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Temporary pacing decision — SCE Acute Medicine MCQ

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ModerateProcedural Knowledge in Acute MedicineTemporary pacing decisionSCE Acute Medicine

A 58-year-old man presents with a procedure-related acute decision. Relevant history includes coagulation, imaging, respiratory physiology or procedural risk. On assessment, bedside findings determine whether the procedure is safe and urgent. Investigations show complete heart block with hypotension despite atropine. What is the most appropriate next step in management?

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Correct answer: B — Arrange urgent temporary pacing while planning permanent pacing

The key discriminator is that complete heart block with hypotension despite atropine, which makes Arrange urgent temporary pacing while planning permanent pacing the single best answer. Start anticoagulation after assessing bleeding risk is less appropriate because it does not address the dominant acute risk in the vignette; Give analgesia and antiemetic therapy would fit a different presentation or later stage of care. Call critical care for escalation and Start broad-spectrum intravenous antibiotics are suboptimal because they would either delay time-critical treatment or follow the wrong acute pathway. Teaching point: SCE-style acute medicine questions usually test prioritisation using physiology, timing and a guideline-defined threshold, rather than isolated factual recall.

Reference: Resuscitation Council UK ALS