ACLS Megacode 4 In-Hospital

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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 signs
  • Pulse rate: 81/min
  • Blood pressure: 112/77
  • Respiratory rate: 10/min
  • Temperature: 38.0 °C
Physiological systems
  • Integumentary: Pale, cool
  • Cardiovascular: Strong palpable peripheral pulses bilaterally
  • Respiratory: Prolonged expirations, visible intercostal retractions
  • Neurological: Weak, but responsive
1. The patient is attached to a cardiac monitor. A rhythm check reveals multifocal premature ventricular contractions at 81/min. What are your initial actions?*