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 two 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 lying 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 belowYou 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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Kira Ridgley says
Jeff,
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”.
Jeff with admin. says
Kira,
That is clarified in question #14.
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
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.
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
Cycles refers to 30 compressions to every 2 ventilations (30:2). Five of these equals approximately two minutes.
Kind regards,
Jeff
Dianne Mendonça says
Hi!
I see in the book dopamine is 2 -10mcg/ kg/ m and not 2-20….
sorry my inglish!!!
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,
Jeff
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,
Jeff
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.
Jeff with admin. says
You are very welcome! Kind regards, Jeff
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.
Jeff with admin. says
Glad to help!
Elaine McKinney says
I see myself getting better and better each day (SMILE)
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.
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,
Jeff
Sam Bado says
Jeff,
According to pg. 152, prophylactic administration of antiarrhythmic medications after ROSC are not supported.
Thank-you,
Samuel
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.
odessue says
Boy, am I ever happy that you are here. This is fantastic.
Jeff with admin. says
I’m so glad that you are finding the site helpful. Kind regards, Jeff
Universe16 says
Excellent material!! Thanks for your help!!
Msrikureja says
Great product. Keep up the good work.