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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

Initiate compressions

Give a beta-blocker

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 50mg of metoprolol and notify cardiology/Cath Lab

Give atropine

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?*

Defibrillate as soon as possible

Give amiodarone

Give epinephrine

Cardiovert as soon as possible

4. What Joules should be used for defibrillation with a monophonic defibrillator with a biphasic?*

300J with monophonic, 200J with biphasic

300J with monophonic, 300J with biphasic

200J with monophasic, 300J with biphasic

150J with monophasic, 300J with biphasic

After initial defibrillation, condition is unchanged.

5. What is the next step in management?*

CPR

Atropine

Cease efforts

Intubation

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

Epinephrine

Amiodarone

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

8. What is the next step in management?*

Check a pulse

Cariovert

Defibrillate

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?*

Synchronized cardio version

Administer amiodarone

Start epinephrine drip

Defibrillate

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?*

Consider intubation, send to cardiac catheterization for cardiac intervention

Admit to the intensive care unit

Give amiodarone

Give nitroglycerin

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

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

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

After initial defibrillation, condition is unchanged.

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

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).

After synchronized cardioversion, patient’s blood pressure improves.

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