CCT Cardiac Monitoring & Emergency Response 5 — Questions and Answers
Question 1: During a rapid response event, the team identifies the rhythm as supraventricular tachycardia (SVT) with a rate of 170 bpm in a hemodynamically stable patient. The first-line pharmacologic treatment is:
- Amiodarone 300 mg IV push
- Adenosine 6 mg rapid IV push (Correct answer)
- Diltiazem 0.25 mg/kg IV infusion
- Metoprolol 5 mg IV slow push
Correct answer: Adenosine 6 mg rapid IV push
Adenosine 6 mg given as a rapid IV push followed by a saline flush is the first-line drug for terminating stable SVT by transiently blocking AV nodal conduction.
Question 2: Which of the following ECG findings is most suggestive of digoxin toxicity?
- Prolonged QT with U waves
- Sagging ST depression with a scooped appearance and slow ventricular rate (Correct answer)
- Tall peaked T waves and wide QRS
- Symmetric T-wave inversions in V1–V4
Correct answer: Sagging ST depression with a scooped appearance and slow ventricular rate
Digoxin produces a characteristic scooped or 'Salvador Dali mustache' ST depression along with bradyarrhythmias due to increased vagal tone.
Question 3: A CCT observes fusion beats and capture beats during a wide complex tachycardia. These findings are diagnostic of:
- Accelerated idioventricular rhythm
- Ventricular tachycardia (Correct answer)
- Atrial flutter with 2:1 block
- Right bundle branch block with SVT
Correct answer: Ventricular tachycardia
Fusion beats (partial sinus and ventricular depolarization) and capture beats (brief sinus capture) are pathognomonic criteria for ventricular tachycardia per Brugada criteria.
Question 4: What is the correct pad placement for anteroposterior (AP) defibrillation?
- Right subclavian and left lateral chest at the 5th ICS midaxillary line
- One pad over the sternum and one pad on the right back
- One pad on the left anterior precordium and one pad on the posterior left thorax (Correct answer)
- Both pads placed on the anterior chest symmetrically
Correct answer: One pad on the left anterior precordium and one pad on the posterior left thorax
AP placement positions one pad over the left precordium (cardiac apex area) and the second pad on the posterior left thorax directly behind the heart.
Question 5: A patient being monitored post-cardiac catheterization develops sudden onset of hypotension, distended neck veins, and muffled heart sounds. The ECG shows low voltage and sinus tachycardia. The technician should suspect:
- Tension pneumothorax
- Acute pulmonary embolism
- Cardiac tamponade (Correct answer)
- Aortic dissection
Correct answer: Cardiac tamponade
Beck's triad (hypotension, JVD, muffled heart sounds) combined with low-voltage ECG after cardiac catheterization strongly suggests pericardial tamponade from procedural complication.
Question 6: In a paced rhythm, which ECG feature confirms ventricular pacing (not atrial pacing)?
- A pacing spike before each P wave
- A pacing spike before each QRS with a left bundle branch block morphology (Correct answer)
- A shortened PR interval following the spike
- Normal narrow QRS following each spike
Correct answer: A pacing spike before each QRS with a left bundle branch block morphology
Ventricular pacing shows a spike immediately before a wide, LBBB-morphology QRS because the right ventricle is stimulated first via a right ventricular lead.
Question 7: When a cardiac monitor shows 60-cycle interference artifact, the most appropriate corrective action is:
- Apply more electrode gel and increase monitor gain
- Check and reattach electrode leads, ensuring good skin contact and proper electrode placement away from power sources (Correct answer)
- Switch to a different monitoring lead and increase the filter setting
- Replace the entire monitoring cable set and reboot the monitor
Correct answer: Check and reattach electrode leads, ensuring good skin contact and proper electrode placement away from power sources
60-Hz AC interference is usually resolved by improving electrode skin contact, ensuring leads are not near electrical equipment, and verifying electrode placement.
CCT Cardiac Monitoring & Emergency Response 5
During a rapid response event, the team identifies the rhythm as supraventricular tachycardia (SVT) with a rate of 170 bpm in a hemodynamically stable patient.
The first-line pharmacologic treatment is: