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Preparing for megacodes with an in-depth study of ACLS algorithms

Mackenzie Thompson

by Mackenzie, Life Saver, NHCPS

Co-authored by Karl Disque, D.O. RPH

posted on May 14, 2021 at 12:21 am

If you are in the healthcare field, you may encounter a megacode at one time or another. In some cases, successful completion of a megacode may be necessary to obtain or keep a job in this field. Although this situation can nerve-racking and even a little overwhelming, there are steps you can take to prepare for megacodes and improve your chances of success. Consult the information below to gain a better understanding of megacodes and how you can master the skills you need to navigate these situations effectively.

What Is a Megacode?

The goal of life support courses is to help you learn specific ACLS algorithms you can use to help someone who is experiencing respiratory arrest, cardiac arrest or another life-threatening condition. However, in real life, patients will rarely follow the book. In fact, patients who are in distress will often transition through a variety of different states that may require different life support techniques. In order to test an individual’s ability to deal with realistic codes successfully, the megacode was developed.

A megacode is a simulation that has been designed to mimic a real-life code as much as possible. When you are engaged in a megacode, you will progress through a series of questions or scenarios that require you to recall your knowledge of patient assessment techniques, as well as management skills. The exact content of a megacode will depend on the purpose, as well as the nature of your training and career path. For example, the megacodes used in basic ACLS certification programs that require knowledge of ACLS algorithms only may not be as intricate or challenging as those that are used in medical school.

How Are Megacodes Used?

Megacodes may be used in a variety of different scenarios. Some examples of situations in which you may encounter a megacode include:

  • In a certification program – Some certification programs require their students to participate in megacodes before they can pass the course. In other situations, certifications may simply offer megacodes to students who want extra practice.
  • For confidence building – Some students may participate in megacodes in order to build their confidence level by practicing their ACLS algorithms in real-life scenarios.
  • As part of an interview process – When interviewing for a job in the healthcare field, you may be asked to complete a megacode to show the potential employer that you are able to manage patients well in real-life emergency situations.
  • As part of training – In some cases, an on-the-job training program may incorporate megacodes. These megacodes will usually be closely related to the job in question and designed to make sure trainees have all the knowledge and skills they need to meet the position’s requirements.
  • In educational programs – Healthcare education programs often include megacodes to improve students’ knowledge and skills, as well as to test students on what they have learned. These megacodes may be used as part of the educational process, or they may be presented in the form of an exam.

What to Expect During a Megacode

During a megacode, you can expect to be acting as the primary caregiver. If you are completing the megacode in person, you will usually be alone in the room with the instructor. During this time, the instructor will provide only minimal assistance, if any. You will be required to assess the patient, arrive at a diagnosis and demonstrate your skills. Some mega codes may be completed online. In these cases, you will be responsible for all aspects of the code and will complete it entirely on your own.

The length of megacodes will vary based on the purpose of the activity. In some cases, several different scenarios may be included in a single megacode experience.

How to Prepare for an ACLS Megacode

nurse-with-stethoscope-using-laptopACLS megacodes are designed to make sure you have not only mastered the knowledge and skills you need for certification, but also to ensure that you are able to recall and utilize this information in a stressful situation. Because of the gravity and unpredictability of these situations, it is only natural to be a little nervous when preparing for an ACLS megacode. However, with the right preparation, you can boost your confidence, reduce your stress and improve your chances of completing the megacode without any problems. To prepare for your ACLS megacode:

  • Understand the purpose of the exercise – Instead of approaching the ACLS megacode with anxiety and apprehension, remind yourself that the purpose of this exercise is to make sure you have mastered ACLS algorithms. If the exercise isn’t successful, it simply means that you need to spend more time studying and building your confidence before you put these skills into practice.
  • Learn the ACLS algorithms – The most obvious tip for anyone hoping to complete a megacode successfully is to learn the ACLS algorithms. However, it is important to note that a basic understanding of these algorithms will not be enough to get you through the megacode. You will need to know these algorithms inside and out, and you will need to be able to move from one to another quickly.
  • Practice megacodes in advance – Although you may not be able to simulate the exact megacode scenario you will face in your training course or with an employer, you can still gain some much-needed practice by going through some examples of megacodes on your own. These practice codes may be available through your ACLS training program.
  • Be prepared to move quickly – One of the most important aspects of providing life support is the ability to make quick decisions and offer prompt treatment. When you are participating in a megacode, it is important to think clearly and move quickly so you can get the best possible result.

ACLS Algorithms to Know

ACLS megacodes vary and are likely to take you through a variety of different scenarios. Some of the ACLS algorithms that may be tested in a megacode include:

Bradycardia with a Pulse Algorithm

This algorithm will be used with patients who have a pulse, symptoms of cardiac distress and a heart rate of less than 50 bpm. The steps in managing this condition are as follows:

      1. Maintain patient airway.
      2. Provide oxygen if the patient is hypoxic.
      3. Use a cardiac monitor to identify the patient’s rhythm.
      4. Obtain a 12-lead ECG.
      5. Establish IV access.
      6. Assess the patient for acute heart failure, ischemic heart discomfort, shock, altered mental status and hypotension. If any of these conditions are present, administer atropine.
      7. If atropine is administered but is ineffective, consider epinephrine, dopamine or transcutaneous pacing.

