ACLS Megacode 7 Out-of-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 as part of an ALS-equipped medical team at a major sports venue. During a collegial basketball game, a security officer requests medical assistance for a 47-year-old female spectator that appears to be experiencing a syncopal episode. You and another team member arrive at their location in the stadium within 2 min, at which point the spectator has regained consciousness, but is now feeling nauseated and complaining of generalized weakness. A rapid initial assessment reveals the following:Vital signsPulse rate: 38/minBlood pressure: 81/52Respiratory rate: 16/minTemperature: 38.2 °CPhysiological systemsIntegumentary: Pale, dryCardiovascular: Palpable peripheral pulses bilaterallyRespiratory: Lungs CTA bilaterallyNeurological: Alert, oriented1. A cardiac monitor is attached to the patient. A rhythm check reveals a second-degree atrioventricular block at 38/min. You provide the patient with supplemental oxygen via NC while your partner establishes IV access. What are your initial actions?* Attempt vagal maneuvers Administer epinephrine 2-0 mcg/min infusion Administer atropine 1.0 mg IVP Deliver a single unsynchronised shock of 120 JAtropine 1.0 mg IVP is administered with no change in condition. A rhythm check reveals a conversion from a second-degree atrioventricular block to a third-degree atrioventricular block. The HR changes from 38/min to 27/min. The patient is complaining of progressive weakness and soon becomes unresponsive to verbal commands. Signs of inadequate perfusion are noted.2. What are your next actions?* Attempt transvenous pacing Administer atropine 1.0 mg IVP Attempt transcutaneous pacing (TCP) Start CPR (five cycles)TCP is not always available3. According to the algorithm for bradycardia, what two ACLS drugs can be administered via IV infusion as alternatives to TCP?* Adenosine and dopamine Dopamine and epinephrine Dopamine and magnesium sulfate Epinephrine and adenosineDopamine and epinephrine can be administered as alternatives when TCP is not available.4. What is the appropriate dosage for a dopamine IV infusion?* 15-22 mcg/kg/min 5-20 mcg/kg/min 4-8 mcg/kg/min 10-14 mcg/kg/minDopamine and epinephrine can be administered as alternatives when TCP is not available.5. What is the appropriate dosage for an epinephrine IV infusion?* 5-10 mcg/min 1-5 mcg/min 2-10 mcg/min 6-12 mcg/minTCP is prepared, but before an attempt to capture can be performed, the patient deteriorates, a drop in BP occurs, and they become unresponsive. A rhythm check reveals a conversion from a third-degree atrioventricular block to ventricular fibrillation. Respiratory support is provided via BVM.6. What are your next actions?* Start CPR Place an advanced airway Deliver a single unsynchronized shock of 120 J Administer epinephrine 1.0 mg IVP without delayEpinephrine is administered and the remaA single unsynchronized shock of 120 J is delivered, and CPR is started for five cycles. After five cycles of CPR, a rhythm check reveals unchanged ventricular fibrillation.7. What are your next actions?* Perform synchronized cardioversion Deliver a single unsynchronized shock of 200 J Administer epinephrine 1.0 mg IVP Resume CPR (five cycles)A single unsynchronized shock of 200 J is delivered, and CPR is resumed for five cycles. Following five cycles of CPR, a rhythm check reveals a conversion from ventricular fibrillation to a second-degree atrioventricular block. A central pulse is weakly palpable, and the patient remains unresponsive. HR 31/min, BP 77/41.8. What are your next actions?* Place an advanced airway and continue assisted ventilation Administer atropine 1.0 mg IVP Administer magnesium sulfate 2.0-4.0 g IV Provide TCPTranscutaneous pacing is attempted, and capture is successful. Strong peripheral pulses are noted bilaterally. HR 59/min, BP 91/70. Spontaneous respirations are noted, and the patient is transported to the hospital for post-cardiac arrest care.9. Which of the following clinical conditions are indications for following the algorithm pathway for an unstable bradycardic rhythm?* Use of statin drugs History of STEMI Ischemic chest discomfort Hypertension