ACLS
Megacode
A
40
year
old
man
arrives
at
the
ER
accompanied
by
his
family.
He
is
complaining
of
palpitations
after
working
outside
for
several
hours.
The
assessment
is
as
follows:
SKIN:
Hydrated,
pale,
warm
and
dry
CVS:
Strong
peripheral
pulses
and
a
BP
of
125/80
CNS:
Fully
intact
RESP:
RR
is
22,
no
resp.
difficulties,
lungs
CTA
You
place
o2
at
2L
by
NC
on
the
patient
and
start
an
IV.
The
monitor
shows
a
narrow
complex
SVT
(160).
What
is
your
next
intervention?
-
ANSWER
attempt
vagal
maneuvers
You
have
performed
vagal
maneuvers.
The
patient
has
shows
no
change
on
the
monitor.
What
is
your
next
step?
-
ANSWER
Give
adenosine
6mg
rapid
IV
push.
If
no
conversion,
give
12mg
rapid
IV
push
You
give
6mg
Adenosine
rapid
IV
push
with
no
effect.
12mg
Adenosine
rapid
IV
push
is
then
given.
The
patient
develops
severe
chest
pain.
You
see
a
change
in
the
rhythm.
The
BP
(not
obtainable),
and
weak
pulse.
The
patient
also
has
LOC
changes.
Your
next
step
should
be?
-
ANSWER
perform
immediate
synchronized
cardioversion
*Synchronized
cardioversion
is
indicated
for
unstable
ventricular
tachycardia
with
a
pulse.
100
J
is
given
for
regular
wide
complex
ventricular
tachycardia.
After
synchronized
cardioversion
is
unsuccessful,
the
pt.
continues
to
deteriorate.
The
patient
is
now
unconscious
with
pusleless
ventricular
tachycardia.
Below
is
what
you
see
on
the
monitor:
-
ANSWER
Give
one
unsynchronized
shock
(120-200
J)
*Defibrillation/unsynchronized
shock
is
the
most
important
intervention
for
the
conversion
of
pulseless
VT.
Defibrillation
should
always
be
performed
as
soon
as
possible
for
pulseless
VT.
You
perform
defibrillation
with
120
J.
What
is
your
next
intervention?
-
ANSWER
Give
5
cycles
of
CPR
After
completing
5
cycles
of
CPR,
the
rhythm
is
unchanged.
You
shock
a
second
time
with
200
J
and
resume
CPR.
While
completing
the
cycle
of
CPR
what
else
should
be
done?
-
ANSWER
Give
Epinephrine
1
mg
IV
push
(repeat
every
3-5
minutes)
You
have
given
the
epinephrine
and
completed
the
5
cycles
of
CPR.
A
rhythm
check
reveals
no
change.
You
attempt
a
third
defibrillation.
What
will
be
your
defibrillator
setting?
Megacode
A
40
year
old
man
arrives
at
the
ER
accompanied
by
his
family.
He
is
complaining
of
palpitations
after
working
outside
for
several
hours.
The
assessment
is
as
follows:
SKIN:
Hydrated,
pale,
warm
and
dry
CVS:
Strong
peripheral
pulses
and
a
BP
of
125/80
CNS:
Fully
intact
RESP:
RR
is
22,
no
resp.
difficulties,
lungs
CTA
You
place
o2
at
2L
by
NC
on
the
patient
and
start
an
IV.
The
monitor
shows
a
narrow
complex
SVT
(160).
What
is
your
next
intervention?
-
ANSWER
attempt
vagal
maneuvers
You
have
performed
vagal
maneuvers.
The
patient
has
shows
no
change
on
the
monitor.
What
is
your
next
step?
-
ANSWER
Give
adenosine
6mg
rapid
IV
push.
If
no
conversion,
give
12mg
rapid
IV
push
You
give
6mg
Adenosine
rapid
IV
push
with
no
effect.
12mg
Adenosine
rapid
IV
push
is
then
given.
The
patient
develops
severe
chest
pain.
You
see
a
change
in
the
rhythm.
The
BP
(not
obtainable),
and
weak
pulse.
The
patient
also
has
LOC
changes.
Your
next
step
should
be?
-
ANSWER
perform
immediate
synchronized
cardioversion
*Synchronized
cardioversion
is
indicated
for
unstable
ventricular
tachycardia
with
a
pulse.
100
J
is
given
for
regular
wide
complex
ventricular
tachycardia.
After
synchronized
cardioversion
is
unsuccessful,
the
pt.
continues
to
deteriorate.
The
patient
is
now
unconscious
with
pusleless
ventricular
tachycardia.
Below
is
what
you
see
on
the
monitor:
-
ANSWER
Give
one
unsynchronized
shock
(120-200
J)
*Defibrillation/unsynchronized
shock
is
the
most
important
intervention
for
the
conversion
of
pulseless
VT.
Defibrillation
should
always
be
performed
as
soon
as
possible
for
pulseless
VT.
You
perform
defibrillation
with
120
J.
What
is
your
next
intervention?
-
ANSWER
Give
5
cycles
of
CPR
After
completing
5
cycles
of
CPR,
the
rhythm
is
unchanged.
You
shock
a
second
time
with
200
J
and
resume
CPR.
While
completing
the
cycle
of
CPR
what
else
should
be
done?
-
ANSWER
Give
Epinephrine
1
mg
IV
push
(repeat
every
3-5
minutes)
You
have
given
the
epinephrine
and
completed
the
5
cycles
of
CPR.
A
rhythm
check
reveals
no
change.
You
attempt
a
third
defibrillation.
What
will
be
your
defibrillator
setting?
