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?* Provide supplemental oxygen Give atropine Start epinephrine infusion Initiate IV, monitor, and gather history 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?* Atropine 0.5mg Synchronized cardio version Transcutaneously pace the patient Adenosine 6mg 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?* Transvenous pacing Intubate Initiate CPR Give atropine, transcutaneous 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?* Amiodarone, 150mg bolus over 10 minutes Epinephrine 2-10mcg/minute infusion Dobutamine 5mcg/kg/minute Diltiazem 5mg/hour 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?* Initiate CPR Give dopamine Defibrillate Cardovert You continue CPR.On re-evaluation, the monitor demonstrates the following: 6. What is your next step in management?* IV fluids Check a pulse Defibrillate Synchronized cardio version 7. Which of the following represents possible causes of PEA arrest?* Hypoxia, hypovolemia Pulmonary embolism, hyperthermia Hypomagnesmia, hypocalcemia Sepsis, myocardial infarction The patient regains a pulse. 8. What is your next step in management?* Start dobutamine Intubate, admit to the ICU Oxygenate appropriately, maintain perfusion, consider therapeutic hypothermia Send for cardiac catheterization
