skip to main content

Acute agitation with psychosis — RCPSC EM MCQ

Instant feedback + full explanation. One question, done properly.

HardPsychiatric emergenciesAcute agitation with psychosisRCPSC EM

A 24-year-old with palpitations is stable but has an irregular wide-complex tachycardia at 220/min and a prior ECG with delta waves. Which pharmacological treatment is most appropriate?

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

Reveal the answer and explanation

Correct answer: D — Give IV procainamide with continuous monitoring

The best answer is “Give IV procainamide with continuous monitoring”. This is pre-excited atrial fibrillation. In a stable patient, IV procainamide is an appropriate pharmacological rhythm-control option; electrical cardioversion is another option if needed. AV-nodal blockers, digoxin and amiodarone can favour accessory-pathway conduction and precipitate ventricular fibrillation, so they are avoided.

Reference: Canadian Cardiovascular Society: Atrial Fibrillation and Special Populations: https://ccs.ca/guideline/2020-atrial-fibrillation/chapter-11-af-and-special-populations/