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Wide-Complex Tachycardia with Hemodynamic Instability

A 62-year-old male with a history of hypertension becomes unresponsive in the ICU, with a monitor revealing wide-complex tachycardia and severe hypotension (BP 70/40 mmHg). Immediate intervention is required to stabilize the rhythm and address the underlying cause of the hemodynamic instability.

Consider immediate interventions for unstable tachycardia.

The patient is unresponsive. What is your first action?

Begin chest compressions

Administer epinephrine 1 mg IV

Defibrillate immediately

Perform synchronized cardioversion

What medication is preferred for ventricular tachycardia?

Synchronized cardioversion is unsuccessful. The patient remains hypotensive with tachycardia. What is your next step?

Administer amiodarone 150 mg IV over 10 minutes

Perform unsynchronized cardioversion

Start an epinephrine infusion

Administer atropine 0.5 mg IV

What is the best vasopressor to support hypotension?

After the amiodarone infusion, the patient’s rhythm converts to sinus tachycardia (rate 110 bpm), but BP remains 75/50 mmHg. What is the next step?

Administer a fluid bolus

Perform synchronized cardioversion again

Start dopamine 10 mcg/kg/min

Begin a norepinephrine infusion for BP support

What are the first steps in managing PEA?

During norepinephrine infusion, the patient suddenly loses consciousness, and the monitor shows pulseless electrical activity (PEA). What is your next step?

Intubate immediately

Start high-quality CPR and administer epinephrine 1 mg IV

Perform immediate defibrillation

Administer amiodarone 300 mg IV

Which cause aligns with the patient’s clinical presentation?

The team is evaluating reversible causes (H’s and T’s) for PEA. Which of the following is the most likely cause in this patient?

Hypovolemia from possible cardiac rupture

Hypoxia

Toxins

Tension pneumothorax

Consider the fastest method to detect pericardial abnormalities.

What diagnostic test should be performed immediately to confirm the suspected reversible cause?

Bedside echocardiogram

Chest X-ray

Arterial blood gas analysis

CT scan of the chest

What is the most direct way to relieve tamponade?

The echocardiogram confirms pericardial tamponade. What is your next intervention?

Start an epinephrine infusion

Perform pericardiocentesis

Perform a thoracotomy

Administer a fluid bolus

What oxygen saturation range minimizes risks during recovery?

ROSC is achieved after pericardiocentesis. BP stabilizes at 90/60 mmHg, and the patient is intubated. What is the target oxygen saturation (SpO2) during post-resuscitation care?

94-99%

100%

88-92%

95%

What medication is most effective for sustained monomorphic VT?

During post-ROSC care, the patient develops VT again. The monitor shows sustained monomorphic VT with a rate of 160 bpm. What is your next step?

Administer adenosine 6 mg IV push

Start synchronized cardioversion immediately

Administer amiodarone 150 mg IV over 10 minutes

Perform defibrillation

Your score is

The average score is 67%