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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Mark Meany says
Going right to pacing without giving atropine violates the bradycardia protocol. Atropine should be tried first.
ACLS says
In the case of unstable complete heart block electrical or chemical pacing is indicated.
Kind regards,
Jeff
Saifullah Shaikh says
Agreed.
URSULA HARRIS-GAULDIN says
Thank you, I keep getting second and third confused. In this last scenario, it appeared to me a QRS dropped. But overall this site is helping me.
jeffrey kasbohm says
Yes, exactly. What works for me differentiating 2nd degree blocks from 3rd degree or complete blocks is backing away and 1) looking at the regularity of p waves, then 2) looking at regularity and morphology of QRS complexes: if P waves are marching regularly and QRS’s are marching regularly, but there’s more Ps than QRS’s, then my assumption is going to 3rd degree or complete block. (I squint a little at the ECG initially so I don’t get bogged down too fast in detail – then I zoom in look at actual intervals and numbers of each. ) In either kind of second degree you’re going to see a change in regularity [ie a drop] of QRS’s. — and there will be extra P waves compared to qrs’s. Its the regularity of the QRS’s thats’ key for me.
Kimberly A Delridge says
I agree
JAMES DIZZLEY says
Best Website I have used to practice Codes for AHA Standard So FAR!
Robert C Boyd says
me too!
monicab says
It’s 3rd degree bloc. Ps March out, QRSs March out but no association between QRS complexes and P waves. And there are more P waves than QRs waves.
Monica B says
This is 3rd degree or complete heart block. More P waves than QRS complexes and each marches out to the beat of a different drum aka they are totally disassociated from one another.
Annie says
Thank you for this analogy…I never understood what was meant by “they are marching out” until now. Wembley G
jeffrey o kasbohm says
Your third degree block seems closer to a 2nd degree mobitz I : you have the increasing PR interval then a dropped p wave. — I think you can justify it as 3rd degree since the R to R interval doesn’t change (ant the p to p wave interval is unchanging) . If real life was as simple. Thanks though MUCH for your site! Great for quizzing.
ACLS says
Thank you for your input! Kind regards, Jeff
Jody says
I disagree. If you see the first p wave, it has a very short PR. Then right after that you have a ‘dropped’ QRS. It does not follow the longer, longer, drop pattern.
Dizzley, James says
You are Referring to A 2nd Degree Type 1 Block
-1 Likes To RUn
-2 Sticks Like Glue
jeffrey kasbohm says
I agree Jody — its the dropped QRS that’s key. If you focus in too soon on the PR intervals you can get fooled. But yes, good observation: the dropped or not-dropped QRS is distinguishing.
Jack M says
the key here is what you said about the P-P and R-R intervals being steady. If it were a 2nd degree type 1 the R-R would shorten and PR lengthen until a qrs is dropped.