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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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.