Ventricular Rhythms

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1

What is the most appropriate next step in management?

A 58-year-old male presents to the emergency department after experiencing severe chest pain followed by loss of consciousness. On the monitor, the rhythm shows a wide QRS complex at a rate of 180 bpm, with no P waves. The patient is pulseless.

Hint: Atropine is indicated for bradycardia rhythms.
2

Which rhythm is the patient most likely in?

A 65-year-old female with a history of heart failure suddenly becomes unresponsive while receiving treatment in the ICU. The monitor displays a rapid, irregular rhythm with a chaotic, disorganized appearance.

Hint: Often called "flatline," this is a type of cardiac arrest where the heart has stopped pumping altogether, and no detectable pulse or blood pressure is present.
3

What is the most appropriate next step in management?

A 72-year-old male with a history of coronary artery disease presents with sudden onset palpitations and dizziness. The ECG shows a monomorphic wide-complex tachycardia with a heart rate of 160 bpm. The patient is conscious and has a blood pressure of 100/60 mmHg and medications have been ineffective.

Hint: Vagal maneuvers are considered for rhythms such as SVT (narrow complex).
4

What should be your first intervention?

A 50-year-old male with no significant medical history presents to the emergency department after collapsing during exercise. His ECG shows a wide complex tachycardia at a rate of 150 bpm. He is unresponsive, and there is no palpable pulse.

Hint: Synchronized cardioversion is considered for NARROW complex tachycardias.
5

What is the best immediate treatment?

A 67-year-old woman presents with chest pain and shortness of breath. Her ECG reveals a wide complex tachycardia with a rate of 180 bpm. She is diaphoretic but remains alert and oriented. Her blood pressure is 80/50 mmHg.

Hint: Consider the patient's blood pressure and symptoms. When a patient has both hypotension and symptoms like chest pain and shortness of breath.
6

What is the most appropriate next step?

A 75-year-old male is brought to the emergency department with severe hypotension and altered mental status. The patient does not have a pulse and is diagnosed with Ventricular tachycardia and CPR has begun.

Hint: Remember, CPR has already begun.
7

What is the most appropriate intervention?

A 68-year-old male with a history of a myocardial infarction presents with syncope. On arrival, he is pale and diaphoretic, with an ECG showing wide complex tachycardia at 190 bpm. His blood pressure is 90/60 mmHg, and he is still responsive but feeling extremely weak.

Hint: Immediate defibrillation is not an appropriate intervention as the patient has a pulse.
8

What is the most appropriate next step?

A 60-year-old woman is brought to the emergency department after a syncopal episode. CPR has begun and the ER staff is preparing for defibrillation.

Hint: Also known as adrenaline, is a hormone and medication that stimulates the heart, increases blood pressure, and helps to constrict blood vessels.
9

Which underlying condition is most likely contributing to his ventricular rhythm?

A 55-year-old male with no prior cardiac history comes to the ED with complaints of palpitations and shortness of breath. His ECG shows a wide complex tachycardia with a rate of 140 bpm. Labs show elevated potassium levels.

Hint: Consider electrolyte imbalances as a cause for wide complex tachycardias
10

What is the most likely underlying mechanism of this rhythm?

A 70-year-old female collapses at home and is brought to the ED by paramedics. The monitor shows a disorganized, chaotic rhythm with no palpable pulse. Her family reports she has a history of coronary artery disease.

Hint: Consider how structural heart disease might contribute to arrhythmias.

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