ACLS Megacode Case Study 6 In-Hospital

You are a healthcare provider working in a community health complex. A 32-year-old male is seen in triage for complaints of dizzy spells that have been occurring sporadically for 2-3 hrs with feelings of breathlessness that have come and gone in the last 30 min. A rapid initial assessment reveals the following:
Vital signs
- Pulse rate: 157/min
- Blood pressure: 101/67
- Respiratory rate: 20/min
- Temperature: 36.9 °C
Physiological systems
- Integumentary: Warm, dry
- Cardiovascular: Strong palpable peripheral pulses bilaterally
- Respiratory: Lungs CTA bilaterally, SpO2 91%
- Neurological: Alert, oriented
1. The patient is attached to a cardiac monitor. A rhythm check reveals stable sinus tachycardia at 157/min. What are your initial actions?*
- Investigate for reversible causes
- All the above
- Establish IV access
- Provide supplemental oxygen

The observed rhythm highlights a wide, stable, and monomorphic QRS complex
2. What three drugs can be given in the given scenario?*
- Procainamide, amiodarone, adenosine
- Adenosine, amiodarone, procainamide
- Adenosine, procainamide, epinephrine
- Epinephrine, atropine, adenosine

Adenosine 6.0 mg IVP followed by adenosine 12.0 mg IVP are administered with no change in condition.
3. What are your next actions?*
- Administer epinephrine 1.5 mg IV over 12 min
- Administer amiodarone 300 mg IVP
- Administer epinephrine 1.0 mg IVP
- Administer amiodarone 150 mg IV over 10 min

Amiodarone 150 mg IV over 10 min is administered with no change in condition. You consider attempting synchronized cardioversion. As you prepare to cardiovert, the patient deteriorates, and a rhythm check reveals a conversion from sinus tachycardia to ventricular tachycardia. Immediate synchronized cardioversion is performed.
4. At what point in the QRS complex is synchronized cardioversion designed to deliver a shock?*
- Immediately after the S wave
- 1 second before the R wave
- 2-3 seconds before the Q wave
- Immediately after the peak of the R wave

Synchronized cardioversion is performed with further deterioration. A rhythm check reveals a conversion from ventricular tachycardia to ventricular fibrillation.
5. What are your next actions?*
- Administer epinephrine 1.0 mg IVP
- Deliver a single unsynchronized shock of 120 J
- Administer atropine 1.0 mg IVP
- Start CPR (five cycles)

A single unsynchronized shock of 120 J is delivered, epinephrine is administered, and CPR is started for five cycles. Following five cycles of CPR, a rhythm check reveals a conversion from ventricular fibrillation to asystole.
6. What are your next actions?*
- Administer dopamine 20 mcg/kg/min IV fluid bolus
- Deliver a single unsynchronized shock of 200 J
- Administer atropine 1.0 mg IV/IO
- Resume CPR (five cycles)

CPR is resumed for another five cycles. During the first cycle of CPR, you administer epinephrine IVP.
7. What is the correct dose and frequency in the given scenario?*
- 0.5 mg IVP every 1-3 min as needed
- 1.0 mg IVP every 3-5 min as needed
- 2.0 mg IVP every 3-5 min as needed
- 1.0 mg IVP (maximum 2 doses)

CPR and epinephrine administration have been continued for nearly 45 min with no change in condition. Regular rhythm checks reveal unchanged asystole. There are no changes in LOC and peripheral and central pulses remain impalpable.
8. What are your next actions?*
- Consider termination of ACLS
- Deliver a single unsynchronized shock of 200 J
- Consider transcutaneous pacing at 60/min
- Seek expert consultation

ACLS Megacode 6 In-Hospital