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 , heparinGive 4 (81mg) Aspirin tablets, 12 lead ekg, IV, oxygenIV, SL ntg ,IV beta blockerIV, chest xray, sl NTG, Arterial blood gas 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 consultAcute anterior STEMI, Aspirin, contact Cardiology for Lytic therapy or emergent cardiac angiography and intervention.Acute inferior STEMI,SL ntg, morphine and beta blockerNon-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?*NSTEMI, aspirin, Beta blocker and heparinAnterior STEMI, IV diuretics, SL NTG, IV beta blocker, lytic therapyInferior STEMI, aspirin, iv diuretics, beta blocker , morphine and cardiology consultInferior 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 intubateIntubate and give amiodaroneIntubate and continue CPRCardiovert, 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?*EpinephrineCardiovertDefibrillateAmiodarone
