ACLS Megacode 8 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 in a rehabilitation center with ALS capabilities. A 66-year-old female 11 days post-op from a total hip arthroplasty complains of general malaise and heavy palpitations. The patient does not report any pain or difficulty breathing. A rapid initial assessment reveals the following: Vital signs Pulse rate: 161/min Blood pressure: 120/80 Respiratory rate: 18/min Temperature: 37.4 °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 sinus tachycardia at 161/min. The patient soon experiences a short run of ventricular tachycardia that converts spontaneously back to sinus tachycardia. During this run, you observe that the patient held their chest and appeared to have difficulty breathing, which has since subsided. What are your initial actions?* Attempt vagal maneuvers Provide supplemental oxygen Prepare the defibrillator and establish IV access Activate a code blue The defibrillator is prepared and IV access is established. Shortly after, the patient soon complains of rapid palpitations and pain radiating down their left arm. A rhythm check reveals conversion from sinus tachycardia to narrow complex supraventricular tachycardia. 2. What are your next actions?* Attempt vagal maneuvers Deliver a single unsynchronized shock of 120 J Administer adenosine 6.0 mg IVP Perform synchronized cardioversion Vagal maneuvers are attempted with no change in condition. A rhythm check reveals unchanged narrow complex supraventricular tachycardia. 3. What are your next actions?* Prepare to perform synchronized cardioversion Administer adenosine 6.0 mg IVP Continue to attempt vagal maneuvers until conversion to sinus rhythm is observed Administer adenosine 12.0 mg IVP Adenosine 6.0 mg IVP is administered with no change in condition. You decide to administer a second dose of adenosine at 12.0 mg IVP further showing no change in condition. You decide to perform synchronized cardioversion. As you prepare to cardiovert, the patient becomes unresponsive, and a pulse is no longer palpable. A rhythm check reveals ventricular tachycardia. 4. What are your next actions?* Start CPR (five cycles) Administer epinephrine 1.0 mg IVP without delay Continue with performing synchronized cardioversion Deliver a single unsynchronized shock of 120 J A single unsynchronized shock of 120 J is delivered, and CPR is started for five cycles. Following five cycles of check compressions, a pulse check reveals a faint but palpable pulse. The monitor shows a HR of 189/min, but an unchanged narrow-complex tachycardia. The patient is not breathing spontaneously. Supported ventilation is provided via BVM. You perform synchronized cardioversion at 100 J with no change in condition. 5. What are your next actions?* Perform synchronized cardioversion at 150 J Administer amiodarone 300 mg IVP Resume CPR (five cycles) Perform a pulse check You perform a pulse check which reveals that a palpable pulse is still present. You consider performing synchronized cardioversion at a higher setting. 6. What setting should you use in the given scenario?* Cardiovert at 200 J Cardiovert at 100 J Cardiovert at 125 J Cardiovert at 220 J Synchronized cardioversion is performed at 200 J, and a rhythm check reveals a conversion from ventricular tachycardia to sinus rhythm. 7. If cardioversion was unable to convert the rhythm, what other actions would you have considered?* Delivering a single unsynchronized shock of 200 J Attempting vagal maneuvers Administration of adenosine 12.0 mg IVP Administration of epinephrine 1.0 mg IVP The patient has been stabilized and transferred to the intensive care unit. 8. What is the name of the ACLS algorithm that should be followed immediately after cardiac arrest resuscitation?* Post-resuscitative care Post-cardiac care Post-arrest care Post-cardiac arrest care 9. The ACLS Post-Cardiac Arrest Care algorithm emphasizes prevention of what three clinical conditions following cardiac arrest?* Hypercapnia, hypotension, hypoxia Hypoxia, hypercapnia, hyperkalemia Hyperoxia, hypoxia, hypotension Hyperkalemia, hyperoxia, hypotension
