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