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:* 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. Acute inferior STEMI, SL ntg, morphine and beta blocker 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 fluid bolus, cardiology consult NSTEMI, aspirin, Beta blocker and heparin Anterior STEMI, IV diuretics, SL NTG, IV beta blocker, lytic therapy Inferior STEMI, aspirin, iv diuretics, beta blocker , morphine and 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?* Intubate and continue CPR Intubate and give amiodarone Defibrillate, prepare to intubate 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?* Epinephrine Cardiovert Defibrillate Amiodarone
