not the name of the specific procedure described.
Option D: A pacemaker is a device used to treat bradycardia (a slow heart rate). It delivers low-energy electrical pulses to pace the heart, not a high-energy countershock to terminate a fast rhythm.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Differentiating between electrical therapies for cardiac arrhythmias, specifically synchronized cardioversion and unsynchronized defibrillation as background academic context rather than a clinical decision trigger.
Understanding the difference between cardioversion and defibrillation is a critical life-saving skill for nurses. Using the wrong procedure can be fatal.
A key nursing responsibility during elective cardioversion is patient monitoring, ensuring proper sedation and analgesia, and operating the defibrillator in 'sync' mode.
The 'R-on-T' phenomenon, where a shock lands on the T-wave, can induce ventricular fibrillation. Synchronization in cardioversion is specifically designed to prevent this complication.

How to Approach the Question

First, identify the most important keyword in the question stem. In this case, it is 'synchronised'.
Understand what 'synchronised' means in the context of cardiac electrical therapy: the shock is timed to a specific part of the ECG.
Evaluate each option based on this key concept.
Recall that Defibrillation is, by definition, an 'unsynchronized' shock used in emergencies like cardiac arrest.
Eliminate 'Pacemaker' as it is used for slow heart rates (bradycardia), not for delivering countershocks for fast rhythms.
Recognize that 'Cardiac stimulator' is a general term, whereas 'Cardioversion' is the specific medical term for a synchronized countershock procedure.

Concept Tested & Keywords

Concept Tested: Differentiating between electrical therapies for cardiac arrhythmias, specifically synchronized cardioversion and unsynchronized defibrillation.
Stem keywords: procedure, synchronised countershock, undesirable rhythm, stable rhythm
Lead-in keywords: Which
Negative lead-in flag: false