Straight A Nursing: Study for nursing school exams & NCLEX · Maureen Osuna, MSN, RN - Nursing school educator, author, and nursing student enthusiast.

ENCORE! #398: Mock Code Blue

·40 min·3 clips

Mr. Williams becomes hypotensive during SVT, requiring synchronized cardioversion to avoid a deadly R-on-T phenomenon.

This episode is a mock code blue simulation led by Nurse Mo from the Straight A Nursing podcast. She guides listeners through a complex resuscitation scenario to review Advanced Cardiac Life Support (ACLS) algorithms. The episode is designed for nursing students and professionals seeking to refresh or practice their emergency response knowledge. The scenario features a fictional patient, Mr. Williams, a 63-year-old male with a history of coronary artery disease and hypertension. He initially presents in supraventricular tachycardia (SVT) with a heart rate of 160 while asymptomatic. The first interventions attempted are vagal maneuvers, followed by administration of adenosine at 6mg and then 12mg via rapid IV push. When Mr. Williams becomes symptomatic with hypotension and chest discomfort, synchronized cardioversion at 50-100 joules is performed. His rhythm converts to sinus rhythm but then deteriorates into pulseless ventricular tachycardia, prompting the initiation of CPR and defibrillation at 200 joules. The algorithm continues with cycles of CPR, subsequent shocks, and administration of medications including epinephrine and amiodarone. After ten minutes, the rhythm changes to asystole, leading to continuous CPR and repeated epinephrine doses. Return of spontaneous circulation (ROSC) is indicated by a rapid rise in end-tidal CO2 to 65mmHg, but the patient is found in third-degree heart block with a heart rate of 41. Transcutaneous pacing is initiated, and after adjusting for capture, Mr. Williams regains consciousness and follows commands. A key insight is the emphasis on performing synchronized cardioversion correctly to avoid triggering ventricular fibrillation via R-on-T phenomenon. The episode clarifies that atropine is ineffective for high-degree heart blocks like third-degree heart block. Nurse Mo explains that end-tidal CO2 readings below 15mmHg during CPR indicate inadequate compressions, while a sudden rise suggests ROSC. The simulation covers the reversible causes of cardiac arrest, known as the H's and T's, including hypoxia and tamponade. A memorable moment is the detailed coaching on ensuring mechanical capture during transcutaneous pacing by correlating QRS complexes with a palpable pulse. The tone is instructional and calm, designed to reduce anxiety around emergency protocols. The style is a step-by-step, interactive simulation where Nurse Mo poses questions to the listener before providing answers. This episode is ideal for nursing students, new nurses, or any clinician preparing for ACLS certification or recertification. Listeners who are not in healthcare or have no interest in clinical emergency procedures would likely find this content too specialized.

As heard by us

A tight ACLS lesson on synchronized cardioversion and the R-on-T risk.

The episode stays tightly on synchronized cardioversion in ACLS. It makes the core point plainly: sync mode has to be turned on by hand, because the device defaults to defibrillation, and a mistimed shock can fall in the refractory period and trigger the R-on-T phenomenon, which…

Read the full review in PlayNext →

Why you'd press play

You want the synchronized cardioversion steps that keep a shock from going sideways.

Read the full recommendation in PlayNext →

Listen to the show on

Apple Podcasts Spotify

Play clips from this episode More from Straight A Nursing: Study for nursing school exams & NCLEX