← Chapter 9
Medical-Surgical Nursing · Chapter 9

Shock, Pace or Treat

Every rhythm emergency runs through the same two questions in the same order. First the fork — is there a pulse, and if not is the rhythm shockable? Then the intervention, with its energy or its dose. Work twelve cases; the widget tells you which of the two decisions you missed and why, because getting the fork wrong is what makes a nurse defibrillate asystole or give a calcium channel blocker to ventricular tachycardia.
Pick a case
Decision 1 — which fork are you on?
Decision 2 — what do you do first?
No cases scored yet.
Pacemaker malfunction identifier

A pacemaker spike appears on the strip immediately before the complex it captures. Three malfunctions are testable. Name each strip, then press check.

The fork comes first
Choose a case on the left, commit to a fork and an intervention, then press Check both decisions.
The two questions, in order
1. Is there a pulse? Assess a central pulse for no more than 10 seconds. Electricity on a monitor is not perfusion. 2. If pulseless, is the rhythm shockable? Only ventricular fibrillation and pulseless ventricular tachycardia are. Asystole and pulseless electrical activity are not — shocking them does nothing and delays what works. If there is a pulse, the question becomes stable or unstable, and instability means the rhythm is causing hypotension, altered mentation, shock, ischaemic chest discomfort or acute heart failure.
Safety is the nurse’s job for both procedures
Ensure everyone is clear — including yourself. Remove supplemental oxygen from the immediate area. Verify no one is touching the bed. Never place a pad directly over an implanted device.
Pacemaker strips
Name all three, then press Check the three strips.