Your patient is a 58-year-old female who is confused and dyspneic. Her daughter called EMS because the patient complained of a fluttering sensation in her chest, followed a few minutes later by chest pain and an acute onset of confusion. She is pale and diaphoretic without a palpable radial pulse. The monitor shows a narrow complex rhythm at a rate of 180. Which of the following is most appropriate?

Question

Quizplus · Accepted Answer

The patient presents with a narrow complex tachycardia at a rate of 180 with acute onset of confusion and no palpable pulse. This is suggestive of unstable atrial fibrillation with rapid ventricular response. Immediate synchronized cardioversion is the most appropriate intervention to restore sinus rhythm and improve perfusion. Valsalva maneuver and IV adenosine are appropriate for diagnosing and treating stable narrow complex tachycardias, but not for unstable patients with no palpable pulse. IV diltiazem is appropriate for treating stable patients with atrial fibrillation with rapid ventricular response, but not for unstable patients.

Your Patient Is a 58-Year-Old Female Who Is Confused and Dyspneic