# 將每個心律與循環狀態群組拖曳到其所需的立即處置路徑。

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=395516&lang=zh-tw  
> language: zh-TW  
> subject: Medical Emergencies  
> category: PA

## 題目

將每個心律與循環狀態群組拖曳到其所需的立即處置路徑。

**1.** 混亂波形且無可辨識的 QRS 波；個案無反應且無脈搏

Select a category
Shockable cardiac arrest: CPR and prompt defibrillation
Unstable tachyarrhythmia with a pulse: synchronized pathway
Nonshockable cardiac arrest: CPR, epinephrine, and reversible causes
Perfusing stable atrial fibrillation: assess and treat the cause or rate

**2.** 寬 QRS 規則心室心律，速率 220 次/分，無脈搏

Select a category
Shockable cardiac arrest: CPR and prompt defibrillation
Unstable tachyarrhythmia with a pulse: synchronized pathway
Nonshockable cardiac arrest: CPR, epinephrine, and reversible causes
Perfusing stable atrial fibrillation: assess and treat the cause or rate

**3.** 有組織的窄 QRS 電氣活動，速率 70 次/分，但無可觸及的脈搏

Select a category
Shockable cardiac arrest: CPR and prompt defibrillation
Unstable tachyarrhythmia with a pulse: synchronized pathway
Nonshockable cardiac arrest: CPR, epinephrine, and reversible causes
Perfusing stable atrial fibrillation: assess and treat the cause or rate

**4.** 在兩個導程確認近乎平坦的波形，且無脈搏

Select a category
Shockable cardiac arrest: CPR and prompt defibrillation
Unstable tachyarrhythmia with a pulse: synchronized pathway
Nonshockable cardiac arrest: CPR, epinephrine, and reversible causes
Perfusing stable atrial fibrillation: assess and treat the cause or rate

**5.** 規則窄 QRS 頻脈，速率 190 次/分，有脈搏、低血壓、胸痛和意識改變

Select a category
Shockable cardiac arrest: CPR and prompt defibrillation
Unstable tachyarrhythmia with a pulse: synchronized pathway
Nonshockable cardiac arrest: CPR, epinephrine, and reversible causes
Perfusing stable atrial fibrillation: assess and treat the cause or rate

**6.** 單形性寬 QRS 頻脈，有脈搏且有休克徵象

Select a category
Shockable cardiac arrest: CPR and prompt defibrillation
Unstable tachyarrhythmia with a pulse: synchronized pathway
Nonshockable cardiac arrest: CPR, epinephrine, and reversible causes
Perfusing stable atrial fibrillation: assess and treat the cause or rate

**7.** 極不規則窄 QRS 心律，有脈搏，血壓 128/74 mm Hg，且無缺血症狀

Select a category
Shockable cardiac arrest: CPR and prompt defibrillation
Unstable tachyarrhythmia with a pulse: synchronized pathway
Nonshockable cardiac arrest: CPR, epinephrine, and reversible causes
Perfusing stable atrial fibrillation: assess and treat the cause or rate

**8.** 新發生的極不規則心律，灌流穩定，需要 12 導程確認和原因評估

Select a category
Shockable cardiac arrest: CPR and prompt defibrillation
Unstable tachyarrhythmia with a pulse: synchronized pathway
Nonshockable cardiac arrest: CPR, epinephrine, and reversible causes
Perfusing stable atrial fibrillation: assess and treat the cause or rate

## 解析

無脈搏心室顫動和無脈搏心室頻脈需要 CPR 和立即去顫。無脈搏電氣活動和心搏停止是不可電擊的心跳停止心律，需要 CPR、腎上腺素和評估可逆原因。有脈搏的不穩定快速心律不整需要立即尋求專家介入，並在適用時進行同步心臟整流。有灌流且穩定的心房顫動型態需要重點評估、12 導程確認、原因評估，以及依醫囑進行速率或節律管理，而非心跳停止的處置。

## 深入解析

快速解答
先確認脈搏：電擊 VF/pVT 停止；不要電擊 PEA/心搏停止；有脈搏的不穩定頻脈進行同步整流；穩定的心房顫動則評估並治療。

臨床判斷
相同的監測速率可能因脈搏和灌流狀況而有不同的處置。快速確認反應性和脈搏，對停止個案開始高品質 CPR，且不要延遲有適應症的電擊。

NCLEX 決策規則
治療個案和循環狀態，而非單獨的監測標籤。參考資料
1AHA 2025 成人高級生命支持
2AHA 2025 成人基本生命支持

## 臨床情境

心律加上灌流
監測器結果已確認且已排除假影。請分類整體臨床狀態，包括是否有脈搏，而非僅命名心律。

## 重要概念

- **可電擊心律** — 一種心臟停止心律，適用非同步去顫，例如心室顫動或無脈搏心室頻脈。
- **無脈搏電氣活動** — 有組織的電氣活動但無可觸及的脈搏或有效機械循環。
- **同步心臟整流** — 針對有脈搏的特定不穩定快速心律不整，將電擊與 QRS 波同步。

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