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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Question 1 of 17
1. Question
Scenario data: A 65-year-old male collapses as he is out for his morning walk. A bystander witnessed the collapse, activates EMS, and begins CPR. The EMS team arrives 6 minutes later. The monitor is attached and the assessment is as follows:
Skin: cold/clammy/cyanotic
Cardiovascular: no pulse
Respiratory: no respirations
CNS: no response
Monitor: rhythm strip below
What ACLS algorithm are you going to begin this scenario with?
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Question 2 of 17
2. Question
As an EMS provider in the out of hospital setting, your first step is to:
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Question 3 of 17
3. Question
While the EMS team is providing 5 cycles of CPR what other activities can be completed?
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Question 4 of 17
4. Question
After your IV is secure, your next step involves giving a medication. What medication should be used?
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Question 5 of 17
5. Question
(True or False)
Vasopressin 40 U IV can replace the 1st or 2nd dose of epinephrine in the cardiac arrest algorithm.CorrectIncorrect -
Question 6 of 17
6. Question
Epinephrine should be repeated at what frequency for the treatment of Asystole?
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Question 7 of 17
7. Question
You give epinephrine 1 mg IV and finish the cycle of CPR. What is your next intervention?
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Question 8 of 17
8. Question
After giving the first dose of epinephrine, you finish the cycle of CPR. A rhythm check shows that the patient's rhythm changed from asystole to the rhythm below. He also remains pulseless. Your first action is to:
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Question 9 of 17
9. Question
You deliver 1 shock of 120J. After the shock what is the your next step?
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Question 10 of 17
10. Question
You have resumed CPR. Your next intervention after 5 cycles of CPR is to:
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Question 11 of 17
11. Question
Your rhythm check reveals continued pulseless VT. What are your next 2 steps?
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Question 12 of 17
12. Question
You give a second shock and perform 5 cycles of CPR. What medication should you give after the second shock during CPR?
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Question 13 of 17
13. Question
The epinephrine is given and the round of CPR completed. A rhythm check reveals no change in the rhythm and pulseless VT continues. You shock with 300 J and start another cycle of CPR. What medication are you going to give at this time?
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Question 14 of 17
14. Question
You give amiodarone 300 mg IV and finish the cycle of CPR, your rhythm check reveals continued pulseless VT, continuing on, you shock the patient with 360 J. What is your intervention at this time.
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Question 15 of 17
15. Question
After completing 5 cycles of CPR a rhythm check reveals the following:
Your pulse check reveals a faint palpable pulse. VS are: HR 30; BP 78/58; and the patient does not have spontaneous breathing. What is the next step?
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Question 16 of 17
16. Question
You recognize this rhythm because there is no apparent relationship between the P-waves and the QRS complexes. What is the rhythm?
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Question 17 of 17
17. Question
After you initiate TCP the patient continues to stabilize. VS are: HR 70; BP 105/75; RR 5; You continue to support ventilation with the bag valve mask, and TCP continues. If transcutaneous pacing was not available, what medication can be considered as an alternative?
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ESTHY says
Thank you for Simplifying ACLS.
ACLS says
Glad to help! Happy Thanksgiving! Kind regards, Jeff
Lynn says
I believe more info about pt could be communicated..each case is different. I felt that in a few questions more then one answer could be used in certain situations. Interesting test. Thank you.
Guy Rigo says
Very usefull and efficient
thanks
harleyjon says
This is a great site! Thank You Very Much! You folks are doing a great job. I really like how you break it down into each little action that needs to be taken. That is how the testing goes so it is good to go over each action that must be taken.
ACLS says
Thanks so much for the feedback! I’m so glad that the site is helpful for you people. Kind regards, Jeff
Sakine says
Thank you sooo very much for making this available. Love the codes. Great learning and refresher. Love the Q and A. Informative. Again. Thank you
ACLS says
You are welcome! Glad you like them.
Kind regards, Jeff
Rhonda Gaines says
If near the end when the rhythm changed and the patient had a faint slow pulse of 30? Why not just do another round of 5 cycles of CPR? At least while setting up TCP
Jeff with admin. says
You could definitely do another round of CPR while setting TCP. This would actually be a very good thing as long as the patient is not conscious. I was just sticking strictly with the guidelines for simplification, but continuing for one more found of CPR would be ok.
Kind regards,
Jeff
Chang Yick cheong w says
I would suggest to restart CPR until the defib is charged
Lucindia Williamson says
Why wasn’t atropine given after TCP during third degree block instead of epi and dopamine?
Jeff with admin. says
The rhythm in question #15 is complete heart block. AHA ACLS Provider Manual Pg. 125 “avoid relying on atropine in Type II second degree block and third-degree AV block.”
