ACLS Megacode 9 Out-of-Hospital

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You are a healthcare provider working on an ALS ambulance. You are dispatched to a bus terminal where a 38-year-old male is having a grand mal seizure. Your response time to the scene is 3 min. Upon arrival, a bystander informs you that the seizure ended 1 min prior to your arrival. A rapid initial assessment reveals the following:

Vital signs
  • Pulse rate: 28/min
  • Blood pressure: Unobtainable
  • Respiratory rate: 28/min
  • Temperature: 38.7 °C
Physiological systems
  • Integumentary: Cyanotic, diaphoretic, cool
  • Cardiovascular: No palpable peripheral pulses bilaterally
  • Respiratory: Lungs CTA bilaterally
  • Neurological: Unresponsive
1. A cardiac monitor is attached to the patient. A rhythm check reveals sinus bradycardia at 28/min. The patient is considered symptomatic. You decide to provide supportive care. In order of importance, what are your initial actions?*