Since I wrote ACLS part 1 that I took the other day, perhaps I should write about the one that I retook. :)
I went to IMU that day, quite early to find out what time it will be hold and to attend my selective in the hospital that started on the same day. :)
It was a fruitful day, to be able to see my close friends after so long and to be independant (attend forensic apartment by myself) and to attend ACLS with confidence. :)
So this is the question that I got.
Patient came in with breathlessness, chest pain, suddenly went unconscious.
First thing CHECK responsiveness.
patient is not responding
Call for help.
Check pulse. (yay, I remembered!)
Pulse present.
So I said get my stuff to assist ABC by using oxygen mask. set up IV lines, get BP reading, and cardiac monitoring. BP was low. forgot how much..
The cardiac monitor shows 2nd degree type 2 heart block. (morbitz type 2)
I got it correct. :)
and so I said (to be safe) check for perfusion status. But if it's already type 2, the right thing is to start TCP right away. So anyway, perfusion status is poor, with all the symptoms going on and low BP, so I prepare for TCP.
while awaiting TCP, I'll start drug:
atropine 0.5mg every 3 to 5 min
then here's what I made wrong, forgot to check the effect. SO must check rhymtm again and pulse and BP.
it doesn't help
add in epinephrine 2-10microgram/min
or dopamine 2-10microgram/kg per min
check rhytm, the rhtyhm changed to ... shocking.. XD Ventricular tachycardia. (VT)
check pulse
no pulse
start CPR right away, prepare defib.
CPR for 5 cycles. no change, shock patient. 200 (for biphasic) and 360J for monophasic
and then resume CPR, check pulse and rhtyhm
pulse resume
rhymthm changed back to second degree heart block type 2
TCP was ready...
so leave to the professionals for that..
End of story..
that's what I got. :)
hope I pass this. :)
EDITED: passeddd! yay!