ACLS Megacode 4 In-HospitalHurry, don’t let time run out!Sorry, time is up!0 Hours 0 mins 0 secsStep 1 of 911%You are a healthcare provider working in the emergency department at a major metropolitan hospital. A 43-year-old female with a history of STEMI presents at triage with complaints of sudden and progressive chest pain that started roughly 20 min prior. They report that the pain they are feeling is similar to what they felt at the time of their STEMI which occurred 18 months prior. A rapid initial assessment reveals the following:Vital signsPulse rate: 81/minBlood pressure: 112/77Respiratory rate: 10/minTemperature: 38.0 °CPhysiological systemsIntegumentary: Pale, coolCardiovascular: Strong palpable peripheral pulses bilaterallyRespiratory: Prolonged expirations, visible intercostal retractionsNeurological: Weak, but responsive1. The patient is attached to a cardiac monitor. A rhythm check reveals multifocal premature ventricular contractions at 81/min. What are your initial actions?* Investigate for reversible causes Deliver a single unsynchronized shock of 120 J Attempt vagal maneuvers Administer oxygen, establish IV access, perform a 12-lead ECGThe patient complains that their chest pain is worsening and that it is becoming increasingly difficult for them to inhale. Moments later, the patient loses consciousness, and a rhythm check reveals a conversion from multifocal premature ventricular contractions to ventricular fibrillation. A single unsynchronized shock of 120 J is delivered.2. What are your next actions?* Start CPR (five cycles) Perform a rhythm check Deliver a single unsynchronized shock of 200 J Administer epinephrine 1.0 mg IVPFive cycles of CPR are performed. Following five cycles of CPR, a rhythm check reveals unchanged ventricular fibrillation. A single unsynchronized shock of 200 J is delivered, and CPR is resumed.3. During the first cycle of CPR, what drug should you administer?* Amiodarone Atropine Lidocaine EpinephrineEpinephrine 1.0 mg IVP is administered with no change in condition.4. What are your next actions?* Deliver a single unsynchronized shock of 360 J Resume CPR (five cycles) Perform a pulse check Prepare to intubateCPR is resumed for another five cycles. Following five cycles of CPR, a rhythm check reveals unchanged ventricular fibrillation.5. What are your next actions?* Administer epinephrine 1.0 mg IVP Perform synchronized cardioversion Deliver a single unsynchronized shock of 360 J Resume CPR (five cycles)A single unsynchronized shock of 360 J is delivered, and CPR is resumed for another five cycles. During the last cycle of CPR, amiodarone 300 mg IVP is administered. Following the last cycle of CPR, a rhythm check reveals a conversion from ventricular fibrillation to asystole.6. What are your next actions?* Resume CPR (five cycles) Deliver a single unsynchronized shock of 360 J Administer epinephrine 1.0 mg IVP Provide transcutaneous pacingTwo cycles of CPR are performed when the patient begins showing signs of inadequate ventilation. You are having difficulty maintaining their airway.7. What are your next actions?* Complete the remaining three cycles of CPR before inserting an advanced airway Insert a nasopharyngeal airway Insert an oropharyngeal airway Insert an ETT while simultaneously continuing compressionsCPR is continued while another team member intubates the patient. Once intubated, epinephrine 1.0 mg IVP is administered. Following five cycles of CPR, a rhythm check reveals a conversion from asystole to ventricular fibrillation.8. What are your next actions?* Resume CPR (five cycles)
