ACLS Megacode 7: STEMIHurry, don’t let time run out!Sorry, time is up!0 Hours 0 mins 0 secsStep 1 of 520%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, SL ntg , IV beta blocker IV, chest xray, sl NTG, Arterial blood gas IV, CT scan chest , heparin Give 4 (81mg) Aspirin tablets, 12 lead ekg, IV, oxygenPt 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 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. Acute anterior STEMI, Aspirin, contact Cardiology for Lytic therapy or emergent cardiac angiography and intervention.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: 36.7After 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 fluid bolus, cardiology consult 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 therapyOn 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 Cardiovert, prepare to intubate Intubate and give amiodaroneAfter 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?* Amiodarone Cardiovert Defibrillate Epinephrine
