Megacode Scenario 1
Instructions: Evaluate the case and use your knowledge of ACLS algorithms to answer each question. You will receive a score at the end of the test. You may repeat this simulation as often as you like, until you are confident in your ability to intervene effectively in similar situations. There are 19 questions in this simulation.
You are called to see a 57-year-old female patient admitted to the orthopedic ward following a motor vehicle accident. Her past medical history is notable for a history of hypothyroidism since adolescence, for which she takes levothyroxine.
She is complaining of palpitations. On examination, you find:
• Cardiovascular: irregularly irregular pulse, heart rate of 94. Blood pressure of 94/48
• Skin: Warm with normal capillary refilling time.
• Respiratory: rate of 20 breaths per minute, lungs are clear and equal bilaterally
• CNS: Patient alert and oriented
1. Identify the rhythm.
2. What are the diagnostic features of atrial fibrillation on an ECG?
3. While you are evaluating the patient, she suddenly becomes unstable with a blood pressure of 74/36. What would be your next immediate step?
4. What is the recommended initial energy using a biphasic waveform defibrillator when cardioverting unstable atrial fibrillation?
5. What is your most important concern before cardioversion if the atrial fibrillation has been present for more than 48 hours?
6. You successfully cardioverted the patient to a normal sinus rhythm. Out of the following available drugs what would have been your initial drug of choice for treatment if patient was hemodynamically stable?
7. Major goals in the management of atrial fibrillation include all of the following except:
8. The patient suddenly becomes unconscious with no palpable pulse, but the cardiac monitor still shows sinus rhythm. You begin CPR. What is your next course of action out of the following?
9. What is the condition of having no palpable pulse with an organized rhythm present on the monitor called?
10. Before the 2010 ACLS guidelines, which of the following drugs was commonly used in the treatment of PEA?
11. After CPR and IV epinephrine, the patient regains consciousness and goes into a symptomatic sinus bradycardia (heart rate 40). You decide to give atropine. What is the initial dose of atropine you will consider?
12. The patient has a worsening symptomatic bradycardia (heart rate 34) with complaints of dizziness and confusion. Atropine has failed to elicit any response. Of the following, which would be the next logical action?
13. Transcutaneous pacing fails to elicit any response and the patient continues to worsen. What would be your next step?
14. Transcutaneous pacing may be indicated for all of the following except?
15. Which of the following is not a common cause of pulseless electrical activity?
16. What is one of the most common neurological complications encountered in patients suffering from atrial fibrillation?
17. What is National Institute of Neurological Disorders and Stroke critical time goal for instituting treatment in a patient with stroke (from time of ED arrival)?
18. What does time zero mean in terms of determining time goals in patients suffering from stroke?
19. All of the following are contraindications for fibrinolytic therapy in treating stroke except:
You answered 0 of 0 correct. Scoring %.
Thanks for taking our Megacode Scenario 1.