STEMI Megacode Scenario Simulation

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
- Give 4 (81mg) Aspirin tablets, 12 lead ekg, IV, oxygen
- IV, chest xray, sl NTG, Arterial blood gas
- IV, SL ntg , IV beta blocker

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:*
- NSTEMI, aspirin, statin, beta blocker and cardiology consult
- Acute inferior STEMI, SL ntg, morphine and beta blocker
- Acute anterior STEMI, Aspirin, contact Cardiology for Lytic therapy or emergent cardiac angiography and intervention.
- 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
- NSTEMI, aspirin, Beta blocker and heparin
- Anterior STEMI, IV diuretics, SL NTG, IV beta blocker, lytic therapy
- Inferior STEMI, aspirin, IV fluid bolus, cardiology consult

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?*
- Defibrillate, prepare to intubate
- Intubate and continue CPR
- Intubate and give amiodarone
- Cardiovert, prepare to intubate

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?*
- Cardiovert
- Epinephrine
- Amiodarone
- Defibrillate