ACLS Megacode Scenario 4: In Hospital Cardiac Arrest

This is the fourth ACLS megacode scenario in the "Megacode Series" by Health Ed Solutions and it will cover In-Hospital Cardiac Arrest (IHCA). The megacode scenarios are intended to test your ability to put your algorithm knowledge to work. For each megacode simulator, there will be a scenario and you will have to identify rhythms, prescribe treatments, and recommend the next steps to properly provide optimal care for the patient. Rationales are included with the correct answers to support each clinical decision.
Thanks for watching and stay tuned for more lessons in our Megacode Series. We will be offering an entire free series of practice megacode simulators covering ACLS, PALS, NRP, and BLS scenarios - all up-to-date with the latest 2020 AHA/ILCOR guidelines and peer-reviewed by the Health Ed Solutions medical review board for clinical accuracy.
Here is some more information about Health Ed Solutions:
Health Ed Solutions is a leading innovator of online certification and recertification in Advanced Cardiac Life Support (ACLS), Pediatric Advanced Life Support (PALS), Basic Life Support (BLS), Neonatal Resuscitation Program (NRP), as well as several additional certifications for health care providers and emergency medical responders.
Our online medical education offerings (such as ACLS, PALS, BLS, NRP, 12-Lead ECG / EKG, Arrhythmia Interpretation, and Monitor Tech) are specifically designed for busy healthcare professionals (paramedics, EMTs, CRNAs, dentists, physical therapists, medical students, registered nurses, physician assistants, nurse practitioners, physicians / doctors, etc.) who are seeking a more convenient, engaging, effective and entertaining (yes entertaining) educational experience. We also offer BLS / CPR / AED / First Aid training courses for anyone who needs to know how to perform CPR, such as athletic trainers, teachers, coaches, lifeguards, and social workers.
At Health Ed Solutions, we believe the certification process should be enjoyable. Our courses follow the latest recommendations from ILCOR, the American Academy of Pediatrics, and the American Heart Association.
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#IHCAMegacode #InHospitalCardiacArrest #HealthEdSolutions

[@HealthEdSolutions]

Thank you for watching! Please hit the like button if you enjoyed the video lesson. Feel free to leave comments if you have questions or feedback. We will try to answer them as soon as possible. Watch the entire Megacode Series Playlist here: kzbin.info/aero/PLJ5kKhwVxA5LWvUYUzhtZIAFDKFibCiZp Check out these other great lesson playlists from our Channel: 👉 Understanding and Interpreting ABGs: kzbin.info/aero/PLJ5kKhwVxA5J9q3KXz-w5Er6itwzIriMw 👉 One Quick Question Series: kzbin.info/aero/PLJ5kKhwVxA5JBIokh4ddyRWelvnXlRtcQ 👉 ECG Rhythm Review: kzbin.info/aero/PLJ5kKhwVxA5LlDt9S-venJPYWNN7_TSEX Visit our website for 100% online certification courses in ACLS, PALS, NRP, BLS and more. We also offer free practice exams, flash cards, study guides and other free educational materials: 🌍 www.healthedsolutions.com

[@anitak4069]

Watching this at 11pm for my ACLS test in the morning. So easy to understand, thank you!!!

[@HealthEdSolutions]

Thanks for watching! Glad it was helpful :)

[@whynotjustmyusername]

In regards to the patient's allocation after ROSC has been achieved: I would not send them to the ICU. She initially presented with symptoms typical of acute coronary syndrome, making it the most likely reversible cause of cardiac arrrest (which it usually is in adults anyway). She should be routed directly to the catheter lab for emergent PTCA and only after that moved to an ICU. Any desired additional instrumentation, such as an arterial line or central line, can be established still in the ED while waiting for the cathlab to get ready or it can wait until after the intervention. Time is muscle.

[@Drsingh98]

After you see VT on your monitor, next step should be to look for the pulse.

[@srisarvinnair5552]

Same thought and answer, agreed.

[@DonPedroIXIV]

She said it was a pulse less rhythm. So she assumed you already checked for pulse, next step is defibrillate.

[@mekrn7014]

@@DonPedroIXIV She didn't say it was a pulseless rhythm though.

[@stephenviggiano1610]

@@mekrn7014 the proctor literally stated “the patient remains pulseless”. To me, that equals a team member palpating a pulse and not finding one. Rewatch that part of the video.

[@ZManiac88]

@@stephenviggiano1610 that would be true... if she prompted it. she never said it.

[@flightrn66]

As an ACLS and BLS instructor, these are great for students to review before or after a course :)

[@HealthEdSolutions]

Thanks for the awesome feedback!

[@gangotribanerjee9100]

love the megacode series.... keep em coming :)

[@HealthEdSolutions]

Thank you 🙏🏼 More to come!

[@ThePaulaann]

Recertification is tomorrow. Awesome review material.

[@nellyrobi6]

Correction please, when the rhythm is asystole,we give Epinephrine ASAP then resume CPR immediately.

[@yuehhanlin]

Why would we not check for pulse first @1:44? I know the monitor says vfib and they did lose consciousness, but I thought we would at least check for a pulse for min 5 seconds before CPR? Thanks for the clarification.

[@yogeshwaman6054]

In-depth case discussion. Got lots to learn. Thanks 🙏 health Ed solutions for your effort to educate us.

[@HealthEdSolutions]

Appreciate the dedication Yogesh!

[@drmahmoudabdelhameed9345]

Thank you so much very valuable and benefitial

[@TalkingwithChart]

thank you very much.

