Advanced Cardiovascular Life Support (ACLS) Practice Exam

What is the next recommended intervention for a patient with narrow-complex tachycardia at a rate of 220/min after vagal maneuvers are ineffective?

1. Cardioversion

2. Adenosine 6 mg IV push

3. Atropine 0.5 mg

4. Dopamine infusion

The correct answer is: Adenosine 6 mg IV push

The next recommended intervention for a patient with narrow-complex tachycardia, particularly after vagal maneuvers have been tried and proved ineffective, is an intravenous push of adenosine. Adenosine works rapidly to interrupt the reentrant circuits that are commonly responsible for this type of tachycardia, especially in cases of paroxysmal supraventricular tachycardia (SVT). By temporarily blocking conduction through the atrioventricular (AV) node, adenosine can effectively restore normal sinus rhythm. In this scenario, age, cardiac history, and potential allergies should be considered before administration. The recommended initial dose is 6 mg given rapidly via IV, followed by a saline flush to ensure the medication reaches the heart quickly. While other interventions, such as cardioversion, atropine, or dopamine infusion, may address certain cardiac scenarios, they are not the appropriate next step in this specific context of narrow-complex tachycardia after ineffective vagal maneuvers. Cardioversion may be indicated if the patient were unstable or in a wider complex tachycardia scenario. Atropine is primarily used for bradycardia and would not be effective in this case. A dopamine infusion is used