# 病人於外科病房倒下,無脈搏,監視器顯示寬QRS型VT。團隊應採取之行動?複選。

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=375078&lang=zh-tw  
> language: zh-TW  
> subject: Management of Care  
> category: MOC

## 題目

病人於外科病房倒下,無脈搏,監視器顯示寬QRS型VT。團隊應採取之行動?複選。

1

若VT/VF持續,第3次電擊後給amiodarone 300 mg IV bolus

2

除顫器到達後立即以200 J biphasic電擊

3

第2次電擊後IV epinephrine 1 mg每3-5分鐘給予

4

以100-120/分鐘、深度2吋執行不中斷高品質CPR

5

對寬QRS波心動過速進行100 J的同步心臟整流

## 解析

無脈搏VT/VF需立即高品質CPR(100-120/分鐘、深2-2.4吋、完整回彈、最少中斷)及盡快電擊(每延遲1分鐘,存活率下降7-10%)。第2次電擊後給epinephrine 1 mg每3-5分鐘。難治性VT/VF於第3次電擊後給amiodarone 300 mg IV(或lidocaine 1-1.5 mg/kg)。Atropine不用於無脈VT/VF,用於症狀性心搏過慢。識別並治療Hs(低血容、缺氧、酸中毒、高/低鉀、低體溫)與Ts(毒素、心包填塞、張力性氣胸、血栓)。

## 深入解析

高品質CPR指標:100-120/分鐘、深2吋、完整回彈、減少中斷、ETCO2>10 mmHg表示按壓有效。

## 臨床情境

目擊性停跳。30秒內開始CPR。AED將到。

## 重要概念

- **無脈搏VT** — 寬QRS型快速心律但無脈搏 — 可電擊節律。
- **Amiodarone** — 第III類抗心律不整藥 — 除顫後心停首選抗心律不整藥。
- **Hs與Ts** — 心停可逆原因之記憶法。

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