Scenario data: You are part of a rapid response team that is called to the room of a patient that was having a grand mal seizure. The patient is a 42-year-old male with a history of seizures. The seizure ends approximately 1 minute after you arrive, and the crash cart is at the bedside. After the seizure has ended, this is the assessment.

Skin: Cyanotic, Diaphoretic, and Clammy
Cardio: HR 28, No palpable peripheral pulse, weak carotid pulse, BP?
Resp: RR 3-4/min
CNS: Unresponsive
Monitor: (see below)

1. In light of the patient's current condition, it is important to establish supportive care on arrival. What are the most important interventions for supportive care?

You and your team are providing all necessary supportive measures and approximately 2 minutes has transpired. The rhythm is as shown below. Which is the best first ACLS intervention?

The first dose of atropine has no effect. As you attach the TCP, you give a second dose of Atropine 1 mg IV. What is the maximum total of atropine that can be given?

The 2nd dose of atropine has no effect and you attempt TCP. You set the pacer for 60 beats/minute and press pace. As you begin pacing, the patient’s rhythm changes. This is what you see:

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Your leads are connected properly. The patient has no pulse. What should be your first intervention?

You begin CPR with a 30:2 compression to ventilation ratio. Of important factors when providing chest compressions which is NOT correct?

After you begin CPR, what is your next intervention?

You give the epinephrine 1mg IV push and follow with a normal saline flush. What is the recommended amount of normal saline following epinephrine?

You finish the cycle of CPR after giving the epinephrine. You now perform a rhythm check, and the patient’s rhythm has changed.

What is the patient’s rhythm?

What should be your first intervention?

After the shock of 120 J, what is your next intervention?

After CPR your rhythm check shows continued VF. You should now do what?

After you shock the patient, what is your next intervention?

Approximately how long should 5 cycles of CPR take?

As you continue with the CPR, what medication should you give to the patient?

After you give epinephrine you continue with 5 cycles of CPR. The epinephrine has no effect and a rhythm check after CPR reveals no change. You shock the patient and repeat 5 cycles of CPR. What would you do now (during CPR)?

After amiodarone, 300 mg is given and 5 cycles of CPR is completed, the rhythm/pulse check shows a change. The patient does have a pulse.

What is this rhythm?

If the patient attains ROSC after the use of amiodarone, and arrhythmias persist in the post arrest phase an amiodarone infusion may be started. Which is correct about an amiodarone infusion?

Of the H’s and T’s of ACLS which associated condition is most likely contributing to the patient’s condition?

Congratulations, the patient has had a return of spontaneous circulation (ROSC) and supportive measures are being implemented. After ROSC, the patient had several short runs of ventricular tachycardia. In light of the continued arrhythmias, Amiodarone should now be started as an infusion. What is the correct dosing for the first 6 hours of an amiodarone infusion?