ACLS Megacode 1: Ventricular Rhythms

A 73-year-old, male presents to the emergency department feeling light-headed and complaining of chest pain.

He appears diaphoretic and uncomfortable. Initial vitals:

T: 35.7, P: 88, R: 30 BP: 180/100, O₂: 93%

IV, oxygen, and monitor are applied. Patient’s vitals remain unchanged.

Initial EKG demonstrates the following:

After giving aspirin, the patient still complains of chest pain and suddenly becomes unresponsive.

The monitor demonstrates the following:

After initial defibrillation, condition is unchanged.

You defibrillate the patient, provide epinephrine and recheck a pulse. The patient remains pulseless.

Rhythm demonstrates the following:

After defibrillation and another round of CPR, with administration of epinephrine, the monitor demonstrates the following:

The patient has a faintly palpable pulse. Patient is hypotensive (70/40).

Monitor demonstrates the following rhythm:

After synchronized cardioversion, patient’s blood pressure improves.

He remains unresponsive, has shallow respirations with oxygen saturation of 90%. Pulse is palpable at 80. Blood pressure 100/60. EKG demonstrates persistent ST elevation.