Find a Course
ACLS Certification & Recertification
ACLS Certification
ACLS Recertification
ACLS For Life Certification
ACLS Certification Bundles
PALS Certification & Recertification
BLS Certification & Recertification
CPR, AED & First Aid Certification
Bloodborne Pathogens Certification
For Life Certifications
3 Course Bundles
2 Course Bundles
View All Courses
Accreditation
Free Resources
Free Training Courses
Advanced Cardiac Life Support Course
Pediatric Advanced Life Support Course
Basic Life Support Course
CPR & First Aid Course
Bloodborne Pathogens Course
ECG Rhythms Course
Practice Tests
ACLS Practice Test
PALS Practice Test
ACLS Practice Questions
PALS Practice Questions
BLS Practice Test
CPR & First Aid Practice Test
Bloodborne Pathogens Practice Test
Megacodes
ACLS Megacodes
PALS Megacodes
ACLS Case Study
PALS Case Study
Algorithms
BLS Algorithms
PALS Algorithms
ACLS Algorithms
CPR Algorithms
Covid-19 Algorithms
Mobile Apps
eBooks
Audiobooks
Journal Articles
Frequently Asked Questions
Group Discounts
FAQ
Login
Your cart is currently empty!
Home
»
Free Resources
»
ACLS Case Study
» In Hospital Case Study 10
ACLS Megacode 10 In-Hospital
Hurry, don’t let time run out!
Sorry, time is up!
0
Hours
0
mins
0
secs
"
*
" indicates required fields
Step
1
of
10
10%
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 signs
Pulse rate:
41/min
Blood pressure:
Unobtainable
Respiratory rate:
Unobtainable
Temperature:
Unobtainable
Physiological systems
Integumentary:
Cool
Cardiovascular:
Weak radial pulses bilaterally
Respiratory:
Lungs CTA bilaterally
Neurological:
Weak, responsive
1. 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
Perform a 12-lead ECG and monitor their vital signs continuously
Establish IV access
All the above
The AHA ACLS 2020-2025 bradycardia algorithm has two pathways: observation and intervention.
2. What clinical factor must be considered in determining the appropriate pathway?
*
History of myocardial infarction
Use of statin drugs
Use of vasodilators such as albuterol
Adequate perfusion
You 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 atropine 1.5 mg IVP
Consider starting CPR (five cycles)
Prepare for transcutaneous pacing
Administer epinephrine 1.0 mg IVP
Transcutaneous 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 epinephrine
Dopamine and atropine
As 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
Start CPR (five cycles)
Administer epinephrine 1.0 mg IVP
Deliver a single unsynchronized shock of 120 J
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?
*
Administer epinephrine 1 mg IVP
Deliver a single unsynchronized shock of 300 J
Deliver a single unsynchronized shock of 200 J
Deliver a single unsynchronized shock of 300 J
A 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?
*
Lidocaine
Dopamine
Amlodipine
Metoprolol
Lidocaine 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?
*
2.0 mg/kg
1.0-1.5 mg/kg
0.5-0.75 mg/kg
3.0 mg/kg
Lidocaine 1.0-1.5 mg/kg is administered, and CPR is resumed for five cycles. Following five cycles of CPR, a rhythm check reveals a conversion from ventricular fibrillation to sinus rhythm. The patient now has a palpable pulse and vital signs are HR 91/min, BP 106/70, RR 6/min. A return of spontaneous circulation is observed but the patient remains unresponsive.
9. What are your next actions?
*
Start targeted temperature management
Transport the patient to the intensive care unit
All the above
Continue providing ventilatory support
Amongst other actions, you have decided to implement targeted temperature management. An optimal target temperature range should be achieved and maintained for at least 24 hrs following cardiac arrest.
10.What should the temperature range be in the given scenario?
*
32-36 °C
30-36 °C
35-40 °C
30-40 °C
Δ