ACLS Megacode Scenario 1 | ACLS-Algorithms.com

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      • Jeff with admin. says

        Because there was a rhythm change from tachycardia with a pulse to pulseless tachycardia this would not be a stacked shock.

        Also, the first shock was synchronize cardioversion and the second shock was defibrillation. You moved from one algorithm to another.

        Kind regards,
        Jeff

    • Jeff with admin. says

      Thank you for the comment. Any changes to the American Heart Association ACLS guidelines will be fully in effect sometime around April or May 2016. Until that time, all ACLS certification classes will still be instructing that vasopressin can be used as an acceptable alternative in replace of the first or second dose of epinephrine within the cardiac arrest algorithm of ACLS protocol.

      Kind regards,
      Jeff

    • Jeff with admin. says

      I wonder if AHA will pick this up in the new guidelines and now just in PA. As soon as I hear how the AHA Sessions go next month, I will update this information. For now, the provider manual recommends cold saline. Kind regards, Jeff

    • MERLE M SIMPSON RRT, TCF says

      THE AMERICAN HEART ASSOCIATION IS RECOMMENDING NOT INDUCING HYPOTHERMIA WITH COLD SALINE IN THE PRE- HOSPITAL SETTING.

    • 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

    • Trey Spooner says

      Pulseless VT is not considered a PEA rhythm. Because this is witnessed VT, CPR is only required while the defibrillator is prepared. Immediate defibrillation is indicated, without 2 minutes of CPR.

      • Jeff with admin. says

        Pulseless VT is not treated as PEA. It is treated using the left branch of the cardiac arrest algorithm. This patient should receive defibrillation immediately. The rhythm changed from tachycardia with a pulse to pulseless VT. This appropriate intervention would be to first defibrillate. Kind regards, Jeff

    • Jeff with admin. says

      Thank you for letting me know about this. I will look into this problem and see if I can determine what is causing this. If this happen very often or just a couple of times?

      Kind regards,
      Jeff

  1. angel says

    I owe a credit for this wonderful site. Just finish my ACLS course yesterday with a good score 🙂 Thank you.. Keep up the good work.

  2. Elizabeth Novotny says

    Thanks to you and to God I got a 90% on my test. And, I did well on my mega code! Thank you so much for everything!!!

    Take care and God bless,
    Elizabeth

    • Jeff with admin. says

      Monophasic uses direct current which passes in one direction from one paddle to the next. Biphasic defibrillation, alternates the direction of the pulses and requires less energy for the same effect.
      Most biphasic defibrillators have a first shock success rate that is significantly higher than monophasic defibrillators. Roughly 20% higher success with biphasic. Here is a study
      Biphasic defibrillation significantly decreases the energy level necessary for successful defibrillation, decreasing the risk of burns and myocardial damage.
      Kind regards,
      Jeff

    • Jeff with admin. says

      The first dose is 300mg IV push and it is given during CPR after the third shock. 3. The second dose is 150mg and can be given any time after the 4th shock during CPR.
      You can read more about amiodarone here.
      Kind regards, Jeff

    • Jeff with admin. says

      After the shock, you will immediately deliver 5 cycles of CPR. This is to help prevent delay in delivery of chest compressions. If chest compressions are delayed, this worsens outcomes and reduces systemic pressure which is critical if ROSC is to be obtained.

      If a shock is effective and causes conversion to a perfusing rhythm, it can take a couple of minutes for the heart to recover and reach sufficient cardiac output. During that couple of minutes CPR can improve cardiac output and cardiac oxygenation which is critical for the heart to achieve full ROSC.

      Kind regards,
      Jeff

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