Also, in this case of a witnessed collapse (MI), “an atropine-mediated increase in heart rate may worsen ischemia or increase infarct size.” Pg. 125.
The patient is unstable and the external pacer-defibrillator is already attached. The administration of atropine would delay pacing in an unstable patient. Immediate pacing would ensure the stability whereas the use of atropine may do nothing or worsen the patient’s condition.
Kind regards,
Jeff
Suzanne Watson says
So after 5 cycles of CPR, then SHOCK….. WHEN do you give epinephrine?
Jeff with admin. says
For VF and pulseless VT, epinephrine is given after the second shock during CPR. Then it is given every 3-5 minutes on its own time table.
For asystole and PEA, epinephrine is given as soon as IV access is avaliable. Then it is given every 3-5 mintues on its own time table.
Kind regards,
Jeff
Elaine McKinney says
Love it love it love it. I get some wrong but mostly right. I enjoy learning, what a great site.Thanks for all you two do!
srenee11 says
Hi,
Please explain megacode 3 qestion 15. The correct answer was start TCP but why wouldn’t it be to give atropine first? Please explain.
Thank you
Jeff with admin. says
The rhythm in question #15 is complete heart block. AHA ACLS Provider Manual Pg. 125 “avoid relying on atropine in Type II second degree block and third-degree AV block.”
Also, in this case of a witnessed collapse (MI), “an atropine-mediated increase in heart rate may worsen ischemia or increase infarct size.” Pg. 125.
The patient is unstable and the external pacer-defibrillator is already attached. The administration of atropine would delay pacing in an unstable patient. Immediate pacing would ensure the stability whereas the use of atropine may do nothing or worsen the patient’s condition.
Kind regards,
Jeff
dws says
Disagree with this answer. The patient is in respiratory arrest and while the HR and BP are not adequate, something needs to be done about breathing. While a bag mask would be adequate as a start, that option isn’t given. With ACLS, Airway/breathing takes priority over Circulation, unlike BLS. Ventilating this patient may actually change the bradycardia and improve vitals without pacing needed, and certainly pacing can be initiated along with airway management. But, if you have to choose between airway management and optimizing circulation, airway gets first priority, for what good is speeding up the HR with no breathing?!
NAMIAH says
I agree with you, if i am the one managing the patient am gonna go with intubation first.
Claudia Gabriel says
I chose intubation for this as well. Perhaps it should be reviewed.
LouiseAW says
i thought its cardio first now above breathing ?
Jeff with admin. says
That is correct. In this scenario, the patient had a sudden collapse. This is a case of sudden cardiac arrest, not respiratory arrest. Kind regards, Jeff
Jeff with admin. says
This patient experienced a witnessed arrest and collapsed. This is not a case of respiratory arrest. This is a case of sudden witness cardiac arrest. Statistically, the most likely cause of this arrest is VF.
Inessa says
Thank you for the question15 (17) in megacode 3: after VF/VT, bradycardia; atropine IV vs transcutaneous pacing.
flieswithsun says
Vasopressin is no longer used. Update your maternal on this one Jeff.
Jeannie RN MICU
Jeff with admin. says
The question about vasopressin was true or false and reads: “Vasopressin 40 U IV can replace the 1st or 2nd dose of epinephrine in the cardiac arrest algorithm.”
The answer was false. The rationale is: “Vasopressin has been removed from the cardiac arrest algorithm and is no longer recommended for use. The removal was due to the fact that there is no added benefit from administering both epinephrine and vasopressin as compared with epinephrine alone.”
Kind regards,
Jeff
vonnie says
This is the best site by far, you men have done a great job! I have shared this site with many people; I respect that when a user replies to you with an incorrect statement or judgement you calmly state the obvious. People misread questions and fire a comment to you but unfortunately hardly ever respond back admitting their mistake. For all the time you men take out of your lives to respond to the subscribers or free users questions THANK YOU 🙂
Jeff with admin. says
Thank you very much for the encouraging feedback. It is my privlage to be able help others learn and master ACLS. You have a blessed day!
Kind regards,
Jeff
lindajane says
Do you do the rhythm check while you are not doing anything else? Or do you do the rhythm check while you are doing the CPR? I would think you would want to do it while doing something else, so there is no interruption of interventions, but it seems to say: shock, CPR, check rhythm.
Jeff with admin. says
You have to stop chest compressions to perform a rhythm check. If you are performing compressions and attempt to check a rhythm, all you will see is crazy squiggly lines from the electrical artifact generated by the compressions.
The rhythm check should really take less than about 3 seconds.
Kind regards,
Jeff