一名 60 歲男性因急性心肌梗塞（MI）被收治至急診室並接受監測。在與護理師交談時，個案突然失去意識並倒下，無反應、無呼吸、無脈搏。床邊心電圖顯示為心室顫動（V-Fib）波形，QRS 結構完全消失。為對抗此致命性心律不整，護理師應立即執行哪一項挽救生命的關鍵介入？
A 60-year-old male is admitted to the emergency department following an acute myocardial infarction (MI). While conversing with the nurse, the client suddenly becomes unresponsive and collapses. The bedside cardiac monitor shows a chaotic, disorganized waveform with no identifiable QRS complexes (Ventricular Fibrillation / V-Fib). Which intervention should the nurse advocate for or perform first?
- APerform an emergency bedside tracheostomy to deliver oxygen directly to the lungs執行緊急床旁氣管切開術以直接向肺部供氧
- BAdminister 3 mg of intravenous Atropine to increase the heart rate給予 3 mg 靜脈注射 Atropine 以增加心率
- CObtain a 12-lead Electrocardiogram (EKG) to confirm the ischemic location before intervention在介入前取得 12 導程心電圖 (EKG) 以確認缺血位置
- DPerform immediate Defibrillation as the priority intervention to convert the lethal rhythm立即執行去顫作為優先介入以轉換致命性心律正確答案
- D立即執行去顫作為優先介入以轉換致命性心律
核心概念：心室顫動（V-Fib）的急性處置。 為何正確答案對： D. 心室顫動是無脈搏性心律不整，心室電氣活動完全紊亂，無法產生有效的心輸出量，是心跳停止（cardiac arrest）的常見原因。根據 AHA ACLS 2020 指引，對於有可電擊心律（V-Fib 或無脈搏性 VT），「立即去顫」是恢復心搏的唯一確定性介入，每延遲 1 分鐘存活率下降 7-10%。電擊能使所有心肌細胞同步去極化，讓自然節律點重新啟動。 為何其他選項錯： B. Atropine 用於治療有症狀的心搏過緩，對 V-Fib 無效，且已從 ACLS 無脈搏性心跳停止處置中移除。 C. 12 導程 EKG 為診斷工具，無法治療 V-Fib，且會延誤關鍵的去顫時機。 A. 緊急氣切並非 V-Fib 處置；在心臟未恢復循環前，僅靠呼吸道介入無法將氧氣輸送至腦部。
- A執行緊急床旁氣管切開術以直接向肺部供氧
氣切無法處理潛在的心跳停止；在心臟未恢復循環前，僅靠呼吸道介入無法將氧氣輸送至腦部。
- B給予 3 mg 靜脈注射 Atropine 以增加心率
Atropine 用於治療有症狀的心搏過緩，對 V-Fib 無效，且已從 ACLS 無脈搏性心跳停止處置流程中移除。
- C在介入前取得 12 導程心電圖 (EKG) 以確認缺血位置
取得 12 導程 EKG 為診斷步驟，會延誤去顫時機，不適用於無脈搏性心律不整的緊急處置。
- D · 正確答案立即執行去顫作為優先介入以轉換致命性心律
根據 AHA ACLS 指引，立即去顫是 V-Fib 的優先處置，是唯一證實能恢復心搏的介入；每延遲 1 分鐘存活率下降 7-10%。
「V-Fib/ Pulseless V-Tach = Defibrillation (用力給他電下去)」。這是 AC LS 急救最重要的核心。只要病患失去脈搏且波型是 V-Fib，毫不猶豫選「電擊去顫」，無需再跑去測量生命徵象浪費時間！
English explanation
Option D is correct because ventricular fibrillation is a pulseless rhythm in which completely disorganized ventricular electrical activity produces no effective cardiac output, making it a common cause of cardiac arrest. Under 2020 American Heart Association advanced cardiovascular life support guidance, immediate defibrillation is the definitive intervention for ventricular fibrillation or pulseless ventricular tachycardia. Each 1-minute delay reduces survival by 7-10%. The shock synchronously depolarizes myocardial cells so that the heart's natural pacemaker can restart an organized rhythm. Option B is incorrect because atropine treats symptomatic bradycardia, has no effect on ventricular fibrillation, and has been removed from pulseless cardiac arrest management. Option C is incorrect because a 12-lead electrocardiogram is diagnostic, does not treat ventricular fibrillation, and would delay essential defibrillation. Option A is incorrect because emergency tracheostomy is not treatment for ventricular fibrillation; before circulation returns, an airway intervention alone cannot deliver oxygen to the brain.
最近修訂：2026-05-08