Tachycardia with a Pulse Algorithm

This algorithm is appropriate in cases where a patient has a heart rate of more than 100 bpm, as well as signs of instability. Tachycardia is considered unstable when it results in compromised cardiac output. The steps in this algorithm are as follows:

      1. Maintain patient airway
      2. Provide oxygen if the patient is hypoxic.
      3. Use a cardiac monitor to identify the patient’s rhythm.
      4. Assess the patient for acute heart failure, ischemic heart discomfort, shock, altered mental status and hypotension. If any of these conditions are present, move on to synchronized cardioversion and consider sedation.
      5. If none of the conditions in step 4 are present, establish IV access and obtain a 12-lead ECG.
      6. Assess the QRS. If the QRS is greater than or equal to 0.12 seconds, consider antiarrhythmic infusion and expert consultation. If the QRS is less than 0.12 seconds, perform vagal maneuvers, administer beta-blockers or calcium channel blockers and consider expert consultation.

Adult Cardiac Arrest Algorithm

The cardiac arrest algorithm is appropriate when patients do not have a pulse. The exact path you will follow will depend on the specifics of the patient’s condition. The steps that should be followed for this algorithm include:

      1. Start CPR, administer oxygen and attach monitor/defibrillator.
      2. Determine whether the rhythm is shockable.
      3. If the rhythm is not shockable, resume CPR. Gain IV access and administer epinephrine every 3-5 minutes. Check for a shockable rhythm every two minutes.
      4. If the rhythm is shockable, administer a shock.
      5. Perform CPR for 2 minutes and gain IV access.
      6. Check for shockable rhythm again. If the rhythm is not shockable, go back to step 3. If the rhythm is still shockable, administer another shock.
      7. Resume CPR for 2 minutes and administer epinephrine every 3-5 minutes.
      8. Check for shockable rhythm again. If the rhythm is not shockable, go back to step 3. If the rhythm is still shockable, administer another shock.
      9. Resume CPR for 2 minutes. Administer amiodarone.

Post-Cardiac Arrest Care Algorithm

This algorithm should be utilized when spontaneous circulation returns. This algorithm includes the following steps:

  1. Optimize the patient’s ventilation and oxygenation. Do not overventilate the patient, but maintain an oxygen saturation of at least 94 percent. Consider an advanced airway.
  2. Treat hypotension with IV bolus and vasopressor infusion.
  3. Obtain a 12-lead ECG.
  4. If the ECG shows signs of ST-elevation myocardial infarction or acute myocardial infarction, initiate coronary reperfusion therapy.
  5. If the patient cannot follow commands, initiate targeted temperature management.
  6. Progress to advanced critical care.

Suspected Stroke Algorithm

This algorithm should be used when the patient shows signs of a possible stroke, which is an interruption in the flow of blood to part of the brain. The suspected stroke algorithm includes the following steps:

  • Assess the patient’s vital signs.
  • Maintain the patient’s airway and administer oxygen if necessary.
  • Establish an IV.
  • Perform lab assessments.
  • Check glucose and provide any necessary treatment.
  • Perform neurological screening.
  • Activate stroke team.
  • Order MRI or CT scan of brain.
  • Obtain 12-lead ECG.
  • Review patient history.
  • Establish time of symptom onset.
  • Perform neurological examination.
  • If the CT scan shows signs of hemorrhage, consult an expert.
  • If the CT scan does not show signs of hemorrhage, consider whether the patient is a candidate for fibrinolytic therapy.
  • If the patient is a candidate for fibrinolytic therapy and consent is obtained, begin therapy.
  • If the patient is not a candidate for fibrinolytic therapy, administer aspirin and seek expert consultation.

Keep in mind that different initial steps may be followed if the event occurs outside of a hospital setting.

Acute Coronary Syndromes Algorithm

This algorithm will be used when patients are showing symptoms of infarction or ischemia. The steps in the acute coronary syndromes algorithm are as follows:

  • Check vital signs and oxygen saturation.
  • Establish IV access.
  • Take medical history and perform brief physical.
  • Complete fibrinolytic checklist.
  • Check cardiac markers.
  • Perform portable chest x-ray
  • Administer oxygen if saturation is low.
  • Administer aspirin and nitroglycerin. Consider morphine.
  • Interpret the ECG and tailor treatment accordingly.

Keep in mind that different initial steps may be followed if the event occurs outside a hospital setting.

How to Get ACLS Training

One of the best ways to ensure that you fully understand all ACLS algorithms before a megacode is to complete a reputable ACLS training program. Save a Life by NHPCS offers an ACLS training program that can be completed entirely online, allowing you to build the knowledge base and skills you need to succeed in your career. Because our course is available online, you can move through the materials in your own time on a schedule that works for you. In addition to providing all of the course materials you need to obtain ACLS certification, we are also proud to offer four ACLS megacode scenarios you can use to prepare yourself for virtually any situation, from megacodes in other environments to real-life emergency situations. Please contact us today to learn more.

About Mackenzie

Mackenzie is a seasoned life saver and a multifaceted professional in the medical field. With an impressive 8-year track record in medical education, Mackenzie boasts a comprehensive set of certifications, including ACLS, PALS, BLS, and CPR, which reflect her unwavering commitment and expertise. Her significant contributions to teaching and the development of medical content underscore her profound knowledge and dedication to advancing healthcare.

Beyond her medical prowess, Mackenzie seamlessly integrates her passion for education with her proficiency in media and marketing. Her academic journey at Indiana University culminated in a degree in Media and Marketing, further solidifying her expertise in these domains.

In addition to her impressive professional achievements, Mackenzie possesses a refined taste for global exploration, photography, design aesthetics, sartorial elegance, and the culinary arts, with a particular affinity for Chinese cuisine. Currently based in the vibrant city of Manhattan, she continues to be a driving force in the medical community. She is an invaluable asset to, where she champions excellence and innovation with unwavering dedication.

Contact Mackenzie at [email protected]


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