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?* Administer epinephrine 2-0 mcg/min infusion Administer atropine 1.0 mg IVP Attempt vagal maneuvers 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 transcutaneous pacing (TCP) Attempt transvenous pacing Administer atropine 1.0 mg IVP 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?* Dopamine and magnesium sulfate Epinephrine and adenosine Dopamine and epinephrine Adenosine and dopamineDopamine and epinephrine can be administered as alternatives when TCP is not available.4. What is the appropriate dosage for a dopamine IV infusion?* 4-8 mcg/kg/min 5-20 mcg/kg/min 15-22 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?* 6-12 mcg/min 1-5 mcg/min 5-10 mcg/min 2-10 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?* Deliver a single unsynchronized shock of 120 J Administer epinephrine 1.0 mg IVP without delay Place an advanced airway Start CPREpinephrine 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?* Deliver a single unsynchronized shock of 200 J Resume CPR (five cycles) Perform synchronized cardioversion Administer epinephrine 1.0 mg IVPA 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?* Administer atropine 1.0 mg IVP Provide TCP Administer magnesium sulfate 2.0-4.0 g IV Place an advanced airway and continue assisted ventilationTranscutaneous 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 Ischemic chest discomfort History of STEMI Hypertension
