Question

your patient is having syncopal episodes, diaphoretic and complaining of chest pain. bp 70/30, hr 39, rr 18. identify the rhythm and your immediate intervention.

1st degree av block: anticipate administration of atropine
sinus brady: immediate synchronized cardioversion
3rd degree av block: anticipate administration of atropine - call for help (rapid response), get code cart, apply pads, anticipate transcutaneous pacing
2nd degree type 2: anticipate administration of atropine - call for help (rapid response), get code cart, apply pads

Explanation:

Analyze the ECG rhythm

• Regular P-P intervals (atrial rate \(\approx 60\text{ bpm}\))
• Regular R-R intervals (ventricular rate \(\approx 39\text{ bpm}\))
• Complete absence of association between P waves and QRS complexes (AV dissociation)
• Diagnosis: Third-degree (complete) AV block

Determine clinical status and intervention

• Patient presentation: Syncopal episodes, diaphoresis, chest pain, hypotension (\(\text{BP } 70/30\)), bradycardia (\(\text{HR } 39\))
• Classification: Unstable bradycardia due to complete heart block
• Immediate interventions: Atropine (as a bridge), call for help, prepare code cart, apply pads, and prepare for immediate transcutaneous pacing (TCP)

Answer:

• 1st degree AV Block: Anticipate administration of Atropine
• Sinus Brady: Immediate synchronized cardioversion
• 3rd degree AV Block: Anticipate administration of Atropine - Call for help (Rapid Response), get code cart, apply pads, anticipate transcutaneous pacing (Correct answer)
• 2nd degree Type 2: Anticipate administration of Atropine - Call for help (Rapid Response), get code cart, apply pads