ACLS Megacode 1: Ventricular Rhythms Hurry, don’t let time run out! Sorry, time is up! 0 Hours 0 Minutes 0 Seconds Step 1 of 10 10% Untitled 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% 1. What is your initial step in management?* Immediately activate Cath Lab and STEMI protocol Place patient on monitor, establish IV access, gather history and examine patient, provide supplemental oxygen, get an EKG Give a beta-blocker Initiate compressions IV, oxygen, and monitor are applied. Patient’s vitals remain unchanged. Initial EKG demonstrates the following: 2. What is your next step in management?* Give 324mg of aspirin and notify cardiology/Cath Lab Give 0.4mg nitroglycerin and notify cardiology/Cath Lab Give atropine Give 50mg of metoprolol and notify cardiology/Cath Lab After giving aspirin, the patient still complains of chest pain and suddenly becomes unresponsive. The monitor demonstrates the following: 3. What is your next step in management?* Cardiovert as soon as possible Give epinephrine Defibrillate as soon as possible Give amiodarone 4. What Joules should be used for defibrillation with a monophonic defibrillator with a biphasic?* 200J with monophasic, 300J with biphasic 300J with monophonic, 200J with biphasic 150J with monophasic, 300J with biphasic 300J with monophonic, 300J with biphasic After initial defibrillation, condition is unchanged. 5. What is the next step in management?* Atropine Cease efforts Intubation CPR 6. What medications can be used to aid resuscitative efforts?* Amiodarone 150mg one time Adenosine 6mg, followed by 12 mg if initial dose is ineffective Epinephrine 1mg, every 3-5 minutes Atropine 0.5 mg, every 3-5 minutes You defibrillate the patient, provide epinephrine and recheck a pulse. The patient remains pulseless. Rhythm demonstrates the following: 7. What is your next step in management?* Cardiovert Defibrillate Amiodarone Epinephrine After defibrillation and another round of CPR, with administration of epinephrine, the monitor demonstrates the following: 8. What is the next step in management?* Defibrillate Cariovert Check a pulse CPR The patient has a faintly palpable pulse. Patient is hypotensive (70/40). Monitor demonstrates the following rhythm: 9. What is the next step in management?* Start epinephrine drip Administer amiodarone Defibrillate Synchronized cardio version 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.10. What is the next step in management?* Give nitroglycerin Give amiodarone Consider intubation, send to cardiac catheterization for cardiac intervention Admit to the intensive care unit
