A patient suddenly develops ventricular fibrillation. Which intervention should the nurse prioritize?

Choice A rationale:

Survivors of sudden cardiac death due to ventricular fibrillation or pulseless ventricular tachycardia are prime candidates for ICDs. These devices detect and terminate life-threatening arrhythmias via defibrillation or antitachycardia pacing. ICDs reduce mortality by preventing recurrence of fatal arrhythmias. Guidelines recommend ICDs for secondary prevention in patients with structurally abnormal hearts and documented ventricular arrhythmias.

Choice B rationale

Spontaneous sustained ventricular tachycardia, especially if symptomatic or hemodynamically unstable, warrants ICD placement. Sustained VT is defined as lasting more than 30 seconds or requiring intervention. ICDs monitor rhythm and deliver therapy when VT is detected, preventing progression to ventricular fibrillation. This is a Class I indication for ICDs in patients with structural heart disease.

Choice C rationale

Unstable angina is caused by transient myocardial ischemia due to plaque rupture or vasospasm. It is managed with anti-ischemic therapy and revascularization. ICDs are not indicated unless the patient develops sustained ventricular arrhythmias or survives cardiac arrest. ICDs do not treat ischemia directly and are not used for primary prevention in unstable angina.

Choice D rationale

Heart failure patients with reduced ejection fraction (≤35%) and NYHA class II–III symptoms despite optimal medical therapy are candidates for ICDs for primary prevention. These patients are at increased risk for sudden cardiac death due to ventricular arrhythmias. ICDs improve survival by terminating malignant rhythms. This is supported by trials like MADIT-II and SCD-HeFT.

Choice A rationale

The American Heart Association (AHA) guidelines for STEMI management in non-PCI capable hospitals emphasize a Door-to-Needle time of 30 minutes for administering thrombolytic therapy. This tight window is crucial because the effectiveness of fibrinolytics in restoring coronary blood flow and minimizing myocardial damage decreases rapidly after symptom onset.

Choice B rationale

A 90-minute timeframe is the target for Door-to-Balloon time (or "Door-to-Sheath") for patients undergoing primary percutaneous coronary intervention (PCI), which is the preferred reperfusion strategy when available. This target does not apply to the administration of thrombolytics in a non-PCI setting.

Choice C rationale

While the overall goal is to provide reperfusion therapy within 12 hours of symptom onset, giving thrombolytics 6 hours after the patient presents to the hospital is too late for the "Door-to-Needle" metric. The benefit of thrombolysis significantly declines after the initial few hours.

Choice D rationale

Administering thrombolytic therapy 12 hours after the patient presents to the emergency department is typically outside the window for maximal benefit, although reperfusion may be considered up to 12-24 hours after symptom onset in specific cases if primary PCI is unavailable. The time-critical "Door-to-Needle" goal is much shorter. —.