SNHD Paramedic Protocols Practice Test

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For unstable tachycardia wide complex VT suspected to be torsades de pointes (polymorphic VT), what is the appropriate action?

Magnesium sulfate 2 g IV/IO in 50 mL NS over 10 min Defibrillate & consider sedation ETOMIDATE 0.15 mg/kg IV/IO Repeat defibrillation; assess need for repeat sedation Synchronized Cardioversion

Correct Answer:

Defibrillate & consider sedation ETOMIDATE 0.15 mg/kg IV/IO

Explanation:

When a wide-complex tachycardia is unstable and torsades de pointes is suspected, the immediate goal is to rapidly terminate the dangerous rhythm to restore perfusion. Delivering a defibrillating shock provides the fastest way to stop the chaotic electrical activity and reset the heart, which is crucial in a hemodynamically compromised patient. Sedation with etomidate can be considered to facilitate the procedure and ensure the patient tolerates it (or to enable a controlled cardioversion if needed), with the dosing typically around 0.15 mg/kg IV/IO. After the rhythm is acutely interrupted, you would address contributing factors and consider magnesium as part of the longer-term management of torsades.

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