Symptomatic atrial fibrillation — DipIMC MCQ

Correct answer: C — Treat as unstable tachyarrhythmia and seek urgent cardioversion support

Explanation lettering: D = shown as A · E = shown as B · A = shown as D · B = shown as E

C is correct: Tachyarrhythmia with shock is unstable and needs immediate escalation for synchronised cardioversion rather than rate control alone. A is less suitable because a detailed survey is inappropriate before correcting an immediate threat; B is less suitable because the vignette contains high-risk features that require escalation; D is less suitable because it does not address the discriminator in the vignette; E is less suitable because it moves the patient before the decisive threat or destination issue is addressed. The most tempting alternative is therefore suboptimal because it either delays the time-critical pre-hospital intervention or sends the patient to the wrong level of care. The key DipIMC principle is focused cABCDE decision-making with early pre-alert, triage or retrieval escalation when the scene physiology demands it.

Reference: JRCALC Guidelines; Resuscitation Council UK; NICE guidance where applicable