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Unstable ventricular tachycardia — SCE Acute Medicine MCQ

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EasyAcute Cardiac PresentationsUnstable ventricular tachycardiaSCE Acute Medicine

A 72-year-old man is assessed on the acute medical unit. He has broad-complex tachycardia at 180/min, chest pain and systolic blood pressure 78 mmHg. He is conscious but clammy and confused. Initial assessment includes relevant observations, bedside tests and urgent blood results. What is the most appropriate next step in management?

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Correct answer: D — Perform synchronised direct-current cardioversion

Perform synchronised direct-current cardioversion is the best answer because adverse features during tachyarrhythmia require synchronised cardioversion rather than drug treatment first. Start intravenous N-acetylcysteine promptly is plausible, but it is less appropriate for the physiology or timing described in this stem. The other distractors either fit a neighbouring presentation, delay definitive treatment, or miss the key immediate risk. Clinical pearl: Instability in tachyarrhythmia is treated electrically.

Reference: Resuscitation Council UK ALS