CLINICAL MEDICINE

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MEDICINE

CARDIOLOGY

Question [CLICK ON ANY CHOICE TO KNOW THE RIGHT ANSWER]
A middle-aged man in ventricular fibrillation has been refractory to several biphasic defibrillations, well-coordinated CPR, adequately performed ventilations, and two doses of epinephrine. What should you do next?
A
Rapidly infuse 2 liters of normal saline solution.
B
Administer 300 mg of amiodarone via rapid IV push.
C
Give 40 units of vasopressin followed by defibrillation.
D
Give amiodarone followed by 1.5 mg/kg of lidocaine.
Explanation: 

Detailed explanation-1: -The guidelines recommend administration of amiodarone for sustained ventricular fibrillation (Vf) and ventricular tachycardia (VT) refractory to CPR, defibrillation, and vasopressor in out-of-hospital cardiac arrest. Lidocaine is recommended as an alternative to amiodarone.

Detailed explanation-2: -If the patient remains in ventricular fibrillation, pharmacological treatment should begin. Epinephrine is the first drug given and may be repeated every 3 to 5 minutes. If epinephrine is not effective, the next medication in the algorithm is amiodarone 300 mg.

Detailed explanation-3: -On a biphasic defibrillator, this is usually between 120 joules to 200 joules. On a monophasic defibrillator, this is usually 360 joules. If the manufacturers recommended dose is unavailable the AHA recommends giving the maximum available dose.

Detailed explanation-4: -First call 911 or your local emergency number. Then start CPR by pushing hard and fast on the person’s chest-about 100 to 120 compressions a minute. Let the chest rise completely between compressions. Continue CPR until an automated external defibrillator (AED) is available or emergency medical help arrives.

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