ACLS Megacode Scenario 2 |


  1. Kira Ridgley says

    I’m not trying to be difficult but Q #13 lacks pertinent info. When it asks the NEXT step after the 5cycles and rhythm check, the answer is give a shock, but fails to indicate there needed to have been an increase from 120 to 200. Not to remain at the same dose which is implied with the simple answer “give a shock”.

  2. Jared Karrasch says

    Regarding #17

    You perform a pulse check. The patient now has 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?

    1. amiodarone
    2. lidocaine
    3. epinephrine
    4. magnesium sulfate

    Pg 152 AHA ACLS Post arrest states no evidence supporting therapeutic medications. Although, Procainamide and Amiodarone are now maintenance inf of choice in stable wide tachy. Pg 133

    • Jeff with admin. says

      Pg. 170 of the AHA ACLS Provider Manual recommends amiodarone for ventricular fibrillation and pulseless ventricular tachycardia that is unresponsive to shock delivery or for recurrent, hemodynamically unstable ventricular tachycardia. Amiodarone should not be used prophylactically, but should be used if tachyarrhythmias persist in the post-arrest phase.
      Kind regards, Jeff

  3. bonzie says

    fantastic site. I have been using your site every 2 years to recertified. so much easier for me than reading thru the book. I am an OB nurse which makes it a little hard due to the fact we don’t see any of this in my line of work.
    Thanks Jeff.

  4. Sara Gough says

    hi Jeff, just to be clear, is 5 cycles of CPR referencing 5 cycles of 100 ?
    Just wondering when you for an advanced airway? Right away or go for cycles of cpr..

    • Jeff with admin. says

      See pg. 126 AHA ACLS Provider Manual:
      Epinephrine infusion should be started at 2-10 mcg/min and titrated to the patient response.
      Dopamine infusion should be started at 2-20 mcg/kg/min and titrated to the patient response.
      Note that epinephrine is not weight based in the bradycardia algorithm.
      Note that dopamine is weight based in the bradycardia algorithm

      Kind regards,

  5. Ava Swenson says

    Question re: number 8. Is it not specified to administer epi as soon as possible in asystole/ PEA if on hand right away? (I understand that CPR is obviously key, but I red that early admin of epinephrine is also important for this case?)

    • Jeff with admin. says

      Early administration of epinephrine is important. However, the most important intervention and the first intervention that will occur when cardiac arrest is identified is CPR.

      Epinephrine would follow very quickly after the initiation of CPR.

      Kind regards,

  6. Sydney Borden says

    Thank-you for providing this site. I am a brand new nurse and I am trying expand my knowledge and skill set. This site explains everything so nicely and in a way I am able to understand. Thank you for providing such clear and concise information.

  7. Regina Del Rosario says

    Jeff, forever grateful to you for creating this site. You are a God-sent to us who are not skilled yet and trying to learn. You explain things in a way I can understand it.

  8. Vislet Gordon says

    Glad I found this site. It helps. I had a disastrous situation at work today and decided to look for simple explanation and found this site thank you guys. I will give this information to my nurses and I hope they are not too cheap to pay the money, they are new nurses and need the information to expand their knowledge and comfort level.

  9. Jenny Truong says

    Hi, Jeff I hope u can help me clarify this question
    According to Cardiac Arrest Algorithm, after the first shock, we do CPR and obtain IV/IO, after the second shock, we do CPR, give Epinephrine, after the third shock we do CPR and Amiodarone. So if we receive pt with IV line, can we give epinephrine after the first shock. Thank you

    • Jeff with admin. says

      There are two branches to the cardiac arrest algorithm. The right branch and the left branch. If IV access is available, Epinephrine administration can be immediate in the right branch of the cardiac arrest algorithm.

      For the left branch of the cardiac arrest algorithm, American Heart Association recommends and administration of epinephrine after the second shock during CPR.

      For this issue, there are many providers that disregard the American Heart Association guidelines and give epinephrine as soon as possible in the left branch of the cardiac arrest algorithm well as the right branch.

      My professional opinion is that you are fine to give epinephrine as soon as possible if you have IV access. Just make sure that the administration of epinephrine does not delay defibrillation or high-quality chest compressions.

      Kind regards,

  10. Sam Bado says


    According to pg. 152, prophylactic administration of antiarrhythmic medications after ROSC are not supported.



    • Jeff with admin. says

      Yes, It is correct that antiarrhythmic therapy should not be used prophylactically. This means that if arrhythmias are not present antiarrhythmics should not be used to prevent them.

      However, if arrhythmias persist in the post cardiac arrest fees, antiarrhythmics may be used to treat arrhythmias.

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