[@stephenviggiano1610]

Did I miss something or did the anti-arrhythmic get pushed prior to 3rd defib? Understandable that this happens sometimes and usually should not negatively affect the outcome however (unless I’m mistaken on the video’s content) this is a deviation from the simplistic AHA cardiac arrest algorithm; i.e. the simplest form for this reference to be “shock, shock, epi, shock, amio/lido”.

[@InspireNewGeneration]

So with pulseless V-tach & Vfib you can give cycle of epi & amiadrone until stopping CPR?

[@user-hf3wc2qh3p]

If the monitor is showing a vt we should check the central pulse ryt

[@RionPhotography]

My issue with this is that the ACLS algorithm has the drugs being administered during the CPR - a shock always follows CPR if the rhythm is shockable. So which way is it on the test???

[@esther1765]

since defib is q5 cycles of CPR (or 2 min), does that mean CPR at: - 1:40 (before 1st defib) - 2:17 (after 1st, before 2nd defib) - 3:55 (after 2nd defib) ...there were 5 cycles of CPR but the video just didn't mention it? *not trying to be picky, just want clarification because I was confused about the timeline of cpr and defib*

[@ileolabi2801]

You have already given 450 mg of ami. WHY would you do an ami drip after ROSC?

[@yuyhbgiyjk7661]

I completely agree, amidro infusion is not indicated here

[@wafaibrahim369]

Thanks for sharing this amazing scenario ☘️☘️😙😎👍❤️😍💜💋💋💋💋💜💜💋💋💋💋💋

[@edmar7317]

AHA recommends cpr then defib then epi q 3-5 m. If you defib after each cpr for the first 2 cprs, that is already 6 m past and epi still has not been given. perhaps what is good is cpr the defib then cpr then first epi then cpr then defib then cpr then second epi then cpr then defib. that would be the first 5 cpr cycles that would be well organized and structured, with epi being given q 3-5 m. The last ecg @6:23 looks bradycardic, why not atropine 0.5 mg iv, instead of amiodarone?

[@OnyedikachiIbekwe]

I agree with this comment . Will like to see more of the rationale for the answers. Haven’t seen amiodarone given during bradycardia.

[@kylecancilla5483]

Also hasn't the max q24 dose of amio already been given? Is it safe to start a drip?

[@brettrautio6990]

Hi Ed Mar, good questions. Yes guidelines have us administering epi after the 2nd pulse check, it is not necessary to complete a full round of CPR before the first pulse check, early defibrillation is key in VF & pVT. In an ED or ICU with well trained staff this should take no more than a minute to accomplish. Add another 2 minutes for the next pulse check +/- defib, and your time before the first epi should be around 3-4 minutes. Epi is good for ROSC but please read this article for more info www.ncbi.nlm.nih.gov/pmc/articles/PMC6330609/ . The rhythm at 6:23 is NSR. Amiodarone was selected after ROSC due to the initial deterioration into VF. I do not like where this video leaves off however, I would like an EKG since one was not obtained before deterioration to determine whether a STEMI precipitated this, hopefully bringing the pt to cath lab instead of the floor.

[@brettrautio6990]

@@kylecancilla5483 the 450 mg given is well under the max dose of 2.2 g/24hr. 900 mg will be infused with a standard infusion without bolus.

[@esther1765]

@@kylecancilla5483 I agree. The 2020 AHA ACLS Providers Manual states on pg.158, "No evidence supports continued prophylactic administration of antiarrhythmic medications once the patient achieves ROSC." Other things we could consider in Post Cardiac Arrest Care include: - Targeted Temperature Management of 32-36C for 24h - treat hypotension if SBP is below 90mmHg (not applicable here) - titrate O2 when on the ventilator to 92-98% - other things like glucose management, prophylactic antibiotics, neuroprotective agents, or routine use of steroids But again, no mention of amiodarone infusion...

[@ThePineistFox]

I don’t know what any of this means, but it’s interesting

[@dylanbrackeen1536]

At 1:43 why would the answer not be A) attach defibrillator pads? I thought immediate defibrillation was the go to for V-fib?

[@talkswithtaylor5345]

CPR always comes first once a pulse is undetected but someone else should be getting the pads ready asap to put on while the CPR is happening.

[@wafaibrahim369]

💕💕💕💕

[@nyamoitaratemo9130]

2ND dose of amiodarone is 150 or 300mg?

[@LittleMissPharmD]

150

[@esther1765]

300 mg initial, 150 mg bolus

[@cultura6446]

I dont get the last step, amiodarone infusion. can somone explain this to me? what algorhitm is that?

[@rapmantheoneman]

Yes, can someone explain the last recommendation for the amio infusion?

[@andresrodriguez663]

Its in the AHA algorithm. You want to put to put them on a 1 mg/kg infusion over 6 hours

[@Pertygd]

Amiodarone is an antiarrhythmic and slows the sinus heart rate. The rhythm looks to be sinus bradycardia. I would think Atropine 0.5mg IV bolus would be next step. Patient isn't really stable yet. But is Atropine not considered because the BP systolic is over 90mmHg?

[@ShahrulKurtAdam]

Hai, the rhythm after ROSC is Sinus Rhythm. Why Amiodarone? To prevent another cardiac arrhythmia since the patient ECG was 1. Sinus Rhythm with PVC (early sign) 2. Then she went into VF 3. After she went into VT After being given a few meds and shock to maintain the heart in the sinus is with Amiodarone cause we don't want it happening again. Then after we could investigate why does she went into those rhythms in the first place properly. That's my opinion tho.

[@ShahrulKurtAdam]

Yes, the rhythm looks like bradycardia but giving IV Atropine won't help the arrhythmias. Cause later it can cause another arrhythmia. Correct me if I'm wrong.