He is noted to be diaphoretic and appears uncomfortable. The nurse is taking his initial vitals when he suddenly becomes unresponsive. You see the following on the monitor.
What is the next best step?
Intubate the patient
Start CPR
Check a pulse
Defibrillate
New ACLS guidelines emphasize “CAB” circulation, airway, breathing. As such, identification of the rhythm is imperative with regards to next steps in ACLS algorithm. An unstable patient with Vtach and a pulse should be cardioverted. Vtach without a pulse should be defibrillated.
What is the next step?
Cease efforts
Continue CPR, administer epinephrine
Get an EKG
Cardiovert
According to pulses Vtach algorithms, Cardioversion is reserved for unstable tachycardias. It is inappropriate to cease efforts after such a short time in arrest. Do not pause CPR for superfluous testing such as getting labs or a formal 12 lead EKG
You attempt defibrillation again and continue CPR.
What medication, other than epinephrine, can be administered next?
Atropine
Adenosine
Amiodarone
Atenolol
Dose at 300mg IV push during codes scenario.
The patient develops the following rhythm:
What is your next step?
Administer Amiodarone
The rhythm is ventricular tachycardia and is classified as stable, unstable, or pulseless, based on the clinical scenario. If the patient is in pulseless vtach, early defibrillation is key, but patients with a pulse should not be defibrillated.
You check the rhythm:
What do you do next?
CPR
Epinephrine
This rhythm is vfib which is not compatible with life and is not a perfusing rhythm. The patient will not have a pulse and should be immediately defibrillated as soon as possible. In a scenario where this is recognized, CPR should ensue until defibrillation can occur. In this particular scenario, as patient has had multiple rounds of CPR etc, defibrillator should be prepared and no time wasted prior to delivering electricity.
What are the appropriate Joules for monophasic and biphasic defibrillators?
360 J for mono, 200 J for biphasic
360 J for mono, 360 J for biphasic
120 J for mono, 360 J for biphasic
100 J for mono, 50 J for biphasic
Monophasic defibrillators deliver electricity in 1 vector whereas biphasic defibrillators deliver electricity in 2 vectors.It is possible to start at a lower J for biphasic defibrillator and increase with each shock. It is important to know what resources you have available at your hospital or clinic. AEDs can be either but more commonly are biphasic
