A 65-year-old man has had vomiting and diarrhea for the past 2 days and complains of severe weakness. His cardiac rhythm is shown below. Treatment for him should include:
A) crystalloid fluid boluses.
B) adenosine, 6 mg rapid IV.
C) synchronized cardioversion.
D) diltiazem, 0.25 mg/kg.
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Given the patient's history of vomiting and diarrhea, the paramedic should conclude that he has a compensatory tachycardia, likely sinus in nature. Heart rates can exceed 150 per minute and still be sinus in origin. The rhythm shown has clearly visible P waves. Treatment should include crystalloid fluid boluses. The patient's tachycardia is likely not of a primary cardiac etiology; it is in response to dehydration. Therefore, interventions aimed at decreasing his heart rate (ie, adenosine, diltiazem) are not indicated; in fact, they could be harmful. Cardioversion is not indicated either; again, this is not a primary cardiac dysrhythmia. As the patient is properly rehydrated, the tachycardia should resolve on its own.