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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Roberta Armstrong says
please differentiate between ivp and iv drip
Jeff with admin. says
IVP means IV push. Push the medication as rapidly as you can press the plunger down without blowing the IV.
IV drip is an IV drip has a slow rate and is given over a more extended period of time.
Kind regards,
Jeff
Roberta Armstrong says
what rate is the amiodarone drip set at?
Jeff with admin. says
All of the information that you need for amiodarone is found on this page. Amiodarone and ACLS. Kind regards, Jeff
Roberta Armstrong says
lidocaine 1 1.5 mg/ kg how fast is this pushed? or is it a drip
Jeff with admin. says
When using lidocaine within the cardiac arrest algorithm, it is pushed as fast as you can push the plunger down (without compromising the IV) and then followed with 20 ml of NS. All medications are rapid push for the cardiac arrest algorithm.
Kind regards,
Jeff
Kellie Goudreau says
Hello.
Question 3 sync vs unsync: are you using sync, despite vt, because there remains a weak pulse? Then unsync when pulseless vt/pVT?
Thank you!
Jeff with admin. says
That is correct. If a pulse is present then you would want to attempt synchronized cardioversion.
Use unsynchronized defibrillation for pulseless Vt and VF.
Kind regards,
Jeff
steveahm@comcast.net says
Hi Jeff – I have been religiously using your site every two years as part of my review in prep for every 2 year ACLS. Great job on your end, as usual. For clarification re: defib dosing in pulseless ventricular scenarios – I’m slightly confused. Your site Iin testing scenarios) advises/tests on sequentially increasing the biphasic dose, yet the book in 2015 seems to advise using sequential same dosing of approx 200 joules (or manufacturer’s recommendation). Which is it, staying consistent and “considering increasing the dose” or sequential increasing? What do you advocate as the best practice? My ER site stays at our 150 j recommended dose and increasing prn poor response. Thanks!
Jeff with admin. says
American Heart Association ACLS guidelines state:
Initial shock dose should be according to Manufacture recommendation for specific machine (typically 120-200 J).
If the manufacturer recommended dose is not known then use the maximum dose available.
Second and subsequent doses should be equivalent entire deuces may be considered.
I will try to make sure this is more clearly stated on the site. Thank you for pointing this out.
Kind regards,
Jeff
Stacie Crawford says
Please explain why you would used synchronized cardioversion vs. defibrillation?
Jeff with admin. says
Here’s a page that will give you a full understanding of the difference between the two.
Synchronized vs. unsynchronized cardioversion
Kind regards,
Jeff
Angie says
Would like to see some different scenarios, I have memorized these as they are the same ones every 2 years
Jeff with admin. says
Thank you for the encouragement, over the next year I plan on adding at least 10 more scenarios to the multiple-choice megacode scenario questions.
Kind regards, Jeff
Michael Daigle says
ques 2 is second injection of adenosine immediate or how long to wait for effect of first dose
Jeff with admin. says
The effect of adenosine will only takes seconds, and the half-life of adenosine is very short and the second dose can be repeated one or two minutes after the initial dose.
Kind regards,
Jeff
alima says
Your site gives me the greatest confidence. It’s been a year since last ACLS test, and needed a refresher. Thanks for jogging my memory, and for a great website!
Llamina Ralls says
In the Cardiac Arrest algorithm Amioderone is given after the 3rd shock during CPR. How quickly should the amio be given. I assume as quickly as possible. Asking because I see that in the Tachy Algorithm for a wide QRS rhythm amio 150 mg over 10 min is recommended for monomorphic VT followed by maintenance inf 1mg/min times 6 hours. The 10 min has me wondering on how fast to be pushed in cardiac arrest situation. I don’t want to get confused on this.
Thanks
Llamina
Jeff with admin. says
When amiodarone is used in the cardiac arrest algorithm, you will give the amiodarone as rapidly as the plunger on the syringe can be pushed. Make sure to follow the amiodarone with 20 ml of NS rapid push.
Kind regards,
Jeff
Viola Kelly says
I start a new job soon and I think this will help me a lot, thanks.
SUSAN ISAAC says
Hi Jeff,
As the pulse is WEAK why not defib rather than synchronised cardivert?
regards ,Susan.
Jeff with admin. says
When a pulse is present, the defibrillator should be able to synchronize with the patients rhythm. Synchronization allows for the electrical shock to be delivered at the correct moment during cardiac electrical cycle.
There are fewer risks involved with synchronized cardioversion, and if the patient has a pulse, synchronize cardioversion should be attempted.
Kind regards,
Jeff
Lucindia Williamson says
What if you do not know the patient’s weight for the lidocaine which is given per kg?
Jeff with admin. says
You can make an approximated guess at the weight and titrate dosing up or down once it is infusing.
Kind regards,
Jeff
Veronica says
I took the ACLS test today and received a high score. The mega code I was told I did very good. I have troubles retaining the written word in a book but this course was like a hands on. Thanks
Nerrine Colón says
i interview tomorrow for my first full time medic position with my county! this has helped a lot!! thanks
Jeff with admin. says
Best wishes in your interview!
Kind Regards, Jeff