ACLS Megacode Scenario 3 | ACLS-Algorithms.com

Comments

  1. 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

      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

    • 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.

  2. 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.

  3. 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.

  4. 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

    • 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

  5. 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

  6. 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.

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