A nurse is viewing the cardiac monitor in a client’s room and notes that the client has just gone into ventricular tachycardia. The client is awake and alert and has good skin color. The nurse would prepare to do which of the following?
A. Immediately defibrillate.
B. Prepare for pacemaker insertion.
C. Administer amiodarone (Cordarone) intravenously.
D. Administer epinephrine (Adrenaline) intravenously.
Correct Answer: C. Administer amiodarone (Cordarone) intravenously.
First-line treatment of ventricular tachycardia in a client who is hemodynamically stable is the use of antidysrhythmics such as amiodarone (Cordarone), lidocaine (Xylocaine), and procainamide (Pronestyl). Cardioversion also may be needed to correct the rhythm (cardioversion is recommended for stable ventricular tachycardia). Procainamide will terminate between 50% and 80% of ventricular tachycardias, and it will slow the conduction of those that it does not terminate. Amiodarone will convert about 30% of patients to sinus rhythm but is very effective in reducing the reversion rate of refractory SMVT.
Option A: Defibrillation is used with pulseless ventricular tachycardia. Pulseless VT requires immediate electrical cardioversion with a high-energy defibrillator (150-200 J on biphasic and 360 J on monophasic). Delaying defibrillation for 2 minutes or more decreases survival rate compared with patients receiving immediate defibrillation (39,3% vs. 22,2%). Defibrillation requires fewer joules if it is done early. After every shock, chest compressions should be performed, along with oxygen delivery and intravenous injection of vasopressors and antiarrhythmic drugs.
Option B: The most common indications for permanent pacemaker implantation are sinus node dysfunction (SND) and high-grade atrioventricular (AV) block. Pacemakers are electronic devices that stimulate the heart with electrical impulses to maintain or restore a functional heartbeat. Pacemakers were initially external and involved the placement of subcutaneous electrodes for patients with inappropriate intrinsic cardiac pacemaker activity and/or abnormal conducting tissue.
Option D: Epinephrine would stimulate an already excitable ventricle and is contraindicated. There are no absolute contraindications against using epinephrine. Some relative contraindications include hypersensitivity to sympathomimetic drugs, closed-angle glaucoma, anesthesia with halothane. Another unique contraindication to be aware of is catecholaminergic polymorphic ventricular tachycardia. As is the case with prescribing any medication, all practitioners should use clinical judgment and evaluate the benefits versus risks with epinephrine.
No comments:
Post a Comment