MEGACODE BLUE SIMULATION
Comprehensive Student Script and Guide
SCENARIO TITLE
Adult Cardiac Arrest Secondary to Acute Myocardial
Infarction
OVERVIEW OF THE SIMULATION
This MegaCode simulation is designed to train students in the management
of an adult patient experiencing cardiac arrest. The simulation focuses on
the application of Basic Life Support (BLS) and Advanced Cardiovascular Life
Support (ACLS) principles.
The simulation emphasizes:
High-quality CPR
Team coordination
Leadership during emergencies
Closed-loop communication
Defibrillation safety
Proper medication administration
Airway management
Documentation and timekeeping
The simulation is intended to mimic an actual hospital Code Blue scenario.
LEARNING OBJECTIVES
At the end of the simulation, students should be able to:
1. Recognize signs of cardiac arrest.
2. Activate the Code Blue system appropriately.
3. Demonstrate proper high-quality CPR.
4. Identify shockable and non-shockable rhythms.
5. Safely perform defibrillation.
6. Demonstrate proper airway management.
7. Administer ACLS medications correctly.
8. Utilize effective teamwork and communication.
9. Document all events accurately.
10. Perform post-ROSC management.
TEAM MEMBERS AND RESPONSIBILITIES
ROLE RESPONSIBILITIES
Physician – Team Captain Leads the code, interprets rhythm,
gives orders
Physician – Intubation Performs airway management and
intubation
Nurse – Ambu Bagging Provides ventilation using BVM
Nurse – CPR 1 Performs chest compressions
Nurse – CPR 2 Relieves compressor every 2
minutes
Nurse – CPR 3 Assists CPR rotation and prepares
backboard
Nurse – Defibrillator Operates monitor/defibrillator and
delivers shock
Nurse – Medication Prepares and administers
emergency medications
Nurse – Documentation/Timekeeper Records interventions and
announces timing
Patient Simulated patient/manikin
EQUIPMENT NEEDED
Hospital bed or stretcher
CPR board/backboard
Defibrillator/monitor
Defibrillator pads
Bag-valve-mask (BVM)
Oxygen source
Suction machine
Intubation set
ET tube
Laryngoscope
IV line and fluids
Emergency medications:
o Epinephrine
o Amiodarone
Clock/timer
Documentation sheet
PATIENT BACKGROUND
Patient Information
Name: Juan Dela Cruz Age: 58 years old Sex: Male Chief Complaint: Severe
chest pain and shortness of breath
History:
Hypertension
Smoker
Type 2 Diabetes Mellitus
Initial Vital Signs:
BP: 90/60 mmHg
HR: 120 bpm
RR: 28 breaths/min
SpO2: 88%
The patient suddenly becomes unresponsive during assessment.
MEGACODE SCRIPT FLOW
SCENE 1 – INITIAL ASSESSMENT
PATIENT
(Complains of severe chest pain)
“Ang sakit ng dibdib ko…”
(Patient suddenly collapses.)
PRIMARY NURSE
“Sir? Sir? Can you hear me?”
(Checks responsiveness.)
“Patient is unresponsive!”
(Checks carotid pulse for 5–10 seconds.)
“No pulse detected!”
(Checks breathing.)
“Patient is not breathing!”
“CALL CODE BLUE!”
SCENE 2 – CODE BLUE ACTIVATION
DOCUMENTATION NURSE
“Code Blue activated at 9:00 AM.”
TEAM CAPTAIN ARRIVES
“What happened?”
PRIMARY NURSE
“58-year-old male, sudden collapse, pulseless and apneic.”
TEAM CAPTAIN
“Start high-quality CPR immediately.” “Attach monitor and defibrillator.”
“Prepare Ambu bag with oxygen.” “Establish IV access.”
SCENE 3 – HIGH-QUALITY CPR
CPR NURSE 1
(Starts chest compressions.)
“Starting compressions.”
Compression standards:
Rate: 100–120/minute
Depth: at least 2 inches
Allow full recoil
Minimize interruptions
AMBU BAGGING NURSE
(Uses BVM.)
“Providing ventilation with Ambu bag.”
Before intubation:
30 compressions : 2 breaths
CPR NURSE 3
“Backboard placed.”
SCENE 4 – RHYTHM IDENTIFICATION
(After 2 minutes.)
DOCUMENTATION NURSE
“2 minutes completed.”
TEAM CAPTAIN
“Pause CPR for rhythm check.”
DEFIBRILLATOR NURSE
“Rhythm shows Ventricular Fibrillation.”
TEAM CAPTAIN
“Ventricular Fibrillation confirmed.” “Prepare for defibrillation.” “Charge to
200 joules biphasic.”
SCENE 5 – FIRST DEFIBRILLATION
DEFIBRILLATOR NURSE
“Charging defibrillator to 200 joules.”
