ACLS Megacode 2: Bradycardia Hurry, don’t let time run out! Sorry, time is up! 0 Hours 0 Minutes 0 Seconds Step 1 of 8 12% Untitled A 58-year-old female with history of hypertension and diabetes presents for evaluation of lightheadedness. Initial vitals: T: 36.5, BP: 140/70, R: 22 P: 34, O2: 100% 1. What is your initial step in management?*Initiate IV, monitor, and gather historyStart epinephrine infusionGive atropineProvide supplemental oxygen While an IV is placed, the patient is attached to a monitor. You appreciate the following rhythm: 2. What is the next step in management?*Adenosine 6mgAtropine 0.5mgSynchronized cardio versionTranscutaneously pace the patient You give atropine without response in heart rate. Patient begins to feel more light-headed and feels like she is going to pace out. Rhythm strip remains unchanged. Repeat vitals demonstrate a thready pulse and BP: 70/30.3. What is your next step in management?*Initiate CPRGive atropine, transcutaneous pacingIntubateTransvenous pacing You attempt to transcutaneously pace the patient but are unable to capture and patient remains persistently bradycardia and hypotensive. 4. Which medication can be started for treatment?*Dobutamine 5mcg/kg/minuteAmiodarone, 150mg bolus over 10 minutesDiltiazem 5mg/hourEpinephrine 2-10mcg/minute infusion You are attempting transcutaneous pacing but the patient remains persistently bradycardic.You attempt dopamine infusion but patient remains bradycardia. The patient now has become completely unresponsive and you are unable to palpate a pulse. Rhythm strip demonstrates the following: 5. What is the next step in management?*DefibrillateCardovertGive dopamineInitiate CPR You continue CPR.On re-evaluation, the monitor demonstrates the following: 6. What is your next step in management?*IV fluidsSynchronized cardio versionCheck a pulseDefibrillate 7. Which of the following represents possible causes of PEA arrest?*Pulmonary embolism, hyperthermiaHypomagnesmia, hypocalcemiaHypoxia, hypovolemiaSepsis, myocardial infarction The patient regains a pulse. 8. What is your next step in management?*Intubate, admit to the ICUStart dobutamineOxygenate appropriately, maintain perfusion, consider therapeutic hypothermiaSend for cardiac catheterization