The best answer is: the patient fails to respond to CPR and defibrillation

The theory behind the use of epinephrine is that it is a vasopressor and its use may enhance greater coronary blood flow during CPR. That is why in earlier recommendations, vasopressin was recommended interchangeably with epinephrine. The current recommendations exclude vasopressin. When a patient responds to defibrillation, then reverts, he/she is described as having a “re-induction”. This is different than “refractory” ventricular fibrillation which cannot be converted with electrical shock.

The best answer is: false

To the contrary, it is always best to provide accurate information to your patient. Misleading a patient about his illness robs him of the ability to make decisions that effect the remainder of his life. Care and human compassion should be foremost on a practitioner’s mind when having these delicate discussions with patients.

The best answer is: speeding up the sinus discharge rate (speed up p-p)

Because atropine (parasympatholytic agent) alters vagal tone, the only two possible cardiac responses to its administration would be: 1. Increased sinus node discharge rate; and, 2. Improvement or acceleration of AV node conduction. With an ventricular escape rate of 30 and wide QRS complexes, the distal pathology is far below the AV node and would not be altered by atropine.

The best answer is: all of the above

According to the most recent Guidelines, the following are relative exclusion criteria:

• Symptoms that seem minor and are clearing rapidly
• Onset of symptoms accompanied by seizure with residual impairment
• Significant trauma or surgery in the previous 14 days
• GI or GU hemorrhage with the last 21 days
• Acute MI within 3 months

The above need to be considered by carefully weighing the risk vs. the benefit when deciding to employ fibrinolytic therapy.

The best answer is: both b. and c.

Vagal maneuvers and adenosine are the recommended first interventions when treating stable PSVT. The most recent guidelines state that vagal maneuvers convert about 25% of patients with PSVT. If adenosine fails, the use of beta blockers or calcium channel blockers is recommended. While amiodarone may be indicated, its use should be employed by expert practitioners rather than as a routine consideration.