Megacode 3

Question 1

You are called by a nursing student because a patient's heart rate is 44 bpm. You will respond immediately, but which of the following facts about the patient would make you feel the most encouraged?

He runs three marathons each year
His normal heart rate, verified on admission, is 88 beats per minute
He was hospitalized for a gastrointestinal bleed
The nursing student manually checked the pulse and got 50 beats per minute

When you enter the room, you find that the patient is an elderly gentleman and presumably not an elite athlete. He is lying on his back and said that he has felt funny for about an hour. He reports some dizziness and some mild chest pain. He almost fell while going to the bathroom. The nursing student adds that he has high blood pressure and is on a beta-blocker. What do you suspect is happening to this patient?

Symptomatic bradycardia with adequate perfusion
Symptomatic bradycardia with poor perfusion
Physiological bradycardia
The heart monitor is inaccurate

You measure the patient's blood pressure and find him to be hypotensive. His blood pressure is 85/55 mm Hg. The nursing student adds that his normal pressure is approximately 140/90 mm Hg. Pulse oximetry reveals an oxygen saturation of 91%. What is the next action?

Provide supplemental oxygen
Retrieve AED
Apply transcutaneous pacing
Begin acute stroke workup

You apply supplemental oxygen via nasal cannula and send someone to retrieve a 12-lead ECG. In the meantime, you decide to treat the symptomatic bradycardia with poor perfusion. What treatment will you choose first?

Transcutaneous pacing
Atropine 0.5 mg bolus IV once
Atropine 1 mg bolus IV once
Epinephrine 1 mg bolus IV once

Another staff member is applying the ECG leads, but it has been about 3 minutes since the first dose of atropine was given. The patient's heart rate initially increased to 60 bpm but now is at 50 bpm. You decide to administer another dose of atropine. What dose will you give?

Atropine 0.5 mg bolus IV once
Atropine 1 mg bolus IV once
Atropine 3 mg bolus IV once
Continuous atropine IV infusion at 2 micrograms per minute

You obtain a 12-lead ECG and there is ST-segment elevation in leads II, III, and aVF. What is your next action?

Continue to treat the bradycardia with atropine
Obtain another ECG to be sure of first reading
Apply transcutaneous pacing
Switch to Acute Coronary Syndrome pathway

You confirm that the patient has no known drug allergies. Since you now suspect a myocardial infarction, what is your next action?

Give 325 mg aspirin orally, asking him to chew it
Notify staff for immediate reperfusion therapy
Draw blood for various labs (cardiac enzymes, electrolytes, coagulation panel)
All of the above

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