A patient suddenly develops a wide QRS complex tachycardi a. ...

[jessicacav]

A patient suddenly develops a wide QRS complex tachycardi
 
  a. The patient's heart rate is 220 beats/min and regular; blood pressure is 96/40 mm Hg; and respiratory rate is 22 breaths/min, and the patient is awake without complaint except for palpitations. Which of the following interventions would be best to try first?
 
  a. Adenosine 6 mg rapid IV push
  b. Lidocaine 1 mg/kg IV push
  c. Verapamil 0.5 mg IV push
  d. Digoxin 0.25 mg IV push

Question 2

Which of the following denotes the most serious prognosis?
 
  a. Decorticate posturing
  b. Decerebrate posturing
  c. Absence of Babinski reflex
  d. GCS score of 14

[elizabethrperez]

Answer to Question 1

B
Because ventricular tachycardia is more dangerous, treatment with lidocaine would be the first intervention. If this rhythm is ventricular tachycardia, lidocaine is the drug of choice. Adenosine and digoxin would have no effect on ventricular tachycardia, and verapamil could cause intractable hypotension. If the rhythm is a supraventricular contraction with aberrant conduction, then lidocaine will do no harm.

Answer to Question 2

B
Outcome studies indicate that abnormal flexion or decorticate posturing has a less serious prognosis than does extension, or decerebrate posturing. Onset of posturing or a change from abnormal flexion to abnormal extension requires immediate physician notification. The Babinski reflex is a pathologic finding; absence of this reflex is a normal neurologic finding in adults. The range of scores for the Glasgow Coma Scale is 3 to 15 . A score of 14 denotes a minimal deficit.