Lethal Rhythms on the NCLEX
VF, pulseless VT, asystole, PEA, recognition and ACLS basics.
Four cardiac rhythms require immediate action. NCLEX tests recognition and first response.
VF (ventricular fibrillation)
Chaotic, no organized waveforms. Defibrillate immediately. CPR between shocks. Epinephrine. Antiarrhythmic (amiodarone or lidocaine).
Pulseless VT
Wide QRS, regular, rapid. Defibrillate if pulseless. Same algorithm as VF.
Asystole
Flat line. CPR, epinephrine, search for reversible causes (H's and T's). DO NOT defibrillate.
PEA (pulseless electrical activity)
Organized rhythm but no pulse. CPR, epinephrine, treat reversible causes. DO NOT defibrillate.
H's and T's
Hs: hypovolemia, hypoxia, H+ (acidosis), hypo/hyperkalemia, hypothermia. Ts: toxins, tamponade, tension pneumothorax, thrombosis (coronary or pulmonary).
Frequently asked
Shock asystole?
No, no electrical activity to convert. Focus on CPR and epi.
Quality CPR rate?
100-120 compressions/min. 2 inches depth. Allow full recoil. Minimize interruptions.
Quick check
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