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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kpurdue says
The problem I see with these guidelines is that you srrss lead II monitoring. It fails to show if the tach is supraventricular. You need V
Chris with admin. says
Keith,
Thanks for your post. As for the V1 lead, I agree that it is needed to differentiate wide complex (WC) supraventricular tachycardia (SVT) from Ventricular Tachycardia (VT), and it is my opinion that ICUs/ERs etc… should utilized at least the 5 lead ecg to achieve this standard of care.
Fortunately, the majority of SVT is narrow complex, and all unstable wide complex tachycardias are treated with synchronized cardioversion. If it is stable a 12 lead ecg is indicated to help determine the diagnosis.
To clinically diagnose a SVT with aberrancy, AV delay/block must be achieved. This is best done with Vagal maneuvers (i.e. valsalva) and/or adenosine. Neither of which will have any effect on VT.
A few things that frequently accompany VT: Age > 35, a previous history of myocardial infarction, recent angina pectoris or congestive heart failure . The hemodynamic stability of the patient cannot be used to differentiate VT from SVT. In fact, VT is often misdiagnosed when the patient is stable.
Blessings,
Chris
1. Baerman JM, Morady F, DiCario LA, et al. Differentiation of ventricular tachycardia from supraventricular tachycardia with aberration: value of the clinical history. Ann Emerg Med 1987;16:40-3
2. Chou P, Young P, Mahmud R, et al. Useful clinical criteria for the diagnosis of ventricular tachycardia. Am J Med 1988;84:53-6.
3. Morady F, Baerman JM, DiCarlo LA Jr, et al. A prevalent misconception regarding wide-complex tachycardias. JAMA 1985;254:2790-2.
4. Spice C, Stewart K. Misdiagnosis of ventricular tachycardia. Lancet 1999;354:2165.
Simone says
A strong help in the practicing of the new ACLS Guidelines. Very good and Thanks !
mansoormasjedi says
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jrj says
this is a great place to prepare yourself prior to the real thing!! because of this website, I passed (100%)!!
ashvin says
The question should specify that the case uses ‘biphasic defibrillators’.
jeff with admin. says
Hi ashvin,
Thanks for the comment. Yes, biphasic can be assumed in all scenarios, quizzes, and videos on this site unless otherwise specified. I have not seen a monophasic defibrillator in quite some time, and I think that this is probably true for most. Thanks.
Jeff
jeff with admin. says
Thanks for the clarification. For the purposes of this website it can be assumed that the scenarios and videos use a biphasic defibrillator. Thanks—-Jeff
dunny says
like the review
oregonnurse says
Remember: AFTER EACH dose of adenosine you must follow with 20cc NS. Flush. Thank you for this site. It is very helpful. ACLS testing can be very stressful, and this site has helped to increase my confidence!!
jeff with admin. says
All medications are followed with 20ml of NS
Anne says
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Sherrye says
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Marylou R says
very helpful and informative. thanks a lot. this will boost my confidence when i finally take my acls.
Carmen says
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