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Home » Free Resources » ACLS Case Study » In Hospital Case Study 1

ACLS Megacode 1 In-Hospital

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You are an internist at a local hospital. One of your patients is a 25-year-old male who was admitted yesterday evening for chronic abdominal pain and a history of gastrointestinal ulcers. You arrive in their hospital room to discuss their lab results when you find them in bed unresponsive. There is a half-eaten sandwich on the table next to the bed, so you assume they were eating shortly beforehand. A rapid initial assessment reveals the following:

Vital signs

Pulse rate: Unobtainable
Blood pressure: Unobtainable
Respiratory rate: Unobtainable
Temperature: Unobtainable

Physiological systems

Integumentary: Moist, cool
Cardiovascular: No palpable pulse
Respiratory: No audible respirations, visible chest rising
Neurological: Unresponsive

1. Based on your initial assessment, you determine the patient is in cardiac arrest and activate the Code Team. IV access has already been established. A cardiac monitor is not attached to the patient at this time. What are your initial actions?*

Administer epinephrine 1 mg IVP

Deliver a single unsynchronized shock of 120 J

Check for an airway obstruction without commencing CPR

Start CPR (five cycles)

You have started CPR and members of the Code Team begin arriving at the room.

2. Which of the following drugs should you consider administering?*

Dopamine 1 mcg/kg

Atropine 1 mg IV/IO

Dopamine 20 mcg/kg/min IV fluid bolus

Epinephrine 1 mg IV/IO

Five cycles of CPR are completed, epinephrine 1.0 mg IVP is administered, and a cardiac monitor is attached to the patient. During CPR, a large bolus of food was dislodged from the patients’ airway. Following five cycles of CPR, a rhythm check reveals pulseless electrical activity.

3. Which of the following H’s and T’s is the most likely cause of the arrest?*

Hypoxia

Tension pneumothorax

Tamponade (cardiac)

Hydrogen ion (acidosis)

CPR is resumed for another five cycles. Following five cycles of CPR, a rhythm check reveals unchanged pulseless electrical activity.

4. What are your next actions?*

Administer amiodarone 300 mg IVP

Administer epinephrine 1 mg IVP

Deliver a single unsynchronized shock of 120 J

Resume CPR (five cycles)

CPR is resumed for another five cycles. Following five cycles of CPR, a rhythm check reveals a conversion from pulseless electrical activity to ventricular tachycardia.

5. What are your next actions?*

Resume CPR (five cycles)

Deliver a single unsynchronized shock of 120 J

Administer adenosine 6 mg IVP

Administer epinephrine 1 mg IVP

A single unsynchronized shock of 120 J is delivered, and CPR is resumed for another five cycles. Following five cycles of CPR, a rhythm check reveals unchanged ventricular tachycardia.

6. What are your next actions?*

Administer amiodarone 300 mg IVP

Administer epinephrine 1 mg IVP

Administer atropine 1 mg IVP

Deliver a single unsynchronized shock of 200 J

A single unsynchronized shock of 200 J is delivered, and CPR is resumed for another five cycles.

7. Following defibrillation, during the first cycle of CPR, what drug should you consider administering?*

Administer amiodarone 300 mg IVP

Administer epinephrine 1.0 mg IVP

Administer atropine 1.0 mg IVP

Administer lidocaine 1.0-1.5 mg/kg IVP

Epinephrine 1 mg IVP is administered while simultaneously continuing CPR.

8. According to AHA ACLS guidelines, what should be done after giving any drug during cardiac arrest?*

Perform a pulse check

Flush the IV line with NS 10 m

Perform a rhythm check

Flush the IV line with NS 20 ml

CPR is resumed for another five cycles. Following five cycles of CPR, a rhythm check reveals unchanged ventricular tachycardia. A single unsynchronized shock of 300 Joules is delivered, and CPR is resumed for another five cycles.

9. What drug is indicated in the given scenario?*

Epinephrine 1.5 mg IVP

Dopamine 2-10 mcg/kg/min

Amiodarone 300 mg IVP

Amiodarone 150 mg IVP

Amiodarone 300 mg IVP is administered, and CPR is resumed for another five cycles. Following five cycles of CPR, a rhythm check reveals a conversion from ventricular tachycardia to sinus tachycardia. A pulse check reveals a faint and weak pulse. Vital signs are HR 162, BP 108/64. There are no spontaneous respirations, and the patient remains unconscious.

10. What are your next actions?*

Transport to the intensive care unit

Seek expert consultation

Monitor for hypotension and signs of inadequate perfusion

Place an advanced airway and provide ventilatory assistance via BVM

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