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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EndoNurse says
My biggest question is, isn’t it a “stacked shock” and that’s what was changed?
EndoNurse says
For question #4
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
delphine says
soon in french ????
swathi reddy says
acc to 2015 guidelines vasopressin is out of algorithm
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
walter says
on question 12, the current rosc guidelines in PA no longer recommend therapeutic hypothermia with cold saline.
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.
cdaddy says
Question 4: Why would we not begin CPR as this is PEA, rather than defibrillate?
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.
Eva says
CPR is appropriate as there is no circulation taking place in PEA- No palpable pulse so CPR should start to stimulate circulation
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
Tizzle says
This is also a witnessed arrest there immediate defib. is the best option for this person.
kim says
In the ED setting, I have never seen any of the docs perfom a vagal trial. They all give adenosine.
Mindy Bontrager says
Why not try noninvasive techniques while another RN pulls medication? No real time loss and you’re not introducing a medication that could result adversely.
Chi-Hsien PAi says
Around 25% PSVT patient will return to normal sinus rhythm after vagal maneuvers. l
B says
62% of all statistics are completely made up on the spot.
Jeff with admin. says
Studies have varied in success rates from 19.4% to 92%.
19.4% study.
92% study.
Eva says
Some physicians are uncomfortable with vasovagal because it can cause Aststole
Heather Holmes says
FYI: occasionally a repeat of the scenario will bounce you to a previous scenario instead.
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
cheryl says
we completed this scenario as a group. Cheryl and Stephanie
Kim Crutcher says
We completed this senario as a group. Heidi, Chris, Rita, and Kim worked on this senario.
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.
Jeff with admin. says
I’m so glad that the site was helpful for you. Great job on your certification!
Kind regards, Jeff
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
DAVID says
i like it and also wants to gain my knowldge
Anessa11 says
Can you please describe the differences between defibrillators: mono vs biphasic. Ty
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
acls algorithms says
What is the dose of Amio infusion
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
David says
The drip is 1mg/min for the first 6 hours and 0.5mg/min for the following 18 hours.
MONIKA says
WHY DO WE NOT ASSESS AFTER THE SHOCK?
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