ACLS Megacode 10 In-HospitalHurry, don’t let time run out!Sorry, time is up!0 Hours 0 mins 0 secsStep 1 of 1010%You are a healthcare provider working in the emergency department. An 83-year-old female in chronic kidney failure arrives by ambulance with complaints of myalgia, nausea, and progressive fatigue over the last 48-hrs. Their last dialysis appointment was three days ago. A rapid initial assessment reveals the following:Vital signsPulse rate: 41/minBlood pressure: UnobtainableRespiratory rate: UnobtainableTemperature: UnobtainablePhysiological systemsIntegumentary: CoolCardiovascular: Weak radial pulses bilaterallyRespiratory: Lungs CTA bilaterallyNeurological: Weak, responsive1. A cardiac monitor is attached to the patient. A rhythm check reveals sinus bradycardia at 41/min. The patient is considered symptomatic. What are your initial actions?* Provide supplemental oxygen Establish IV access All the above Perform a 12-lead ECG and monitor their vital signs continuouslyThe AHA ACLS 2020-2025 bradycardia algorithm has two pathways: observation and intervention.2. What clinical factor must be considered in determining the appropriate pathway?* Use of vasodilators such as albuterol Adequate perfusion Use of statin drugs History of myocardial infarctionYou provide supplemental oxygen, perform a 12-lead ECG, monitor vitals, and establish IV access. You determine that the patient is not perfusing adequately and decide to administer atropine 1.0 mg IV bolus. A rhythm check reveals unchanged sinus bradycardia. There are no changes in spontaneous circulation.3. What are your next actions?* Administer epinephrine 1.0 mg IVP Consider starting CPR (five cycles) Administer atropine 1.5 mg IVP Prepare for transcutaneous pacingTranscutaneous pacing is not always available depending on the provider or environment. Certain drugs can be administered as an alternative to transcutaneous pacing for patients with symptomatic sinus bradycardia.4. What two drugs would you consider in the given scenario?* None of these drugs are appropriate alternatives for transcutaneous pacing Atropine and epinephrine Dopamine and atropine Dopamine and epinephrineAs you prepare transcutaneous pacing, the patient complains of a sudden tightness in their chest and a feeling of breathlessness. A rhythm check reveals a conversion from sinus bradycardia to a third-degree atrioventricular block. An attempt to pace the rhythm is unsuccessful and a second rhythm check reveals a conversion from a third-degree atrioventricular block to ventricular fibrillation. The patient no longer has a palpable pulse.5. What are your next actions?* Continue to attempt transcutaneous pacing Deliver a single unsynchronized shock of 120 J Administer epinephrine 1.0 mg IVP Start CPR (five cycles)A single unsynchronized shock of 120 J is delivered, and CPR is started for five cycles. Following five cycles of CPR, a rhythm check reveals unchanged ventricular fibrillation.6. What are your next actions?* Deliver a single unsynchronized shock of 200 J Administer epinephrine 1 mg IVP Deliver a single unsynchronized shock of 300 J Deliver a single unsynchronized shock of 300 JA single unsynchronized shock of 200 J is delivered, and CPR is resumed for five cycles. During the first cycle of CPR, you administer epinephrine 1.0 mg IVP. Following five cycles of CPR, a rhythm check reveals unchanged ventricular fibrillation. A single unsynchronized shock of 300 J is delivered, and CPR is resumed for another five cycles. You consider administering an antiarrhythmic drug, but the Code Team advises you that amiodarone is not available.7. Which drug is considered an appropriate alternative in the given scenario?* Dopamine Metoprolol Amlodipine LidocaineLidocaine is a class IB antiarrhythmic that increases the electrical stimulation threshold of the ventricle, suppressing the automaticity of conduction through the tissue.8. What is the appropriate dosage for the initial dose of lidocaine in the given scenario?*
