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