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.
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Question 1 of 12
1. Question
A 40-year-old man arrives at the ER accompanied by his family. He is complaining of palpitations after working outside for several hours. The assessment is as follows:
SKIN: Hydrated, pale, warm and dry
CVS: Strong peripheral pulses and a BP of 125/80
CNS: Fully intact
RESP: RR is 22, no resp. difficulties, lungs CTAYou start an IV on the patient. The monitor shows a narrow complex SVT (160).
What is your next intervention?
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Question 2 of 12
2. Question
You have performed vagal maneuvers. This is what you see on the monitor:
What is your next step?CorrectIncorrect -
Question 3 of 12
3. Question
You give 6mg Adenosine rapid IV push with no effect. 12mg Adenosine rapid IV push is then given. The patient develops severe chest pain, his rhythm is the same, and his vital signs are: HR 220, BP (not obtainable), and weak pulse. The patient also has LOC changes. Your next step should be?
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Question 4 of 12
4. Question
After synchronized cardioversion is unsuccessful, the pt. continues to deteriorate. The patient is now unconscious with pulseless ventricular tachycardia. Below is what you see on the monitor:
What is the first and most important intervention?
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Question 5 of 12
5. Question
You perform defibrillation with 120 J. What is your next intervention?
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Question 6 of 12
6. Question
After completing 5 cycles of CPR, the rhythm is unchanged. You shock a second time with 200 J and resume CPR. While completing the cycle of CPR what else should be done?
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Question 7 of 12
7. Question
You have given the epinephrine and completed the 5 cycles of CPR. A rhythm check reveals no change. You attempt a third defibrillation. What will be your defibrillator setting?
(In all scenarios, assume that the biphasic defibrillator shock setting can be from 50-360 Joules. The shock selection on many biphasic defibrillators can vary.)CorrectIncorrect -
Question 8 of 12
8. Question
The third shock is delivered and you restart CPR (5 cycles). What medication should be given after the 3rd shock during CPR?
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Question 9 of 12
9. Question
What is the correct dosing for amiodarone in the Cardiac Arrest Algorithm?
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Question 10 of 12
10. Question
You give amiodarone 300 mg (first dose) and finish the cycle of CPR. Upon a rhythm check, you see, the patient has converted to a normal sinus rhythm and has a pulse (ROSC). As you begin the post-arrest phase, the patient has a short run of VT. In light of the continued arrhythmia, you are instructed to start an amiodarone drip for post-resuscitation maintenance therapy. What is maximum cumulative dose for amiodarone in a 24 hour period?
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Question 11 of 12
11. Question
Lidocaine can be used instead of amiodarone as an antiarrhythmic during cardiac arrest. What is the proper dosing of lidocaine?
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Question 12 of 12
12. Question
Great Job! You saved the patient He has been stabilized and intubated, but does not respond to verbal commands. He is transported to the hospital's ICU. Since the patient is not responsive what would be the most important intervention in the post-cardiac arrest phase.
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cam8582000 says
Plus we already cardioverted. That’s a shock, right?
Jeff with admin. says
The cardioversion failed and the patient deteriorated into pulseless VT. The most appropriate intervention should be defibrillation.
Kind regards,
Jeff
cam8582000 says
Not sure why you went straight to a shock after patient went into VT after vagal manuvers failed. Why wouldn’t we do CPR first? That is what it shows on Fig 19, pg 61 for VF/Pulseless VT. Wouldn’t I do that while the defibrilator is being set up?
Jeff with admin. says
Vagal maneuvers failed, then adenosine failed. The synchronized cardioversion failed and he patient deteriorated into pulseless VT. Since synchronized cardioversion was attempted, we know that the defibrillator is already attached. Therefore since this is a witnessed arrest, the first intervention would be defibrillation.
I hope that makes sense.
Kind regards,
Jeff
Yolanda says
when should you give epi
Jeff with admin. says
The first dose of epinephrine is given after the 2nd shock and during CPR. After the first dose, epinephrine is given every 3-5 minutes and should be given while chest compressions are being administered. Kind regards, Jeff
Agnes says
Pulseless V tach (PEA) i thought is treated with 1 mg IV epinephrine. I thought PEA is a non shockable rhythm
Jeff with admin. says
Pulseless VT is not considered PEA. It is considered Pulseless VT. It is treated the same what that VF is treated. VF and Pulseless VT are both treated with the left branch if the cardiac arrest algorithm which includes defibrillation. PEA is any organized rhythm that does not have a pulse except for pulseless VT. Kind regards, Jeff
joycemwachia says
Jeff why not assess the outcome first
Jeff with admin. says
I’m not sure I understand the context of your question. Can be explain what in the scenario, you are addressing?
Kind regards, Jeff
Laura says
We always use a 22 micron filter for amio drips…. in a code situation would you need a filter to push amio? Do you mix it in a 25 ml bag or some minibag and give it as a bolus with a filter. Or push it without a filter?
Jeff with admin. says
In a code, you will push amiodarone as fast as you can push down on the plunger. Follow with 20ml NS rapid push as well. Amiodarone will be drawn up in a syringe for this. No filter will be used in a code situation. Amio has a potential to precipitate when infusing slow. The rapid IV push will not need the filter.
In a non-code situation. Dilute the amio in 250ml D5W and use the filter.
Kind regards,
Jeff
Cherie says
Thank you for this site, so helpful and so accurate with scenarios. I feel like I’m at work within these.
It has taken me a few attempts to get a 100%, but finally I did and each step of the way I’m gaining a “clearer view”.
sarakutty says
Oh ghosh! I had such acofusion about the shock and treatment. i feel like from the 1rst scenorio itself I mregaining my confident.
ccurran says
I have never done ACLS- I found this to be GREAT! It was clear & easily understandable.
MK Nunley says
Rhythms, scenarios & quizzes appreciated
Great to review material
Irene says
This is the best class I have ever taken for help with acls .I will use it again this year.I love this site I have told all of my friends about it .thanks Jeff you make it so easy to learn ànd fun . thanks irene musick
Jadran68 says
If indicated, when the 2nd dose of Amiodaron should be given? After 4th shock?
Jeff with admin. says
Yes, any time after the fourth shock during CPR.
Kind regards,
Jeff
saeeda says
Correct information
rhonda says
Start with Vagal maneuvers this product is in SVT and awake no shock if Vagal maneuvers fail adenosine IV
Jadran68 says
In #6 Epinephrine should be given before (during the 2nd CPR cycle) or after the 3rd shock?
Thanks
Jeff with admin. says
The first dose of epinephrine is given after the 2nd shock when CPR is restarted. Kind regards, Jeff
Danisrt says
When do we induce hypothermia?
Jeff with admin. says
After you have achieved ROSC and the patient remains unresponsive. Kind regards, Jeff