A patient suddenly develops a wide QRS complex tachycardi
a. The patient's heart rate is 220 beats/min and regular; blood pressure is 96/40 mm Hg; and respiratory rate is 22 breaths/min, and the patient is awake without complaint except for palpitations. Which of the following interventions would be best to try first?
a. Adenosine 6 mg rapid IV push
b. Lidocaine 1 mg/kg IV push
c. Verapamil 0.5 mg IV push
d. Digoxin 0.25 mg IV push
B
Because ventricular tachycardia is more dangerous, treatment with lidocaine would be the first intervention. If this rhythm is ventricular tachycardia, lidocaine is the drug of choice. Adenosine and digoxin would have no effect on ventricular tachycardia, and verapamil could cause intractable hypotension. If the rhythm is a supraventricular contraction with aberrant conduction, then lidocaine will do no harm.
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