ACLS MEGACODE 2

Scenario data: A 65-year-old male collapses as he is out for his morning walk. A bystander witnessed the collapse, activates EMS, and begins CPR. The EMS team arrives 6 minutes later. The monitor is attached and the assessment is as follows:

Skin: cold/clammy/cyanotic
Cardiovascular: no pulse
Respiratory: no respirations
CNS: no response
Monitor: rhythm strip below

What ACLS algorithm are you going to begin this scenario with?

• Cardiac Arrest (VT/VF branch)

• Bradycardia (unstable branch)

• • Cardiac Arrest (Asystole/PEA branch)

• Unstable Tachycardia

As an EMS provider in the out of hospital setting, your first step is to:

• Give epinephrine 1mg IV/IO

• Give CPR for 5 cycles

• Give atropine 1mg IV/IO

• Give 1 unsynchronized shock (120-200 J)

Answer explanation

Effective CPR is the foundation for any successful resuscitation attempt. Also, the primary intervention for the right branch (PEA/Asystole) of the cardiac arrest algorithm is chest compressions.

While the EMS team is providing 5 cycles of CPR what other activities can be completed?

• secure the airway

• • start an IV

• provide the patient with oxygen

• all of the above.

Answer explanation

Securing the airway, providing oxygen, and starting an IV are all important interventions that will improve the providers ability to carry out effective resuscitation efforts.

After your IV is secure, your next step involves giving a medication. What medication should be used?

• epinephrine 0.5mg IV

• • atropine 1mg IV

• • vasopressin 40 U IV

• epinephrine 1mg IV

Vasopressin 40 U IV can replace the 1st or 2nd dose of epinephrine in the cardiac arrest algorithm.

• TRUE

• FALSE

Epinephrine should be repeated at what frequency for the treatment of Asystole?

• every 3-6 minutes

• every 3-5 minutes

• only 3 times

• after each cycle of CPR

Answer explanation

Within the cardiac arrest algorithm, epinephrine is always repeated every 3-5 minutes.

You give epinephrine 1 mg IV and finish the cycle of CPR. What is your next intervention?

• give amiodarone 300 mg IV

• give epinephrine 1 mg IV

• shock 120-200 J

• rhythm check

After giving the first dose of epinephrine you finish the cycle of CPR. A rhythm check shows that the patient's rhythm changed from asystole to the rhythm below. He also remains pulseless. Your first action is to:

• • give 5 cycles of CPR

• • give another dose of epinephrine 1mg IV

• • give 1 unsynchronized shock (120-200 J)

• give amiodarone 300mg IV x 1

Answer explanation

This change in the rhythm would lead to a change to the left branch of the cardiac arrest algorithm. The patient remains pulseless and therefore would be treated for pulseless ventricular tachycardia. The first and most important intervention for pulseless VT (and VF) is high energy unsynchronized shocks (defibrillation). When there is a change in the algorithm, it is best practice to start at the top of the new algorithm and ensure that interventions are systematically carried out.

You deliver 1 shock of 120J. After the shock what is the your next step?

• deliver a second shock

• check a pulse

• resume CPR (5 cycles)

• give epinephrine 1mg IV

Answer explanation

Always begin CPR immediately after defibrillation. Don’t look at the rhythm. For every second that chest compressions are stopped during CPR, this reduces the volume of blood that is circulated in the patient and decreases the likelihood of ROSC.

You have resumed CPR. Your next intervention after 5 cycles of CPR is to:

• perform a rhythm check

• assess breathing

• Shock before any other intervention

• give epinephrine

Answer explanation

A rhythm check always occurs after 5 cycles of CPR.