香港执业医生考试 LMCHK Part1 MCQ讨论

A 67-year-old woman is admitted with blackouts.
Her electrocardiogram shows ventricular escape with complete heart block. As you are standing there she blacks out once more. Her rhythm strip shows P wave asystole.
Which of the following would be the initial immediate treatment here after airway and breathing?



A.Adenosine 6 mg
B.Adrenaline 1 mg
C.Atropine 0.6 mg
D.Transcutaneous pacing
E.Transvenous pacing

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A B C D E

• 【正确答案】D
• 【所在章】 General-Medicine General-Medicine
• 【知识点】 Anaesthetics & ITU Emergency Medicine
• 【答案解析】
• Occasionally, atrial electrical activity continues in the absence of ventricular impulses. This is referred to as P-wave asystole and may respond to electrical pacing. This can be achieved by transvenous, transcutaneous or manual techniques. Transvenous pacing takes longer to instigate, and transcutaneous pacing is therefore the initial choice here. Manual pacing is an effective holding measure before more definitive pacing is instituted.
  Atropine can also be used, as can adrenaline, for sustained P wave asystole but pacing is the initial treatment of choice. All crash trollies within UK hospitals contain the equipment required to externally pace patients.
  Adenosine can induce asystole, and is only indicated in the treatment of supraventricular tachycardias.
  
  
  

为什么是D不是C呢？临床上不是先给药再送导管室吗？