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 strip

• The P-P interval is regular and constant.
• The R-R interval is regular and constant.
• There is no relationship between the P waves and the QRS complexes (complete AV dissociation), which is diagnostic of a 3rd-degree AV block.

Assess patient stability and clinical status

• The patient is symptomatic and unstable: hypotensive (BP 70/30), bradycardic (HR 39), experiencing syncopal episodes, diaphoretic, and complaining of chest pain.

Determine the immediate intervention

• For unstable third-degree heart block, immediate interventions include preparing for transcutaneous pacing (applying pads), calling for rapid response/help, obtaining the code cart, and anticipating atropine administration as a temporary bridge while pacing is established.

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