ACLS MEGACODE 1

A 40-year-old man arrives at the ER accompanied by his family. He is complaining of palpitations after working outside for several hours. The assessment is as follows:

SKIN: Hydrated, pale, warm and dry
CVS: Strong peripheral pulses and a BP of 125/80
CNS: Fully intact
RESP: RR is 22, no resp. difficulties, lungs CTA

You start an IV on the patient. The monitor shows a narrow complex SVT (160).

what is your next intervention?

• Give adenosine 6mg rapid IV push

• Attempt vagal maneuvers

• Perform immediate synchronized cardioversion

• Give epinephrine 1mg IV push

You have performed vagal maneuvers. This is what you see on the monitor:

what is your next step?

• Give adenosine 6mg rapid IV push. If no conversion, give 12mg rapid IV push

• Give adenosine 12mg rapid IV push. If no conversion, give another 12mg rapid IV push.

• Give Amiodarone 150mg over 10 minutes. May repeat as needed

• Continue to attempt vagal manuvers until the patient converts to a regular sinus rhythm

You give 6mg Adenosine rapid IV push with no effect. 12mg Adenosine rapid IV push is then given. The patient develops severe chest pain, his rhythm is the same, and his vital signs are: HR 220, BP (not obtainable), and weak pulse. The patient also has LOC changes. Your next step should be?

• perform immediate defibrillation

• give 2nd dose of 12mg adenosine rapid IV push

• perform immediate synchronized cardioversion

• perform precordial thump

After synchronized cardioversion is unsuccessful, the pt. continues to deteriorate. The patient is now unconscious with pulseless ventricular tachycardia. Below is what you see on the monitor:

What is the first and most important intervention?

• Begin CPR and give 5 cycles before shocking

• Give Epinephrine 1mg IV push (repeat every 3-5 minutes)

• Give one unsynchronized shock (120-200 J)

• Place an advanced airway

You perform defibrillation with 120 J. What is your next intervention?

• Deliver a second shock (120-200 J)

• • Give 1mg Epinephrine IV push (repeat the epinephrine every 3-5 minutes)

• Give 5 cycles of CPR

• Check the rhythm and the pulse

After completing 5 cycles of CPR, the rhythm is unchanged. You shock a second time with 200 J and resume CPR. While completing the cycle of CPR what else should be done?

• Give Epinephrine 1 mg IV push (repeat every 3-5 minutes)

• Vasopressin 40 U IV push to replace the 1st or 2nd dose of epinephrine

• Give Epinephrine 0.5mg IV push (repeat every 3-5 minutes)

• Either 1 or 2 is correct

You have given the epinephrine and completed the 5 cycles of CPR. A rhythm check reveals no change. You attempt a third defibrillation. What will be your defibrillator setting?
(In all scenarios, assume that the biphasic defibrillator shock setting can be from 50-360 Joules. The shock selection on many biphasic defibrillators can vary.)

• 300 Joules

• 150 Joules

• 120 Joules

• • 50 Joules

The third shock is delivered and you restart CPR (5 cycles). What medication should be given after the 3rd shock during CPR?

• Amiodarone

• Lopressor

• Atropine

• Dopamine

What is the correct dosing for amiodarone in the Cardiac Arrest Algorithm?

• 150mg IV once. If this in not effective give 300mg IV once.

• 200mg IV once.

• 300mg IV once. Then consider an additional 150mg IV once.

• give IV infusion of 300mg per hour

You give amiodarone 300 mg (first dose) and finish the cycle of CPR. Upon a rhythm check, you see, the patient has converted to a normal sinus rhythm and has a pulse (ROSC). As you begin the post-arrest phase, the patient has a short run of VT. In light of the continued arrhythmia, you are instructed to start an amiodarone drip for post-resuscitation maintenance therapy. What is maximum cumulative dose for amiodarone in a 24 hour period?

• 2.2 grams

• 3.2 grams

• 1.5 grams

• 5.6 grams