Megacode 1

Question 1

You witness a middle-aged, obese male pedestrian collapse on an escalator in an airport. He is clutching his chest and slumps over on the person behind him. The bystander places him on the floor at the end of the down-moving escalator track. As a first responder certified in ACLS, which of the following is your first course of action?

Move the man out of the way of pedestrian traffic on the escalator
Stabilize the man’s cervical spine
Check for a pulse
Begin high-quality CPR

You have moved the man to a seating area near the bottom of the escalator. The man is gasping for breath but does not appear to be effectively breathing. You yell at him "Are you alright?" but he does not respond. What is your next action?

Begin high-quality CPR
Send someone to get an AED device
Check for a pulse
Secure the cervical spine

After sending for EMS and waiting for an AED to arrive, you continue to attend to the man. The man is unresponsive and he is now only gasping. What is your next action?

Begin high-quality CPR
Obtain IV or IO access
Check for a pulse
Count his breaths per minute

You find a definite pulse on his carotid artery. It is fast, but clearly present. What is your next action?

Begin high-quality CPR (30 compressions and 2 breaths)
Give one breath every 5-6 seconds
Check for a pulse in the other carotid or in the radial artery
Apply "watchful waiting" since the AED device will arrive soon.

The AED device has not yet arrived. You have been delivering breaths for two minutes, spaced 5-6 seconds apart. He is not breathing spontaneously. What is your next action?

Check for a pulse
Continue giving one breath every 5-6 seconds until the AED or EMS arrives
Apply "watchful waiting" since the AED device will arrive soon
Begin high-quality CPR until the AED arrives

You pause rescue breathing to check for a pulse. You cannot feel a definite pulse after 10 seconds of trying. What is your next action?

Continue checking for a pulse for 10 more seconds because you may have missed it
Check to see if the patient is breathing normally
Apply "watchful waiting" since the AED device will arrive soon
Begin chest compressions

You start high-quality CPR at a rate of 100-120 compressions per minute. The AED arrives moments later. You open the man's shirt to find a copious amount of thick hair covering his chest and he is damp with sweat. The AED cannot get a good signal through the pads because of the hair, even though you have pressed them down very hard. What is your next action?

Do not use the AED and wait for EMS to bring better equipment
Find a razor and neatly shave the man's chest hair
Rip the pads off the man's chest and apply new pads in the same locations
Apply the pads to less hairy portions of the body (e.g. inner arm and neck)

With hair removed and new pads placed, the AED gets a good signal from the patient. It reports that there is a shockable rhythm. You clear everyone from the patient, announce the shock, and then deliver one shock. What is your next action?

Immediately check to see if another shock is needed; one is usually not enough
Resume high-quality CPR immediately
Check the carotid artery for a pulse
Turn up the voltage for a second shock

After two minutes of CPR, what is your next action?

Activate EMS again; clearly the first call has failed
Maximize voltage for a third shock
Check for a pulse
Resume high-quality CPR immediately

The man has a strong, regular pulse. He is not responsive, but appears to be breathing. You feel air movement through his mouth. What is your next action?

Resume high-quality CPR for two additional minutes
Deliver breaths every 5-6 seconds
Continue to monitor pulse, breathing, and rhythm until EMS arrives
Take off AED pads awaiting EMS arrival

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