ACLS Megacode 5: In-Hospital

You are interning at a nearby hospital. Upon entering the hospital room of a 25-year-old male who was admitted the previous evening for chronic abdominal pain and a history of gastrointestinal ulcers, you find them unresponsive, lying in bed. On the table next to the bed is a half-eaten sandwich, so you assume he was eating shortly before. A rapid initial assessment reveals the following:

Vital Signs

• Pulse rate, Blood pressure, Respiratory rate, Temperature: Unobtainable

Physiological systems

• Integumentary: Moist, cool
• Cardiovascular: No palpable pulse
• Respiratory: Visible chest rising, no audible respirations
• Neurological: Unresponsive

CPR has been initiated and the Code Team is arriving to the hospital room.

Five cycles of CPR have been performed, the patient received 1.0 mg of epinephrine via IVP and a cardiac monitor has been connected. A large amount of food was cleared from the patient's airway while performing CPR. After the completion of five CPR cycles, the cardiac rhythm check showed pulseless electrical activity.

Another five cycles of CPR are performed. After completing these cycles, a check of the cardiac rhythm shows that pulseless electrical activity remains unchanged.

Another five cycles of CPR are performed. After completing these cycles, a check of the cardiac rhythm shows that there has been a transition from pulseless electrical activity to ventricular tachycardia.

A 200 J unsynchronized shock is administered and another five cycles of CPR are performed.

Epinephrine 1 mg IVP is administered while simultaneously continuing CPR.

Another five cycles of CPR are performed. After completing these cycles, a check of the cardiac rhythm shows that the ventricular tachycardia remains unchanged. A 300 Joules unsynchronized shock is administered and another five cycles of CPR are performed.

300 mg of amiodarone is given via IVP and another five cycles of CPR are performed. After completing these cycles, a check of the cardiac rhythm shows a transition from ventricular tachycardia to sinus tachycardia. A weak and faint pulse is detected during a pulse check. Vital signs are 162 bpm heart rate, 108/64 mmHg blood pressure. The patient is not breathing spontaneously and remains unconscious.