(Defibrillator charges.)
“Charged and ready.”
TEAM CAPTAIN
“Everybody clear!”
DEFIBRILLATOR NURSE
“Clear from the patient!”
(Checks surroundings.)
“CLEAR!”
(Shock delivered.)
“Shock delivered.”
TEAM CAPTAIN
“Resume CPR immediately.”
SCENE 6 – MEDICATION ADMINISTRATION
TEAM CAPTAIN
“Prepare Epinephrine 1 mg IV push.”
MEDICATION NURSE
“Preparing Epinephrine 1 mg IV push.”
(Administers medication.)
“Epinephrine 1 mg IV push administered.”
DOCUMENTATION NURSE
“Epinephrine given at 9:03 AM.”
SCENE 7 – CPR ROTATION
DOCUMENTATION NURSE
“2 minutes completed. Rotate compressors.”
CPR NURSE 2
“Takes over chest compressions.”
TEAM CAPTAIN
“Ensure minimal interruption during switching.”
SCENE 8 – AIRWAY MANAGEMENT
TEAM CAPTAIN
“Prepare for intubation.”
INTUBATION PHYSICIAN
“Preparing ET tube, laryngoscope, and suction.”
(Performs intubation.)
“Tube inserted.”
AMBU BAGGING NURSE
“Chest rise observed.”
INTUBATION PHYSICIAN
“Bilateral breath sounds confirmed.” “Tube secured.”
TEAM CAPTAIN
“Continue ventilation at 1 breath every 6 seconds.”
SCENE 9 – SECOND RHYTHM CHECK
DOCUMENTATION NURSE
“2 minutes completed.”
TEAM CAPTAIN
“Pause CPR for rhythm check.”
DEFIBRILLATOR NURSE
“Still Ventricular Fibrillation.”
TEAM CAPTAIN
“Prepare second shock.” “Charge to 200 joules.”
SCENE 10 – SECOND DEFIBRILLATION
DEFIBRILLATOR NURSE
“Charging.”
“Charged and ready.”
TEAM CAPTAIN
“Everybody clear!”
DEFIBRILLATOR NURSE
“CLEAR!”
(Shock delivered.)
“Shock delivered.”
TEAM CAPTAIN
“Resume CPR immediately.”
SCENE 11 – ANTIARRHYTHMIC
ADMINISTRATION
TEAM CAPTAIN
“Prepare Amiodarone 300 mg IV push.”
MEDICATION NURSE
“Preparing Amiodarone 300 mg IV push.”
(Administers medication.)
“Amiodarone 300 mg IV push administered.”
DOCUMENTATION NURSE
“Amiodarone administered at 9:07 AM.”
SCENE 12 – RETURN OF SPONTANEOUS
CIRCULATION (ROSC)
DOCUMENTATION NURSE
“2 minutes completed.”
TEAM CAPTAIN
“Pause CPR. Rhythm check.”
DEFIBRILLATOR NURSE
“Sinus rhythm noted.”
TEAM CAPTAIN
“Check pulse.”
CPR NURSE
“Pulse present.”
TEAM CAPTAIN
“We have ROSC.”
SCENE 13 – POST-ROSC MANAGEMENT
TEAM CAPTAIN
“Continue oxygenation.” “Monitor vital signs.” “Maintain IV fluids.” “Prepare
patient for ICU transfer.” “Obtain 12-lead ECG.”
DOCUMENTATION NURSE
“ROSC achieved at 9:10 AM.”
SAMPLE CLOSED-LOOP COMMUNICATION
TEAM CAPTAIN
“Give Epinephrine 1 mg IV push.”
MEDICATION NURSE
“Epinephrine 1 mg IV push.”
(Administers medication.)
“Epinephrine 1 mg IV push given.”
COMMON CARDIAC RHYTHMS
SHOCKABL
RHYTHM E
Ventricular Fibrillation YES
Pulseless Ventricular YES
Tachycardia
Asystole NO
SHOCKABL
RHYTHM E
Pulseless Electrical Activity NO
HIGH-QUALITY CPR CHECKLIST
Compression rate: 100–120/minute
Compression depth: at least 2 inches
Full chest recoil
Minimize interruptions
Rotate compressors every 2 minutes
Avoid excessive ventilation
DEFIBRILLATION SAFETY CHECKLIST
Before shocking:
1. Ensure nobody is touching the patient.
2. Remove oxygen away from chest area.
3. Loudly announce “CLEAR.”
4. Visually confirm safety.
5. Deliver shock.
COMMON ERRORS TO AVOID
Delayed CPR initiation
Long interruptions in compressions
Failure to rotate compressors
Poor communication
Forgetting to resume CPR immediately after shock
Incorrect medication timing
Unsafe defibrillation practices