ACLS Megacode 7: STEMI Hurry, don’t let time run out! Sorry, time is up! 0 Hours 0 mins 0 secs Step 1 of 5 20% Pt arrives to ED/Casualty with diaphoresis, midsternal chest pain radiating to left arm and jaw. 1. What are the best diagnostic / therapeutic first steps?* IV, CT scan chest , heparin IV, SL ntg , IV beta blocker IV, chest xray, sl NTG, Arterial blood gas Give 4 (81mg) Aspirin tablets, 12 lead ekg, IV, oxygen Pt is a 54 y/o male, smoker, c/o chest heaviness ,diaphoresis, nausea present to ED/casualty via paramedics. IV placed an EKG has been done in Triage. 2. Interpret the ekg and choose the best therapies:* Acute anterior STEMI, Aspirin, contact Cardiology for Lytic therapy or emergent cardiac angiography and intervention. Acute inferior STEMI, SL ntg, morphine and beta blocker NSTEMI, aspirin, statin, beta blocker and cardiology consult Non-diagnostic EKG, admit for observation and stress test. 62 y/o woman with diabetes presents to ED/Casualty with epigastric discomfort, nausea and vomiting. BP: 150/80 P: 85 R:22 O2: 100% Temp: 36.7 After she is seen by the Surgical resident, she develops hypotension BP 90/50 and an ekg is performed. 3. What should be done urgently?* Inferior STEMI, aspirin, iv diuretics, beta blocker , morphine and cardiology consult Anterior STEMI, IV diuretics, SL NTG, IV beta blocker, lytic therapy Inferior STEMI, aspirin, IV fluid bolus, cardiology consult NSTEMI, aspirin, Beta blocker and heparin On the next rhythm check, the patient demonstrates the following rhythm: She now has a palpable pulse but is hypotensive, unresponsive, and hypoxic.4. What are the next appropriate steps in management?* Intubate and give amiodarone Cardiovert, prepare to intubate Defibrillate, prepare to intubate Intubate and continue CPR After cardioverting and intubating, you get an EKG which demonstrates the following: You re-assess the patient and cannot palpate a pulse.5. What is the next step?* Defibrillate Epinephrine Amiodarone Cardiovert
