RN Nursing · Dysrhythmias · Practice question
A patient with a symptomatic bradycardia is diaphoretic with BP 78/40 and HR 32/min.
-
Amiodarone Intra Venous
-
✓
Transcutaneous pacing
-
Adenosine Intra Venous
-
Carvedilol by mouth
Answer & explanation
Correct: Transcutaneous pacing
This client presents with symptomatic bradycardia — a heart rate of 32 beats per minute accompanied by hemodynamic instability evidenced by a blood pressure of 78/40 mmHg and diaphoresis. This is a life-threatening emergency requiring immediate intervention. According to ACLS guidelines, when bradycardia is symptomatic and associated with hemodynamic instability (hypotension, altered consciousness, signs of shock, or ischemia), the first pharmacological intervention is intravenous atropine. However, if atropine is ineffective or unavailable, transcutaneous pacing is the next priority intervention and is the most appropriate definitive stabilizing measure in this scenario. Transcutaneous pacing externally stimulates ventricular contractions, immediately correcting the bradycardia and supporting cardiac output. Amiodarone (option A) is an antidysrhythmic used for tachyarrhythmias, not bradycardia, and is contraindicated here. Adenosine (option C) slows conduction through the AV node and is used to terminate supraventricular tachycardias; giving it to a bradycardic, hypotensive patient would be dangerous. Carvedilol (option D) is a beta-blocker that would further slow the heart rate and worsen the hemodynamic instability, making it absolutely contraindicated. Transcutaneous pacing is the priority intervention when the patient is this unstable.
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