ACLS Megacode 1 In-Hospital Hurry, don’t let time run out! Sorry, time is up! 0 Hours 0 mins 0 secs Step 1 of 10 10% You are an internist at a local hospital. One of your patients is a 25-year-old male who was admitted yesterday evening for chronic abdominal pain and a history of gastrointestinal ulcers. You arrive in their hospital room to discuss their lab results when you find them in bed unresponsive. There is a half-eaten sandwich on the table next to the bed, so you assume they were eating shortly beforehand. A rapid initial assessment reveals the following: Vital signs Pulse rate: Unobtainable Blood pressure: Unobtainable Respiratory rate: Unobtainable Temperature: Unobtainable Physiological systems Integumentary: Moist, cool Cardiovascular: No palpable pulse Respiratory: No audible respirations, visible chest rising Neurological: Unresponsive 1. Based on your initial assessment, you determine the patient is in cardiac arrest and activate the Code Team. IV access has already been established. A cardiac monitor is not attached to the patient at this time. What are your initial actions?* Administer epinephrine 1 mg IVP Deliver a single unsynchronized shock of 120 J Check for an airway obstruction without commencing CPR Start CPR (five cycles) You have started CPR and members of the Code Team begin arriving at the room. 2. Which of the following drugs should you consider administering?* Dopamine 1 mcg/kg Atropine 1 mg IV/IO Dopamine 20 mcg/kg/min IV fluid bolus Epinephrine 1 mg IV/IO Five cycles of CPR are completed, epinephrine 1.0 mg IVP is administered, and a cardiac monitor is attached to the patient. During CPR, a large bolus of food was dislodged from the patients’ airway. Following five cycles of CPR, a rhythm check reveals pulseless electrical activity. 3. Which of the following H’s and T’s is the most likely cause of the arrest?* Tension pneumothorax Hypoxia Tamponade (cardiac) Hydrogen ion (acidosis) CPR is resumed for another five cycles. Following five cycles of CPR, a rhythm check reveals unchanged pulseless electrical activity. 4. What are your next actions?* Administer amiodarone 300 mg IVP Resume CPR (five cycles) Administer epinephrine 1 mg IVP Deliver a single unsynchronized shock of 120 J CPR is resumed for another five cycles. Following five cycles of CPR, a rhythm check reveals a conversion from pulseless electrical activity to ventricular tachycardia. 5. What are your next actions?* Administer adenosine 6 mg IVP Deliver a single unsynchronized shock of 120 J Administer epinephrine 1 mg IVP Resume CPR (five cycles) A single unsynchronized shock of 120 J is delivered, and CPR is resumed for another five cycles. Following five cycles of CPR, a rhythm check reveals unchanged ventricular tachycardia. 6. What are your next actions?* Administer epinephrine 1 mg IVP Deliver a single unsynchronized shock of 200 J Administer amiodarone 300 mg IVP Administer atropine 1 mg IVP A single unsynchronized shock of 200 J is delivered, and CPR is resumed for another five cycles. 7. Following defibrillation, during the first cycle of CPR, what drug should you consider administering?* Administer amiodarone 300 mg IVP Administer epinephrine 1.0 mg IVP Administer lidocaine 1.0-1.5 mg/kg IVP Administer atropine 1.0 mg IVP Epinephrine 1 mg IVP is administered while simultaneously continuing CPR. 8. According to AHA ACLS guidelines, what should be done after giving any drug during cardiac arrest?* Perform a rhythm check Perform a pulse check Flush the IV line with NS 10 m Flush the IV line with NS 20 ml CPR is resumed for another five cycles. Following five cycles of CPR, a rhythm check reveals unchanged ventricular tachycardia. A single unsynchronized shock of 300 Joules is delivered, and CPR is resumed for another five cycles. 9. What drug is indicated in the given scenario?* Epinephrine 1.5 mg IVP Dopamine 2-10 mcg/kg/min Amiodarone 300 mg IVP Amiodarone 150 mg IVP Amiodarone 300 mg IVP is administered, and CPR is resumed for another five cycles. Following five cycles of CPR, a rhythm check reveals a conversion from ventricular tachycardia to sinus tachycardia. A pulse check reveals a faint and weak pulse. Vital signs are HR 162, BP 108/64. There are no spontaneous respirations, and the patient remains unconscious. 10. What are your next actions?* Monitor for hypotension and signs of inadequate perfusion Place an advanced airway and provide ventilatory assistance via BVM Seek expert consultation Transport to the intensive care unit
