In this ACLS megacode scenario, use the appropriate ACLS algorithms to treat the patient. There are 17 questions for this ACLS training scenario.
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Question 1 of 17
1. Question
You are caring for a 50-year-old female. She is 2 days post-op. from a total hip replacement. 6L/min by nasal cannula. When you enter the patient's room, she appears to be unconscious and you note that her nasal cannula is laying beside her bed. Your initial assessment reveals:
SKIN: ashen, diaphoretic, warm
CVS: Carotid pulse only, HR 25, unable to obtain blood pressure
RESP: sporadic and shallow
CNS: Unresponsive
Monitor: See below
You have called for help. Being an in-hospital setting emergency, your first priority is to:
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Question 2 of 17
2. Question
Which is the correct order for treatment in this scenario?
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Question 3 of 17
3. Question
An IV has been established. The patient is showing clear signs of poor perfusion with the following rhythm.
What should be your next intervention?
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Question 4 of 17
4. Question
You give atropine 1 mg IV push. There is no change in the patients rhythm/rate. What will be your next intervention?
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Question 5 of 17
5. Question
Transcutaneous pacing is attempted. You set the pacing rate for 60/min and attempt capture. After trying for about 30-40 seconds, you are unable to achieve capture. What other medication may now be considered for use in the bradycardia algorithm?
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Question 6 of 17
6. Question
7. As you prepare for an epinephrine infusion and consider transvenous pacing, the patient's rhythm suddenly changes. This is what you see on the monitor.
What should be checked to ensure that this is true asystole?
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Question 7 of 17
7. Question
Which is the correct dosing for an epinephrine infusion in the bradycardia algorithm?
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Question 8 of 17
8. Question
You confirm that this is true asystole and that the patient has no pulse. You begin the cardiac arrest algorithm. Your first step is to:
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Question 9 of 17
9. Question
After you begin CPR what is your next step?
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Question 10 of 17
10. Question
As you begin CPR, you recall the number of CPR cycles that are to be delivered between other interventions is ________ and you also recall that the correct compression-to-ventilation ratio is __________.
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Question 11 of 17
11. Question
As you finish up with the first cycle of CPR and give the first dose of epinephrine (1mg IVP), the rhythm changes. The rhythm below is what you now see on the monitor. The patient remains unresponsive. What is this rhythm?
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Question 12 of 17
12. Question
You determine that this rhythm is ventricular fibrillation, and you begin the VF cardiac arrest algorithm (left branch). What is your first intervention?
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Question 13 of 17
13. Question
You shock the patient with 120 J and continue CPR immediately. After 5 cycles of CPR, your rhythm check reveals continued ventricular fibrillation. What is your next step?
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Question 14 of 17
14. Question
A second shock is delivered at 200 J, and CPR is continued. Your next intervention is to:
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Question 15 of 17
15. Question
The epinephrine is given, and after the cycle of CPR is completed a rhythm check reveals continued ventricular fibrillation. You give a third shock (300 J) and resume CPR. What is your next intervention during CPR?
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Question 16 of 17
16. Question
You give the amiodarone 300 mg IV and after completing the 5 cycles of CPR you check the rhythm:
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Question 17 of 17
17. Question
You shock the patient and complete 5 cycles of CPR. After the CPR, you see the following rhythm on the monitor.
You perform a pulse check. The patient now has a palpable pulse. VS are: HR 60; BP 105/65; RR 5-8
You have corrected the ventricular fibrillation and the patient is stabilizing but has had several short runs of ventricular tachycardia post-arrest. You now consider maintenance antiarrhythmic therapy that can be started if any arrhythmias persist in the post-arrest phase. Which is the best drug of choice in this scenario?
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Hope says
Question 8 asks about the first step for true asystole and indicates it is to begin CPR. The 2020 guidelines seem to indicate that you give epinephrine ASAP before initiating CPR (ideally in a hospital both could be done at the same time, but for the purposes of the question and the algorithm it lists epi before CPR), but the quiz indicates to do CPR first. Am I missing something?
ACLS says
The first priority is always CPR.
Providing epinephrine is now considered an important priority and should be done as soon as possible, but it is not greater in order of importance than CPR.
Kind regards, Jeff
Matt says
I noticed the same thing as you. ie, the adult cardiac arrest algorithm diagram states to give epi ASAP for asystole, THEN it says to start CPR in the next bubble.
However, the ACLS provider manual 2020 does say that the initial step is CPR (page 132, middle of the page).
I think the algorithm diagram ought to better reflect this.
