Correct!
5. Both 1 and 3

This EKG shows bradycardia although tachycardia would be expected in the presence of hypotension. The ST depressions in inferior and lateral leads are nonspecific. The QTc interval is prolonged and eventually was more than 600 milliseconds for this patient. He does not have first degree AV block.

Acquired prolonged QT syndrome can be seen with many drugs including most antiarrythmics, haloperidol, macrolide antibiotics or methadone, which was of potential concern for this patient. Use of cocaine, cinchona(from which quinine is derived), and licorice extract have led to prolonged QT intervals. Electrolyte abnormalities including hypokalemia, hypomagnesemia and hypocalcemia predispose to prolonged QT and risk for the torsades de pointes form of polymorphic ventricular tachycardia.

The next appropriate step in the management of this patient’s bradycardia and associated shock are the following: (click on the correct answer to proceed to the next panel)

1. Additional intravenous fluids
   
2. Atropine
   
3. Transcutaneous/transvenous pacing
   
4. Vasopressors
   
5. 1 and 3
   
6. All of the above

Home/Critical Care