ACLS Megacode Scenario 1
By Mark Dzwonkiewicz, FP-C, LI | Medically reviewed by Eileen Johnson, RN on October 18, 2024
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Question 1 of 7
1. Question
A 23-year-old woman presents to the emergency department. She walks in unassisted, accompanied by her husband. She complains that her heart is “pounding.”She states that her symptoms started approximately 20 minutes ago. She is pale and complains of feeling weak. She denies having had similar symptoms before. You take her to a room with a monitored bed, obtain vital signs, and hook her up to the cardiac monitor.
Her vital signs are: HR 180 bpm and regular; RR 24 breaths per minute; BP 118/68 mmHg; SpO2 96% on room air.
You observe the following rhythm on the monitor.
1. What rhythm do you observe?
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Question 2 of 7
2. Question
2. What initial intervention will you consider?
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Question 3 of 7
3. Question
You know that carotid massage is a type of vagal maneuver you could quickly try. Before attempting carotid massage, you evaluate the patient for contraindications.3. Which of the following is NOT a contraindication to carotid massage?
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Question 4 of 7
4. Question
You find no contraindications to carotid massage.You perform carotid massage for 5 seconds over the point of maximal carotid impulse on both the right and left sides of the neck, taking a 30-second break in between sides. The patient’s heart rate decreases transiently; however, it increases back to 180 bpm soon after you have performed the vagal maneuver.
4. What is your next intervention?
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Question 5 of 7
5. Question
5. What is the recommended initial dose of adenosine?
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Question 6 of 7
6. Question
You prepare a syringe of 20 mL of NS along with the 6 mg dose of adenosine.You inject the adenosine into the IV and immediately follow it with the 20 mL bolus of NS. You raise the patient’s IV arm above the level of the heart to speed drug circulation.
After administration of adenosine 6 mg, you watch the cardiac monitor and note that the patient’s rhythm slows.There is a brief period of asystole. The patient complains of shortness of breath, chest discomfort, and flushing.
6. How should you respond to the asystole?
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Question 7 of 7
7. Question
The patient’s ECG rapidly cycles out of asystole and into a normal sinus rhythm, but after a couple of minutes, the ECG again shows SVT.You reassess the patient. Her vital signs are BP 110/60 mmHg; RR 25 breaths per minute; HR 190 bpm; SpO2 95%. The patient remains alert.
7. What is your next intervention?
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ACLS Megacode Scenario 1 Video
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