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Bradycardia peri-arrest — DipIMC MCQ

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HardResuscitationBradycardia peri-arrestDipIMC

A patient with hypotension and syncope has a broad-QRS complete atrioventricular block at 28/min. Oxygenation and reversible causes are being addressed. Which immediate rhythm intervention is preferred?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: A — Begin transcutaneous pacing while arranging expert escalation

The best answer is “Begin transcutaneous pacing while arranging expert escalation”. High-degree atrioventricular block with a broad QRS and adverse features carries a high risk of asystole. Current ALS guidance advises against relying on atropine in high-degree block and supports prompt pacing, with analgesia or sedation when feasible and escalation to expert or transvenous support. Cardioversion and adenosine do not treat this bradyarrhythmia.

Reference: Resuscitation Council UK 2025, Adult advanced life support: https://www.resus.org.uk/professional-library/2025-resuscitation-guidelines/adult-advanced-life-support-guidelines