A patient in a mall suddenly suffers from tachycardia and syncope. What will you do as emergency measure till the medical team arrives? A. CPR 60:2 B. Continue to eat your burger C. Comfort the patient by rubbing her feets, giving her water and giving more air circulation D. JV massage
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Now I have enough information from the textbooks to give a thorough, well-supported answer. Let me analyze each option carefully.
Answer: C - Comfort the patient by laying her flat, elevating her legs, and improving air circulation
The correct answer is C, but the reasoning requires some nuance. Here is a full breakdown:
Why this is a clinical reasoning question, not a cardiac arrest question
The scenario describes tachycardia and syncope - not confirmed cardiac arrest. The patient has a pulse (tachycardia implies the heart is beating) and has lost consciousness (syncope = transient loss of consciousness). This is fundamentally different from pulseless cardiac arrest.
The priority steps before the medical team arrives:
- Assess responsiveness and call EMS (911) - first and always
- Lay the patient flat and elevate the legs - increases venous return to the heart, which is the standard first-line maneuver for syncope
- Loosen clothing and ensure air circulation - reduces vagal stimulation and heat stress
- Do NOT give water to an unconscious/syncopal patient - aspiration risk
- Monitor breathing and pulse - if the patient becomes pulseless/apneic, then escalate to CPR
Option-by-Option Analysis
| Option | Assessment | Why |
|---|---|---|
| A. CPR 60:2 | ❌ WRONG - and the ratio is wrong | CPR is for confirmed cardiac arrest (no pulse, no breathing). The patient here has tachycardia (a pulse). Also, the correct adult BLS ratio is 30:2 (30 compressions : 2 breaths), not 60:2. According to Goldman-Cecil Medicine: "the lungs should be inflated twice in succession after every 30 chest compressions." CPR at 60:2 is not a recognized standard. |
| B. Continue eating your burger | ❌ Obviously wrong | Abandoning a person in medical distress is ethically and legally wrong - duty to render aid. |
| C. Comfort the patient - lay flat, elevate legs, improve air circulation | ✅ CORRECT | For syncope with preserved pulse, the first-line response is: lay the patient supine, elevate legs to improve cerebral perfusion, loosen tight clothing, and ensure airflow. Call EMS. This is consistent with standard syncope management. Note: giving water should be withheld until the patient is fully conscious and protected airway is confirmed. |
| D. Jugular Vein (JV) massage | ❌ Wrong and potentially harmful | "Jugular vein massage" is not a recognized emergency procedure. You likely mean carotid sinus massage (CSM), which can terminate certain SVTs. However, CSM is a medical procedure requiring trained personnel, ECG monitoring, IV access, crash cart availability, and prior auscultation for carotid bruits. Rosen's Emergency Medicine explicitly warns: "Auscultate the neck for bruits before carotid sinus massage, particularly in older patients, and avoid the maneuver if any are found or preexisting carotid disease is likely." Performing this without training in a mall setting could cause stroke or worsening arrhythmia. |
Key Teaching Points
- Syncope ≠ Cardiac arrest. A patient with tachycardia has a beating heart. CPR is contraindicated with a palpable pulse.
- Standard adult CPR ratio is 30:2, not 60:2. Option A is doubly wrong - wrong indication AND wrong ratio.
- Positional maneuvers (supine + legs elevated) are the cornerstone bystander intervention for syncope.
- Carotid sinus massage is a clinical procedure, not a bystander emergency measure.
- Always call EMS first, then support the patient until help arrives.
Sources: Goldman-Cecil Medicine, Basic Life Support section; Rosen's Emergency Medicine, Arrhythmia Management section; Braunwald's Heart Disease, Circulation/BLS chapter.
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