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, chest xray, sl NTG, Arterial blood gas Give 4 (81mg) Aspirin tablets, 12 lead ekg, IV, oxygen IV, SL ntg , IV beta blocker IV, CT scan chest , heparin 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 inferior STEMI, SL ntg, morphine and beta blocker Non-diagnostic EKG, admit for observation and stress test. NSTEMI, aspirin, statin, beta blocker and cardiology consult 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: 36.7 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 Inferior STEMI, aspirin, IV fluid bolus, cardiology consult Anterior STEMI, IV diuretics, SL NTG, IV beta blocker, lytic therapy 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 continue CPR Cardiovert, prepare to intubate Defibrillate, prepare to intubate Intubate and give amiodarone 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 Amiodarone Defibrillate Epinephrine
