In this ACLS Megacode scenario, use the appropriate ACLS algorithms to treat the patient. There are 17 questions for this ACLS megacode scenario.
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taylor05 says
Great scenario my first time using the site and enjoying it.
Marujamd says
Thank you took acls yesterday and passed see you in two years!!
rnmarlie says
If you are doing hands on CPR how can you do all of the other three steps…considering that you have a citizen provider to help..
Jeff with admin. says
This scenario states: “the EMS team arrives shortly.”
You do have a team to work with.
cpatterson411 says
Question #7 Why is this an unsynchronized shock instead of a synchronized shock?
Jeff with admin. says
In this question, the patient’s rhythm changed from asystole to a pulseless ventricular tachycardia.
Pulseless VT is treated with unsynchronized shocks.
If the patient had a pulse but was symptomatic, then you would treat with synchronized shocks if the defibrillator would sync with the rhythm.
Kind regards,
Jeff
jill says
i had the same question. thank you Jeff for clarifying.
klabieniec says
Question 17, Don’t we give atropine first if TCP not available?
Jeff with admin. says
If TCP were not available you would give atropine first.
However, this question is simply asking what medications are now considered equivalent alternative to TCP.
Kind regards,
Jeff
CPR_Lady says
I disagree with the answer. He can’t breath on his own….Tube him. Besides, the atropine dose is too much, only give 0.5 when they’re alive.
Candace Coggins says
Question #15 suggests transcutaneous pacing as the correct answer (before trying atropine). The AHA ACLS Adult Bradycardia Algorithm suggests TCP if atropine is ineffective. Seems they are suggesting atropine before TCP. What do you think?
Jeff with admin. says
On page 113 of the AHA ACLS provider manual (Bradycardia Section) it states:
“consider giving atropine before pacing in mildly symptomatic patients. Do not delay pacing for unstable patients particularly those with high-degree block.”
In the case of this very unstable patient in a complete heart block (this is the highest degree block), who is already attached to the pacer/defibrillator it would be very appropriate to immediately start TCP.
Kind regards,
Jeff
doc.gooogles says
It seems counter-intuitive for AHA to suggest this.
While TCP was being set-up, 0.5mg Atropine would be very quickly pushed IV.
bekgardner says
It’s not the speed and ease of administration, but the effectiveness of the intervention considered.
LRTrog says
Great scenario!
sasrn says
I agree that it is definitely 3rd degree HB
PattiLT says
Question #3…Really? How are you supposed to do anything else while you are doing 5 cycles of CPR??
Jeff with admin. says
The scenario reads: “The EMS team arrives shortly, takes over CPR, and attaches a defibrillator.”
You are not alone in this scenario. You are working with a team.
Kind regards, Jeff
sar2010 says
Watch rhythm.
Jr Zhen says
The q15 is tricky. The “absence of spontaneous breathing” has distracted me from paying attention to the high risk of asystole and the urgent need of TCP.
sar2010 says
not sure.
Linda Welch says
I agree 3rd degree heart block.
Judy Taylor says
1. What ACLS algorithm are you going to begin this scenario with ? (Shows asystole, but does it????? anytime you have flatline/asystole you need to check in 2nd lead to verify what you’re dealing with. The question doesn’t say “after verifying in 2nd lead”?.
Jeff with admin. says
In this scenario, leads were just attached by EMS, the patient was found unresponsive, pulseless, and the collapse was witnessed. You stated “anytime you have a flatline/asystole you need to check in 2nd lead.” You will not find this in the ACLS provider manual for any of the algorithms. Checking a 2nd lead is a good practice, but it is not necessary for the purposes of ACLS. I also did a search at the AHA website and the little bit that I could find stated “confirm 2 leads if possible.”
Don’t get me wrong, confirmation of a 2nd lead is a good thing, but in this scenario, you have an unresponsive and pulseless patient who you just connected to the monitor (ie.. the leads are connected properly). I am open to your feedback if you have any AHA literature that states that the 2nd lead is necessary please let me know.
Kind regards, Jeff
lyndsey williams says
Rhythm
jwares says
Why in q 15 is atropine not correct? Not PEA if has faint pulse… Thx
Jeff with admin. says
The rhythm is complete heart block (3rd degree hear block). A faint pulse is a pulse. The patient has ROSC (return of spontaneous circulation) at this point and the bradycardia algorithm should be initiated. Since you already have the monitor defibrillator attached, going directly to TCP (transcutaneous pacing) is indicated. —regards, Jeff
mmcphailfnp says
I’m confused about the supposed correct answer for the question (16), I believe, regarding the rhythm, 2nd or 3rd degree AV block. From 22 yrs of nursing and a veteran ACLS instructor this is clearly 2nd degree AV block, not 3rd degree AV block. Now, I’m wondering what other answers are incorrect. I will gladly listen to any rationale anyone can offer me explaining why this is supposedly 3rd degree AV block.
Jeff with admin. says
The rhythm strip was used from a patient that was in complete heart block. P-waves and QRS-waves are completely disassociated. The p-waves are regular and have there own atrial rate. The QRS waves are regular and have there own ventricular rate. Here is a page that explains the rational and uses the same image that is in the scenarios.
Kind regards, Jeff
middiesmom says
That is clearly 3rd degree–there is no correlation of the p’s and qrs’s, and no consistent PR interval.
Bruni Lee says
In Mega Scenario #3, question #13, I selected epi, because the Asystole /PEA Algorithm states Use Epi or Vasopressin… yet the correct answer if amidarone so I’m a bit confused.
Jeff with admin. says
In this scenario, the pt. is in Pulseless VT. Upon the second rhythm check, the pt’s rhythm had changed from Asystole to pulseless VT.–Kind regards, Jeff