ACLS Megacode Scenario 3: Bradycardia to Ventricular Fibrillation to ROSC

[Music] an 80 year old unconscious female was brought to the emergency department by the emergency response team the patient has an intravenous line and she is also hooked to a biphasic defibrillator you are told that she was found unconscious in bed and her family couldn't arouse her you get the following vital signs heart rate equals 42 beats per minute respiratory rate equals 25 breaths per minute blood pressure equals 80 over 60 millimeters of mercury temperature equals 36.8 degrees celsius she is hooked to a biphasic defibrillator and you note the following ecg tracing question one what is the ecg finding a normal sinus rhythm b premature junctional beat c idioventricular rhythm d sinus bradycardia correct answer d sinus bradycardia the presence of a p wave and a regular rr interval makes this ecg finding a normal sinus rhythm but since the heart rate is in the 40s it is known as sinus bradycardia question 2 what should you do next a administer amiodarone 150 milligrams intravenous infusion over 10 minutes b administer atropine 0.5 milligrams intravenous bolus c defibrillate joules d administer adenosine 6 milligrams intravenous followed by a 20 milliliter saline flush correct answer b administer atropine 0.5 milligram intravenous bolus the american heart association guidelines for bradycardia with a pulse suggest that when a patient has acutely altered mental status and hypotension the most appropriate choice of treatment is atropine incorrect answers amiodarone is an antiarrhythmic potassium channel blocker with calcium and sodium blocker properties it will potentiate the effects of bradycardia and worsen the patient never defibrillate a patient with a pulse adenosine is the pharmacologic treatment for narrow qrs complex tachyarrhythmia with regular rr intervals such as peroxismo supraventricular tachycardia after your initial management you check her vital signs and cannot feel a pulse blood pressure cannot be measured and there is no spontaneous breathing you check the ecg monitor and find the following tracing [Music] question 3 what is the ecg finding a atrial flutter b ventricular tachycardia c idioventricular rhythm d ventricular fibrillation correct answer d ventricular fibrillation the characteristic ecg finding of ventricular fibrillation is a very rapid rhythm with no qrs complex and absent p waves in ventricular fibrillation there is disorganized electrical conduction throughout the heart depolarization and repolarization are occurring at the same time which prevents the pumping function of the ventricles question four what is the next most appropriate action a high quality cpr for two minutes administer epinephrine one milligram iv bolus followed by 20 milliliter saline flush b apply advanced airway with waveform capnography c defibrillate 120 joules d intravenous administration of atropine 0.5 milligram bolus [Music] correct answer c defibrillate 120 joules american heart association guidelines recommend early defibrillation once ventricular fibrillation is documented since she is already hooked up to a biphasic defibrillator it is recommended that the initial energy is 120 joules up to 200 joules you check the vital signs and there is no change question five what is the next most appropriate action a high quality cpr for two minutes administer epinephrine one milligram iv bolus followed by a 20 milliliter saline flush b insert an advanced airway with waveform capnography c defibrillate 120 joules d intravenous administration of atropine 0.5 milligram bolus [Music] correct answer a high quality cpr for two minutes administer epinephrine one milligram iv bolus followed by 20 milliliter saline flush this is the next step after defibrillating the patient following the acls algorithm after performing your previous intervention you observed the following rhythm question 6 what is the next most appropriate action a defibrillate 150 joules b administer atropine 0.5 milligram intravenous bolus injection c administer transcutaneous pacing d check vital signs correct answer d check vital signs always check the patient first for signs of improvement to know the next most appropriate action to take checking her vital signs you do not feel a pulse blood pressure cannot be measured and there is no spontaneous breathing you again check the cardiac monitor question 7 what is your assessment a agonal rhythm b premature atrial beat c idioventricular rhythm d pulseless electrical activity correct answer d pulseless electrical activity that is why it is important to check the patient and record her vital signs after each step in the algorithm in this case the patient is impulseless electrical activity question eight what is your next appropriate action a continue cpr for two minutes followed by epinephrine one milligram intravenous bolus every three to five minutes b defibrillate 150 joules c administer transcutaneous pacemaker d administer atropine 0.5 milligram intravenous bolus [Music] correct answer a continue cpr for two minutes followed by epinephrine one milligram intravenous bolus every three to five minutes postless electrical activity is not a shockable rhythm hence the healthcare provider should continue cpr with the administration of epinephrine one milligram intravenous bolus every three to five minutes after performing your previous intervention there is still no change in the condition of the patient and you still have the following ecg finding question 9 what should you be considering during this time a given her age and present condition we should halt resuscitative efforts and declare the patient deceased b seek expert help immediately c defibrillate 200 joules d continue cpr and apply advanced airway with waveform capnography with the administration of epinephrine correct answer d continue cpr and apply advanced airway with waveform capnography with the administration of epinephrine following the aha guidelines this is the next most appropriate step this is only the second round of cpr it may also be appropriate to consider the placement of advanced airway and waveform capnography incorrect answer it is not appropriate to haunt resuscitative efforts since this is only the second round of cpr healthcare providers always keep in mind that there should be minimal interruptions to high quality cpr after performing the previous management you observed the following rhythm question 10 what is your next appropriate action a continue cpr for two minutes followed by epinephrine one milligram intravenous bolus every three to five minutes b defibrillate 100 joules c defibrillate 150 tools d synchronized cardioversion 50 joules [Music] correct answer c defibrillate 150 joules ventricular fibrillation is a shockable rhythm the energy must be the same or higher than the previous defibrillation after your previous intervention the patient has a palpable pulse you check the ecg monitor and find the following question 11 what is your interpretation of this ecg finding a ventricular fibrillation converts to ventricular tachycardia b ventricular fibrillation converts to supraventricular tachycardia c ventricular fibrillation converts to atrial fibrillation d ventricular fibrillation converts to sinus tachycardia [Music] correct answer d ventricular fibrillation converts to sinus tachycardia this corresponds to successful defibrillation the ecg tracing shows p waves normal qrs complex regular rr interval followed by a t wave question 12 what is your next course of action a defibrillate 150 joules b administer atropine 0.5 milligram intravenous bolus injection c seek expert consultation d administer transcutaneous pacing e check vital signs correct answer e check vital signs always check the patient after performing a stage on the algorithm look for a pulse and blood pressure to determine if the patient has achieved a return of spontaneous circulation to guide you on what to do next you check the vital signs and find the following heart rate equals 140 beats per minute blood pressure equals 80 over 60 millimeters of mercury respiratory rate is 12 per minute temperature equals 36.1 degrees celsius the patient is still incoherent you prepare the patient for the icu question 13 following american heart association guidelines what have you achieved at this time a successful resuscitation b return of spontaneous circulation c cardiac revival d resumption of sustained cardiac function [Music] correct answer b return of spontaneous circulation [Music] american heart association guidelines suggest the return of spontaneous circulation if a cardiac arrest patient has regained a pulse and blood pressure and if waveform capnography is being measured a sustained increase in petco2 if greater than or equal to 40 millimeters of mercury you

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Keywords: Bradycardia, ACLS Scenarios, ACLS megacode, ACLS megacode 2020, ACLS megacode simulator, ACLS Simulator, Vfib, ROSC, Return of spontaneous circulation, Ventricular fibrillation, Health Ed Solutions, Health Ed Solutions Megacode, How to treat Bradycardia, bradyarrhythmia, How to treat bradyarrhythmia, Advanced Cardiovascular Life Support, acls megacode scenarios 2020, acls megacode bradycardia, acls megacode examples, acls test questions and answers

Id: -YrUvYFSh2E

Length: 13min 37sec (817 seconds)

Published: Sun Nov 01 2020