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MegaCode Simulation • AHA 2026 Guidelines

Code Blue: ACLS Resuscitation Sim

Cardiac Arrest Team Leader, Defibrillation & Reversible Causes Reflex Trainer

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ACLS 2026 MegaCode SimLab

Code Blue: ACLS Resuscitation

Take charge of the hospital crash cart. Analyze telemetry ECG rhythms in real time, differentiate shockable from non-shockable arrest, time 2-minute CPR cycles, and identify reversible H's & T's causes to achieve Return of Spontaneous Circulation (ROSC).

Shockable Rhythms

VF & Pulseless VT. Immediate 200J unsynchronized defibrillation $\to$ 2 min CPR $\to$ Epinephrine $\to$ Amiodarone.

Non-Shockable

Asystole & PEA. Do NOT shock! Immediate CPR, early IV Epinephrine 1mg, and rapid search for 5 H's and 5 T's.

High-Quality CPR

100–120 compressions/min, 5–6 cm depth, allow full chest recoil, minimize interruptions (< 10s), switch compressors every 2 minutes.

Hands-Free Voice Commander (Shout “Shock”, “Push Epi”) Lead II Real-Time Telemetry Monitor 110 BPM Metronome Audio Guide 200J Biphasic Capacitor Discharge
Clinical Reference & Guidelines

AHA ACLS 2026 Cardiac Arrest Management Framework

During a cardiac arrest event, survival depends on rapid rhythm differentiation and high-quality cardiopulmonary resuscitation with minimal interruptions:

Shockable Path: VF & Pulseless VT

Defib 200J
  1. Deliver Shock 1 (200J Biphasic): Do not pause for pulse checks immediately post-shock.
  2. Resume CPR immediately for 2 minutes. Establish IV/IO access.
  3. Shock 2: If rhythm persists $\to$ Deliver 2nd Shock $\to$ Resume CPR $\to$ Epinephrine 1mg IV every 3–5 min.
  4. Shock 3: If rhythm persists $\to$ Deliver 3rd Shock $\to$ Resume CPR $\to$ Amiodarone 300mg IV (or Lidocaine 1–1.5 mg/kg). Second dose Amiodarone is 150mg.

Non-Shockable Path: Asystole & PEA

DO NOT SHOCK
  1. Immediate CPR for 2 minutes: Prioritize continuous compressions and bag-mask ventilation.
  2. Early Epinephrine 1mg IV Push: Give as soon as possible after establishing IV/IO access.
  3. Investigate the 5 H's and 5 T's: PEA always has an underlying cause. Reversing the cause is the only way to achieve ROSC.
  4. Re-evaluate rhythm every 2 minutes: If organized rhythm appears, check carotid pulse. If pulse is palpable $\to$ ROSC!

Reversible Causes: The 5 H's and 5 T's

High-yield clinical triggers and emergency corrective actions for NextGen NCLEX-RN and ACLS certification:

Hypovolemia: Most common cause of PEA arrest. Treat with rapid crystalloid boluses and blood products (1:1:1 protocol).
Hypoxia: Cyanosis, low SpO2 prior to arrest. Provide 100% FiO2 and ensure patent endotracheal tube placement.
Hydrogen Ion (Acidosis): Severe DKA, sepsis. Ensure adequate tidal volume; consider sodium bicarbonate in toxic/severe acidotic arrest.
Hyperkalemia / Hypokalemia: Peaked T-waves, missed dialysis. Give Calcium Gluconate/Chloride IV for hyperkalemia.
Hypothermia: Patient cold to touch. Active rewarming; defibrillation is often unsuccessful until core temp > 30°C.
Tension Pneumothorax: Tracheal deviation, absent breath sounds, high ventilator pressures. Immediate needle decompression!
Tamponade (Cardiac): Beck's triad (hypotension, JVD, muffled heart sounds). Immediate emergency pericardiocentesis.
Toxins: Opioids (Naloxone), Tricyclics (Bicarbonate), Beta-blockers (Glucagon), Local anesthetics (Lipid emulsion).
Thrombosis (Pulmonary - PE): Sudden collapse, right heart strain, high D-dimer. Give systemic thrombolytics (Alteplase/tPA).
Thrombosis (Coronary - STEMI): Sudden cardiac death. Ongoing mechanical CPR $\to$ transfer to cardiac catheterization lab for emergent PCI.

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