Arrhythmia Recognition: The Art of Interpretation

1. Many clinicians, when faced with a WCT, tend to concentrate on proving the fact that the rhythm is an SVT-A. What should be the correct emergent course of action?

A. Evaluate the strip completely to rule in VTach as the culprit.

B. Evaluate the strip to arrive at the correct diagnosis.

C. Discuss the outpatient scenario and the surroundings with fire rescue.

D. Obtain all necessary strips, a 12-lead ECG, labs, and x-rays as quickly as possible to aid in your assessment.

E. Take a few seconds to ask the patient what happened and any history of allergies to medications; perform a brief, focused exam to evaluate the patient’s hemodynamic status; take a brief look at the strip; and begin emergent treatment of the patient without delay according to the established guidelines.

2. What is the most common lethal arrhythmia?

A. Antidromic atrioventricular reentry tachycardia

B. Uncontrolled, rapid atrial fibrillation

C. Multifocal atrial tachycardia

D. VTach

E. Complete heart block

3. An unconscious patient was brought into the emergency department by family. The family states that the patient was eating comfortably when he suddenly grasped his throat and, within a few seconds, became unresponsive. The nurses placed him on a monitor and the patient was in a WCT. What should be your next step?

A. Obtain a 12-lead ECG.

B. Open the patient’s airway while getting ready to defibrillate.

C. Begin chest compressions.

D. Evaluate the patient’s blood pressure bilaterally to rule out a dissecting aneurysm.

E. Start two large-bore IV lines.

4. When approaching a patient in hemodynamic compromise due to an arrhythmia, the most important thing is to make the right diagnosis so that you don’t look like an idiot. True or False.

5. The chances that a rhythm is VTach when evaluating a WCT is approximately ____%. If the patient has a history or findings consistent with a structural abnormality or an old MI, the probability increases to ____%.

6. We presently have multiple criteria to distinguish between SVT-A and VTach. Applying some or all of those criteria, we can always diagnose VTach with 100% certainty. The diagnosis of WCT of unknown origin is a thing of the past. True or False.

7. A patient is brought to a Level 1 Acute Cardiac Care hospital with a strip showing a WCT at 180 beats per minute. The patient’s blood pressure is 66/palp; respiratory rate is 24 breaths per minute, weak and shallow; and pulse oximetry shows 86% on 2-L nasal canula. On general examination, the patient is lethargic and diaphoretic, skin is pale, and there is decreased capillary refill. Both the catheterization (cath) team and the electrophysiology team are in the hospital. What should be your next move?

A. Call the cath team to evaluate for a possible acute MI, which could be hidden by the morphology of the WCT.

B. Call the electrophysiology team to establish a clear and indisputable diagnosis of VTach.

C. Obtain a stat echocardiogram to evaluate wall motion abnormalities.

D. Do a transesophageal echocardiogram to evaluate for possible P waves.

E. Grab your paddles and cardiovert or defibrillate the patient emergently.

8. In the emergent stage, you should focus on things that will kill the patient first and foremost. True or False.

9. In the urgent stage, you should focus on things that will hurt your patient. True or False.

10. In the nonurgent stage, you should focus on everything not covered in the emergent and urgent stages. True or False.