ACLS Megacode Scenario #2

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:

Which is the correct order for treatment in this scenario?

An IV has been established. The patient is showing clear signs of poor perfusion with the following rhythm.

What should be your next intervention?

You give atropine 0.5mg IV push. There is no change in the patients rhythm/rate. What will be your next intervention?

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?

7. As you prepare for an epinephrine infusion and consider transvenous pacing, the patients rhythm suddenly changes. This is what you see on the monitor.

What should be checked to ensure that this is true asystole?

Which is the correct dosing for an epinephrine infusion in the bradycardia algorithm?

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:

After you begin CPR what is your next step?

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 __________.

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?

You determine that this rhythm is ventricular fibrillation, and you begin the VF cardiac arrest algorithm (left branch). What is your first intervention?

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?

A second shock is delivered at 200 J, and CPR is continued. Your next intervention is to:

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?

You give the amiodarone 300 mg IV and after completing the 5 cycles of CPR you check the rhythm:

What is your next step?

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?