Ray says
Yes you are missing something. Epinephrine may not be readily available when asystole occurs and you cannot wait for the medication or crash cart to arrive. You need to do something immediately until the medication arrives. Furthermore, what happens if your IV site is turns out to be no good. CPR is always priority.
Shauna Fox says
Do the new 2020
guidelines now
recommend atropine 1 mg up to 3 mg instead of 0.5mg?
ACLS says
Yes that is correct.
Kind regards,
Jeff
emmurphyfnp says
I believed for a non perfusing rhythm such as brady at 25bpm cpr should be first is it not? of course the o2 is critical also
ACLS says
Thank you for the question. You asked:
I believed for a non perfusing rhythm such as brady at 25bpm cpr should be first is it not? of course the o2 is critical also.
Reply:
This is true for pediatric patients. However, in the adult bradycardia algorithm the intervention should be atropine if it does not delay transcutaneous pacing. If transcutaneous pacing is going to be delayed then transcutaneous pacing should be initiated as soon as possible.
Kind regards, Jeff
Traci says
Those options were not offered in the scenario. Walked in, pt unresponsive etc..options provided..Epi, Airway, IV access or compressions. This only left compressions as best initial action correct?
ACLS says
The best initial option for respiratory distress and failure is to use a bag valve mask and provide ventilation. Kind regards, Jeff
shannon says
how can I find out what question I got wrong?
ACLS says
At the end of the quiz before you click on “finish quiz”, you can review each question in the quiz using the block navigation at the top of the quiz that shows the individual quiz numbers.
Kind regards, Jeff
Kyle Kressman says
Shouldn’t the second defibrillation be at 300j? I thought just the first dose is 120j-200j, and subsequent defibrillation doses are higher than that even if you elect to start on the lower end of that starting range.
ACLS says
If the first dose given is 120 J then the second dose can be 200 J. If the first shock dose is 200 J then you would provide 300 J or 360 J as the second dose.
Kind regards,
Jeff
Essam Elgarhy says
Regarding sinus bradycardia with unstable patient I feel that the recommendation should be clear give atropine 0.5 mg IV and increase up to 3 mg if no Trans cutaneous pacing available . But if Trans cutaneous pacing available use it immediately after 0.5 mg atropine( if not effective) .
Eric says
For biphasic defibrillators, it is best to give 360j for every shock?
ACLS says
AHA recommend starting biphasic defibrillation with 120 J and increasing the dose in a stepwise manner. 120-300-360J.
Healthcare providers may tailor the interventions to the specific situation. I know cardiologists that go straight to 360 J when they provide defibrillation for VF and pVT. They say providing less is a waste of time.
There is a high percentage of cardioversion of the ventricular fibrillation that occurs with 120 J. I don’t think that 360 J is necessary in most cases, but automatically defaulting to 360 J does simplify things.
Kind regards,
Jeff
moaz says
Biphasic: Manufacturer recommendation (eg, the initial dose of 120-200 J);
if unknown, use the maximum available. Second and subsequent doses should be equivalent, and higher doses may be considered.
Monophasic: 360 J
Denis says
For question 8, if I witnessed the pt go into asystole, why would I not immediately defibrillate instead of beginning CPR first?
Jeff with admin. says
Defibrillation is not indicated for asystole. If witnessed arrest occurs and the rhythm is asystole, the primary intervention would be high-quality chest compressions. Would follow the right branch of the cardiac arrest algorithm.
Kind regards,
Jeff
emergency_training_center says
In the question 14, about which drugs we should give while the patient is in V-fib. Shouldn’t we give antiarrythmics such as amiodarone instead of adrenaline ? since we already gave adrenaline, as we were in the asystole algorithm ?
Thanks for your answer.
Jeff with admin. says
This question has more to do with the order of the administration of medications. Epinephrine is given after the second shock during CPR. It is given every 3 to 5 minutes after that. The first dose of amiodarone is given after the third shock during CPR. This is the sequence for the administration of medications within the American heart Association guidelines for cardiac arrest.
Kind regards,
Jeff
Teresa Echevarria says
regarding question #4. the answer showed attempt TCP. my concern is that only 0.5mg Atropine was given. Shouldn’t they attempt another dose with a maximum of 3mg until they attempt TCP?
Jeff with admin. says
For the treatment of bradycardia, the maximum INDIVIDUAL does is 0.5 mg IV.
The 3 mg maximum dose is the maximum total COMBINED doses. Multiple doses of 0.5 mg can be given up to a total maximum dose of 3 mg.
For symptomatic unstable bradycardia, atropine may be attempted, but it also may be excluded if it’s administration will delay transcutaneous pacing.
Kind regards,
Jeff