Paramedic Mega Code

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ACLS Mega Codes for Paramedics

The paramedic mega code is a simulation exercise used to assess the competency of paramedics in advanced cardiac life support (ACLS). This exercise involves a simulated cardiac emergency scenario, where the paramedic must demonstrate their knowledge and skills in the assessment, diagnosis, and treatment of life-threatening cardiac arrhythmias. 

RELATED: ACLS Certification for Your Medical Team with Medical ProCerts

Scenarios in which paramedics use mega code:

Cardiac arrest: 

This scenario involves a patient who is in cardiac arrest and requires immediate intervention to restore circulation and prevent brain damage.

Ventricular fibrillation: 

This is a life-threatening cardiac arrhythmia that requires prompt defibrillation to restore the heart’s normal rhythm.

Pulseless ventricular tachycardia: 

This is a fast and regular rhythm that can lead to ineffective contractions of the heart. It can progress to ventricular fibrillation if not treated promptly, making defibrillation a critical intervention.

Mega codes help paramedics prepare for emergency situations.

RELATED: How to Renew Your ACLS Certification

Cardiac Arrest Mega Code Scenario:

Scenario: A 55-year-old male patient presents with severe chest pain and shortness of breath. The patient is pale and diaphoretic, with a blood pressure of 90/60 mmHg, pulse rate of 120 beats per minute, and respiratory rate of 22 breaths per minute. The patient suddenly becomes unresponsive, pulseless, and apneic while on the ambulance stretcher.

Step 1: Quickly assess the patient for responsiveness, breathing, and pulse.

Step 2: Simultaneously, direct a team member to call for backup and activate the emergency response system.

Step 3: Start high-quality CPR at a rate of 100-120 compressions per minute, ensuring adequate depth (2-2.4 inches) and full chest recoil.

Step 4: Apply the defibrillator pads and assess the patient’s cardiac rhythm.

Step 5: If ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT) is identified, deliver a shock at 200 joules (monophasic) or 120-200 joules (biphasic).

Step 6: Immediately resume CPR for two minutes, focusing on compressions, airway management, and assisted ventilations.

Step 7: Re-assess the patient’s cardiac rhythm and pulse. If the patient remains in VF/VT, deliver another shock and continue CPR. If the patient has a return of spontaneous circulation (ROSC), proceed with post-cardiac arrest care.

Step 8: Administer intravenous or intraosseous epinephrine (1 mg) every 3-5 minutes during CPR, and consider advanced airway placement.

Step 9: If the patient remains in VF/VT after the second shock, administer an antiarrhythmic such as amiodarone (300 mg IV/IO) or lidocaine (1-1.5 mg/kg IV/IO).

Step 10: Continue cycles of CPR, rhythm checks, defibrillation, and medication administration until ROSC is achieved or the patient is pronounced dead.

Throughout the scenario, the paramedic should also communicate effectively with the team, assign roles, and ensure proper documentation.

RELATED: Understanding Advanced Algorithms for the Treatment of Ventricular Fibrillation


Mega code is an essential part of paramedic training

The paramedic mega code is an essential part of ACLS training, as it helps assess the competency of paramedics in emergency situations. By simulating real-life scenarios, paramedics can demonstrate their ability to provide appropriate and effective interventions and improve patient outcomes.

RELATED: The Latest ACLS Guidelines and How to Implement Them in Your Practice

Where can paramedics go to get ACLS training?

Medical ProCerts offers an online ACLS certification course that covers the latest interventions and protocols for ACLS, including an exam that includes paramedic mega code assessment. Our courses are designed to help healthcare providers improve their knowledge and skills in emergency medicine and critical care and meet the continuing education requirements for ACLS certification. By completing our course, paramedics can be better prepared for the paramedic mega code assessment and provide the best possible care to their patients.

Learn more and sign up today at

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