ACLS Megacode 7 Out-of-Hospital Hurry, don’t let time run out! Sorry, time is up! 0 Hours 0 mins 0 secs Step 1 of 9 11% 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 signs Pulse rate: 38/min Blood pressure: 81/52 Respiratory rate: 16/min Temperature: 38.2 °C Physiological systems Integumentary: Pale, dry Cardiovascular: Palpable peripheral pulses bilaterally Respiratory: Lungs CTA bilaterally Neurological: Alert, oriented 1. 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 atropine 1.0 mg IVP Administer epinephrine 2-0 mcg/min infusion Attempt vagal maneuvers Deliver a single unsynchronised shock of 120 J Atropine 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) Administer atropine 1.0 mg IVP Start CPR (five cycles) Attempt transvenous pacing TCP is not always available 3. According to the algorithm for bradycardia, what two ACLS drugs can be administered via IV infusion as alternatives to TCP?* Epinephrine and adenosine Adenosine and dopamine Dopamine and epinephrine Dopamine and magnesium sulfate Dopamine and epinephrine can be administered as alternatives when TCP is not available. 4. What is the appropriate dosage for a dopamine IV infusion?* 10-14 mcg/kg/min 4-8 mcg/kg/min 5-20 mcg/kg/min 15-22 mcg/kg/min Dopamine and epinephrine can be administered as alternatives when TCP is not available. 5. What is the appropriate dosage for an epinephrine IV infusion?* 2-10 mcg/min 6-12 mcg/min 1-5 mcg/min 5-10 mcg/min TCP 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 Place an advanced airway Start CPR Administer epinephrine 1.0 mg IVP without delay Epinephrine 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?* Resume CPR (five cycles) Deliver a single unsynchronized shock of 200 J Perform synchronized cardioversion Administer epinephrine 1.0 mg IVP 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?* Administer magnesium sulfate 2.0-4.0 g IV Place an advanced airway and continue assisted ventilation Provide TCP Administer atropine 1.0 mg IVP Transcutaneous 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?* Hypertension Use of statin drugs History of STEMI Ischemic chest discomfort
