DC Treatment Planning & Management 2 — Questions and Answers
Question 1: A patient in stable monomorphic ventricular tachycardia with a heart rate of 150 bpm and a BP of 98/60 mmHg. What is the most appropriate initial treatment?
- Immediate synchronized cardioversion
- IV amiodarone 150 mg over 10 minutes (Correct answer)
- IV adenosine 6 mg rapid push
- Unsynchronized defibrillation at 200 J
Correct answer: IV amiodarone 150 mg over 10 minutes
Stable monomorphic VT is treated with IV amiodarone; cardioversion is reserved for hemodynamic compromise.
Question 2: Which energy level is recommended for synchronized cardioversion of atrial flutter?
- 200 J biphasic
- 100–200 J biphasic
- 50–100 J biphasic (Correct answer)
- 360 J monophasic
Correct answer: 50–100 J biphasic
Atrial flutter typically converts with low energy (50–100 J biphasic) due to the organized reentrant circuit.
Question 3: A patient with torsades de pointes remains hemodynamically stable. Which treatment should be given first?
- IV amiodarone 300 mg
- IV magnesium sulfate 1–2 g (Correct answer)
- Overdrive pacing at 80 bpm
- Synchronized cardioversion at 100 J
Correct answer: IV magnesium sulfate 1–2 g
IV magnesium sulfate is the first-line treatment for torsades de pointes to terminate the arrhythmia.
Question 4: During a pulseless VT/VF arrest, after the first unsuccessful defibrillation and 2 minutes of CPR, what medication is indicated?
- Lidocaine 1.5 mg/kg IV
- Epinephrine 1 mg IV every 3–5 minutes (Correct answer)
- Amiodarone 150 mg IV bolus
- Atropine 1 mg IV
Correct answer: Epinephrine 1 mg IV every 3–5 minutes
Epinephrine 1 mg IV/IO is given every 3–5 minutes during pulseless VT/VF per ACLS guidelines.
Question 5: A patient on sotalol develops prolonged QTc and then torsades de pointes. What is the most important next step?
- Increase the sotalol dose to suppress ectopy
- Discontinue sotalol and administer IV magnesium (Correct answer)
- Add amiodarone to sotalol therapy
- Perform immediate ablation
Correct answer: Discontinue sotalol and administer IV magnesium
Sotalol causes QT prolongation and should be discontinued; IV magnesium treats torsades de pointes.
Question 6: Which criterion best indicates that synchronized cardioversion should be used instead of unsynchronized defibrillation?
- The patient is pulseless
- A QRS complex is identifiable on the monitor (Correct answer)
- The heart rate exceeds 300 bpm
- The rhythm is fine ventricular fibrillation
Correct answer: A QRS complex is identifiable on the monitor
Synchronized cardioversion is appropriate when a QRS complex can be identified, avoiding delivery on the T-wave.
Question 7: A patient with permanent atrial fibrillation develops a ventricular rate of 140 bpm and remains symptomatic. Which medication class is most appropriate for rate control?
- Class IA antiarrhythmics (e.g., quinidine)
- Beta-blockers or non-dihydropyridine calcium channel blockers (Correct answer)
- Class IC antiarrhythmics (e.g., flecainide)
- Class III antiarrhythmics (e.g., dofetilide)
Correct answer: Beta-blockers or non-dihydropyridine calcium channel blockers
Beta-blockers and non-DHP CCBs (diltiazem, verapamil) are first-line agents for ventricular rate control in AF.
DC Treatment Planning & Management 2
A patient in stable monomorphic ventricular tachycardia with a heart rate of 150 bpm and a BP of 98/60 mmHg.
What is the most appropriate initial treatment?