ACLS Megacode Scenario 1 | ACLS-Algorithms.com
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Learn and Master ACLS/PALS

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ACLS Megacode Simulator 1

In this ACLS Megacode scenario, use the appropriate ACLS algorithms to treat the patient. There are 12 questions for this ACLS megacode scenario. Assume the use of biphasic defibrillator in all scenarios.

(2020-2025 guidelines)

Comments

    • Jeff with admin. says

      Concerning outcomes, there is no difference. They are both being used for their ability to vasoconstrict which will help improve cardiac output. You can use either and expect the same outcome. You can only use vasopressin once because its half-life is much longer than epinephrine. So after it is used, you will be giving epinephrine every 3-5 minutes. Remember, vasopressin can only be given in replace of the 1st or 2nd dose of epinephrine.

      Kind regards,
      Jeff

      Reply

  2. yems says

    this is helpful, very very helpful. I have never taken acls class before, I did the pretest and got 35%, so i’m kind of dreading the class but especially the test. thanks for the scenarios here!

    Reply

  8. Dr. Rafael Pérez González says

    You have completed ACLS Megacode Simulator- Senario 1.

    You scored 12 out of 12.

    Your Grade is 100.00 %

    Reply

  9. Adam S says

    You have completed ACLS Megacode Simulator- Senario 1.

    You scored 12 out of 12.

    Your Grade is 100.00 %

    Reply

  11. Tex says

    Looked this site up to help a friend out. Passed each mega easily. As a doctor, my assessment of the site is that it is very clear and concise. At this point, the “rationale” is based on your education. If you’re not understand the “why”, then the practice test provides the rationale.

    What you need to do is truly understand what certain meds do so that you are not stopping to think about which one to give. As each piece becomes instinctual and automatic, the codes you run will become easier.

    The biggest reason for failure is not understanding the “WHY” — if you learn the mechanics, then you can apply that to the question and deduce the answer.

    It’s useful to make associations so that memory is engrained. For example… “mi corazon” in spanish means “My heart” or if you say, “Ah mi corazon,” to someone special, it is more akin to “my sweetheart” or “my love”, etc. So… A-Mi-odarone…. Amiodarone is for “The Big One” as in Ventricular. Redd Foxx, on the old TV show “Sandford & Son” used to always look to Heaven and say, “Oh… it’s the big one, Elizabeth! I’m comin’ home, Elizabeth”.

    Now you remember easily that the big one is the heart + VENTRICULAR… so for VT & VF, you must shock them out of those rhythms… and will be using AMIodarone. Ah, mi corazon!

    Adenosine is used for blocking bad electrical pathways… so it’s used for PSVT, especially for WPW Syndome. One way to recall aDENosine is to remember it is associated with longer acronyms… PSVT, SVT, and the WPW Syndrome, for starters. Then WPW is WOLFf-Parkinson-White… so for me, I see a DEN and a wolf and I’m thinking animals, but I tend to think of BEARS with cubs in a DEN… which reminds me of the Chicago Bears… known for Defensive and BLOCKING ENTRY into the end zone. So aDENosine is for blocking entry…

    Now I see adenosine and I think PSVT, SVT, WPW… block re-entry to bad electrical pathways… and I know that it is for the less severe cardiac arrest rhythms.

    Come up with your own way, and don’t try to memorize what rhythms are PEAs… understand that a PEA is any rhythm where you cannot find a pulse.

    As you learn the algorithm, don’t try to memorize it… rather, understand that you shock VT, VF because you need to get the Atrial pathway back up and running. Think of the Atrium as The Battery and in VT & VF the battery is obviously dead… so you “jump start” it with some jumper cables.

    For other PEAs, the atrium is working… so you do NOT jump start it!!

    Asystole is not a shockable rhythm. Why? The BATTERY IS DEAD! There is not a single cell in that battery showing life… so if it was a car, you would NOT be able to jump start it.

    Now you start to form easy images of the pathways and before long, you see VT or VF and you make sure they have oxygen flowing and you’re going to automatically know that after starting CPR, you will be reaching for the cables to jump start that heart.

    Epi is used on both pathways. It’s easy to remember if you’ve ever watched a single TV show. Everyone always calls for Epi.

    Vasopressin 40mg is only for Ventricular Tach/Fib…. Both start with “V” so you only use that on the VT/VF pathway.

    A-Mi-odarone is only for THE BIG ONE and Ventricular-initiated firing of the heart means a BIG ST segment… Redd Foxx grabbing his heart… A Mi Corazon… — heart, big… Ventricular… Amiodarone.

    Pretty soon, the pathways are automatic and it’s down to numbers. All that CPR made you hungry and you remember that Arby’s has a 2 for $5 deal… then you laugh because it’s “CPR for 2 mins for 5 cycles” and epi is every 3-FIVE minutes.

    When you start to understand the WHY and HOW of the little things, you’ll find your own easy way to recall meds, etc. If you’ve spend a moment in the medical world, especially in surgery, then you understand that we all are considered dysfunctional by the non-medical world because we think about food and get hungry while cracking RIBS and spreading them for emergency open heart surgery etc… so don’t worry if you’re thinking about the “2 for $5” special at Arby’s while doing CPR and calling for epi on a VT patient. We ALL do it, or something like it, all the time.

    Use what works for you… but under pressure, rote memory will fail you if there is the slightest PERCEIVED deviation from the way you memorized things. Understand, be able to move from the right pathway (PEA & Asystole) to the left pathway if the patient goes into VT or VF… realizing that now you’re not only shocking, but possibly using Amiodarone.

    Once those are automatic, then the rote memory items, such as Max Dose q24h is trivial and easier.

    I hope this helped someone. As I read through the notes and saw the anxiety and questions about rationale, I realized many people were not comfortable with how and why things are used. Many students, residents, etc. benefit from correlations they draw, as I did above, that bring them to a new comfort level with the material. They develop confidence and re-direct their negative fears into powerful sponge-like absorption of the material they’re studying.

    Best of luck to everyone who is taking ACLS for the first time! After the first time, it’s not a worry… just one of those worrisome things that you have to do that you dread doing. LOL

    Reply

  12. Waqar says

    You have completed ACLS Megacode Simulator- Senario 1.

    You scored 10 out of 12.

    Your Grade is 83.33 %

    Reply

  13. fleurdeliz says

    This scenario is referring to pulseless VT. Why is the answer “synchronize cardioversion when the patient condition deteriorates to pulseless VT/PEA?

    Reply

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