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ACLS Megacode Simulator 1

In this ACLS Megacode scenario, use the appropriate ACLS algorithms to treat the
patient. There are 12 questions for this ACLS megacode scenario. Assume the use of
biphasic defibrillator in all scenarios.
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
The monitor/ECG shows narrow complex SVT with a HR of 180.

1. You place o2 at 2L by NC on the patient and start an IV. The monitor continues to
show a narrow complex SVT

What is your next intervention?

Give adenosine 6mg rapid IV push

Attempt vagal maneuvers (CORRECT)

Perform immediate synchronized cardioversion

Give epinephrine 1mg IV push

n this ACLS Megacode scenario, use the appropriate ACLS algorithms to treat the
patient. There are 12 questions for this ACLS megacode scenario. Assume the use of
biphasic defibrillator in all scenarios.
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
The monitor/ECG shows narrow complex SVT with a HR of 180.

2. You have performed vagal maneuvers and there is no change in the patients heart
rate and rhythm. What is your next step?

Give adenosine 6mg rapid IV push. If no conversion, give 12mg rapid IV push

Give adenosine 12mg rapid IV push. If no conversion, give another 12mg rapid IV push.

Give Amiodarone 150mg over 10 minutes. May repeat as needed

Continue to attempt vagal manuvers until the patient converts to a regular sinus rhythm

n this ACLS Megacode scenario, use the appropriate ACLS algorithms to treat the
patient. There are 12 questions for this ACLS megacode scenario. Assume the use of
biphasic defibrillator in all scenarios.
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
The monitor/ECG shows narrow complex SVT with a HR of 180.

3. You give 6mg Adenosine rapid IV push with no effect. 12mg Adenosine rapid IV push
is then given. The patient develops severe chest pain and his vital signs are: HR 220, BP
(not obtainable), and weak pulse. The patient also has LOC changes. Your next step
should be.

perform immediate defibrillation


give 2nd dose of 12mg adenosine rapid IV push

perform immediate synchronized cardioversion (CORRECT)

perform precordial thump

ACLS Megacode Simulator 1


In this ACLS Megacode scenario, use the appropriate ACLS algorithms to treat the
patient. There are 12 questions for this ACLS megacode scenario. Assume the use of
biphasic defibrillator in all scenarios.
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
The monitor/ECG shows narrow complex SVT with a HR of 180.

4. 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:

What is your first intervention.

Begin CPR and give 5 cycles before shocking

Give Epinephrine 1mg IV push (repeat every 3-5 minutes)


Give one unsynchronized shock (120-200 J) (CORRECT)

Place an advanced airway

In this ACLS Megacode scenario, use the appropriate ACLS algorithms to treat the
patient. There are 12 questions for this ACLS megacode scenario. Assume the use of
biphasic defibrillator in all scenarios.
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
The monitor/ECG shows narrow complex SVT with a HR of 180.

5. The patient does not respond to the defibrillation with 120 J. He remains unconscious
in ventricular tachycardia. What is your next intervention?

Deliver a second shock (120-200 J)

Give 1mg Epinephrine IV push (repeat the epinephrine every 3-5 minutes)

Give 5 cycles of CPR (CORRECT)

Check the rhythm and the pulse

In this ACLS Megacode scenario, use the appropriate ACLS algorithms to treat the
patient. There are 12 questions for this ACLS megacode scenario. Assume the use of
biphasic defibrillator in all scenarios.
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
The monitor/ECG shows narrow complex SVT with a HR of 180.

6. After completing 5 cycles of CPR, your rhythm check indicates a second shock. You
shock a second time with 200 J, and the patient's rhythm does not change. You resume
CPR. While completing the cycle of CPR what else should be done?

A. Give Epinephrine 1 mg IV push (repeat every 3-5 minutes)

B. Vasopressin 40 U IV push to replace the 1st or 2nd dose of epinephrine

C. Give Epinephrine 0.5mg IV push (repeat every 3-5 minutes)

D. Either A or B is correct (CORRECT)

In this ACLS Megacode scenario, use the appropriate ACLS algorithms to treat the
patient. There are 12 questions for this ACLS megacode scenario. Assume the use of
biphasic defibrillator in all scenarios.
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
The monitor/ECG shows narrow complex SVT with a HR of 180.

7. You have given the epinephrine or vasopressin and completed the 5 cycles of CPR. A
rhythm check reveals no change. You attempt at third defibrillation. What will be your
defibrillator setting?

300 Joules (CORRECT)

200 Joules
160 Joules

400 Joules

In this ACLS Megacode scenario, use the appropriate ACLS algorithms to treat the
patient. There are 12 questions for this ACLS megacode scenario. Assume the use of
biphasic defibrillator in all scenarios.
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
The monitor/ECG shows narrow complex SVT with a HR of 180.

8. The third shock does not change the rhythm and you restart CPR (5 cycles). You have
shocked, you have given vasopressors (epinephrine and/or vasopressin), you have
continued with effective CPR. What medication should be considered at this point?

Amiodarone (CORRECT)

Lopressor

Atropine

Dopamine

In this ACLS Megacode scenario, use the appropriate ACLS algorithms to treat the
patient. There are 12 questions for this ACLS megacode scenario. Assume the use of
biphasic defibrillator in all scenarios.
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
The monitor/ECG shows narrow complex SVT with a HR of 180.

9. What is the correct dosing for amiodarone in the Pulseless Arrest Algorithm?

150mg IV once. If this in not effective give 300mg IV once.

200mg IV once.

300mg IV once. Then consider an additional 150mg IV once. (CORRECT)

give IV infusion of 300mg per hour

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n this ACLS Megacode scenario, use the appropriate ACLS algorithms to treat the
patient. There are 12 questions for this ACLS megacode scenario. Assume the use of
biphasic defibrillator in all scenarios.
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
The monitor/ECG shows narrow complex SVT with a HR of 180.

10. Lidocaine can be used instead of amiodarone as an antiarrhythmic for pulseless


arrest. What is the proper dosing of lidocaine?
1.5 mg IV first dose, then 0.75 mg IV

3 mg/kg rapid IV push

0.5 to 0.75 mg/kg IV, if no affect 1 to 1.5 mg/kg IV

1 to 1.5 mg/kg first dose, then 0.5 to 0.75 mg/kg IV (CORRECT)

In this ACLS Megacode scenario, use the appropriate ACLS algorithms to treat the
patient. There are 12 questions for this ACLS megacode scenario. Assume the use of
biphasic defibrillator in all scenarios.
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
The monitor/ECG shows narrow complex SVT with a HR of 180.

11. You give amiodarone 300 mg first dose and the patient converts to a Normal Sinus
Rhythm. You are instructed to start an amiodarone drip for the postresuscitation
maintenance therapy. What is maximumcumulative dose for amiodarone in a 24 hour
period?

2.2 grams (CORRECT)

3.2 grams
1.5 grams

5.6 grams

In this ACLS Megacode scenario, use the appropriate ACLS algorithms to treat the
patient. There are 12 questions for this ACLS megacode scenario. Assume the use of
biphasic defibrillator in all scenarios.
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
The monitor/ECG shows narrow complex SVT with a HR of 180.

12. Great Job! You saved the patient He has been stabilized and intubated, but does
not respond to verbal commands. He is transported to the hospital's ICU. Since the
patient is not responsive what would be the most important intervention in the post-
cardiac arrest phase.

monitor waveform capnography

obtain an arterial blood gas

induce therapeutic hypothermia (CORRECT)

monitor oxygen saturation