`

MEGACODE TESTING CHECKLIST 8

Bradycardia → Pulseless VT → PEA → PCAC

Name: ______________________________ Section: __________ Date: ____________ Rating: __________ Remarks: ___________

Critical Performance Steps Weight Check if done correctly

Team Leader
Ensures high-quality CPR at all times 5
Assigns team member roles 5
Ensures that team members perform well 5
Bradycardia Management
Starts oxygen if needed, places monitor, starts IV 6
Places monitor leads in proper position 3
Recognizes symptomatic bradycardia 10
Administers correct dose of atropine 10
Prepares for second-line treatment 5
Pulseless VT Management
Recognizes pVT 10
Clears before analyze and shock 3
Immediately resumes CPR after shocks 5
Appropriate airway management 5
Appropriate cycles of drug-rhythm check/shock-CPR 5
Administers appropriate drug(s) and doses 10
PEA Management
Recognizes PEA 10
Verbalizes potential reversible causes of asystole/PEA (H’s and T’s) 10
Administers appropriate drug(s) and doses 10
Immediately resumes CPR after rhythm and pulse checks 5
Post-Cardiac Arrest Care
Identifies ROSC 10
Ensures BP and 12 lead ECG are performed, O2 saturation is monitored, verbalizes need 5
for endotracheal intubation and waveform capnography, and orders laboratory tests
Considers targeted temperature management 10
Total 142
Comments:
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
Remediation (if needed):
Instructor’s Signature:_________________________________ Instructor’s Signature:__________________________
Print Instructor’s Name:_______________________________ Print Instructor’s Name:________________________
Date:______________________________________________ Date:_______________________________________
• A check mark (✓) will be indicated if the management/procedure was successfully performed.
• If the grade is below 90% but not less than 75% there will be a remediation after the student reviewed the Critical Performance Steps
but the initial grade will be recorded. If the grade is below 75%, remediation will be done and the score that can only be obtained after
passing the remediation is 75%.
• If the remediation is to be schedule, the instructor will collect this sheet before the student leaves the laboratory.
• Instructor’s signature affirms that skills tests were done according to the current AHA Guidelines

Adapted and modified from the American Heart Association ACLS Provider Manual 2015
 MEGACODE TESTING CHECKLIST 12
Bradycardia → VF → Asystole → PCAC

Name: ______________________________ Section: __________ Date: ____________ Rating: __________ Remarks: __________
_
Critical Performance Steps Weight Check if done
correctly
Team Leader
Ensures high-quality CPR at all times 5
Assigns team member roles 5
Ensures that team members perform well 5
Bradycardia Management
Starts oxygen if needed, places monitor, starts IV 6
Places monitor leads in proper position 3
Recognizes symptomatic bradycardia 10
Administers correct dose of atropine 10
Prepares for second-line treatment 5
VF Management
Recognizes VF 10
Clears before analyze and shock 3
Immediately resumes CPR after shocks 5
Appropriate airway management 5
Appropriate cycles of drug rhythm check/ shock-CPR 5
Administers appropriate drug(s) and doses 10
Asystole and PEA Management
Recognizes asystole and PEA 10
Verbalizes potential reversible causes of asystole (H’s and T’s) 10
Administers appropriate drug(s) and doses 10
Immediately resumes CPR after rhythm and pulse checks 5
Post-Cardiac Arrest Care
Identifies ROSC 10
Ensures BP and 12 lead ECG are performed, O2 saturation is monitored, verbalizes need 5
for endotracheal intubation and waveform capnography, and orders laboratory tests
Considers targeted temperature management 10
Total 147
Comments:
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
Remediation (if needed):
Instructor’s Signature:________________________________ Instructor’s Signature:__________________________
Print Instructor’s Name:_______________________________ Print Instructor’s Name:________________________
Date:______________________________________________ Date:_______________________________________
• A check mark (✓) will be indicated if the management/procedure was successfully performed.
• If the grade is below 90% but not less than 75% there will be a remediation after the student reviewed the Critical Performance
Steps but the initial grade will be recorded. If the grade is below 75%, remediation will be done and the score that can only be
obtained after passing the remediation is 75%.
• If the remediation is to be schedule, the instructor will collect this sheet before the student leaves the laboratory.
• Instructor’s signature affirms that skills tests were done according to the current AHA Guidelines

Adapted and modified from the American Heart Association ACLS Provider Manual 2015
 MEGACODE TESTING CHECKLIST 7/10
Tachycardia → VF → PEA → PCAC

Name: ______________________________ Section: __________ Date: ____________ Rating: __________ Remarks: ___________

Critical Performance Steps Weight Check if done

correctly
Team Leader
Ensures high-quality CPR at all times 5
Assigns team member roles 5
Ensures that team members perform well 5
Tachycardia Management
Starts oxygen if needed, places monitor, starts IV 8
Places monitor leads in proper position 3
Recognizes unstable tachycardia 10
Recognizes symptoms due to gunshot wound 5
VF Management
Recognizes VF 10
Clears before analyze and shock 3
Immediately resumes CPR after shocks 5
Appropriate airway management 5
Appropriate cycles of drug-rhythm check/shock-CPR 5
Administers appropriate drug(s) and doses 10
PEA Management
Recognizes PEA 10
Verbalizes potential reversible causes of PEA/asystole (H’s and T’s) 10
Administers appropriate drug(s) and doses 10
Immediately resumes CPR after rhythm and pulse checks 5
Post-Cardiac Arrest Care
Identifies ROSC 10
Ensures BP and 12 lead ECG are performed, O2 saturation is monitored, verbalizes need 5
for endotracheal intubation and waveform capnography, and orders laboratory tests
Considers targeted temperature management 10
Total 139
Comments:
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
Remediation (if needed):
Instructor’s Signature:________________________________ Instructor’s Signature:__________________________
Print Instructor’s Name:_______________________________ Print Instructor’s Name:________________________
Date:______________________________________________ Date:_______________________________________
• A check mark (✓) will be indicated if the management/procedure was successfully performed.
• If the grade is below 90% but not less than 75% there will be a remediation after the student reviewed the Critical Performance
Steps but the initial grade will be recorded. If the grade is below 75%, remediation will be done and the score that can only be
obtained after passing the remediation is 75%.
• If the remediation is to be schedule, the instructor will collect this sheet before the student leaves the laboratory.
• Instructor’s signature affirms that skills tests were done according to the current AHA Guidelines

Adapted and modified from the American Heart Association ACLS Provider Manual 2015
 MEGACODE TESTING CHECKLIST 5
Bradycardia → VF → Asystole → PCAC

Name: ______________________________ Section: __________ Date: ____________ Rating: __________ Remarks: ___________

Critical Performance Steps Weight Check if done

correctly
Team Leader
Ensures high-quality CPR at all times 5
Assigns team member roles 5
Ensures that team members perform well 5
Bradycardia Management
Starts oxygen if needed, places monitor, starts IV 6
Places monitor leads in proper position 3
Recognizes symptomatic bradycardia 10
Administers correct dose of atropine 10
Prepares for second-line treatment 5
VF Management
Recognizes VF 10
Clears before analyze and shock 3
Immediately resumes CPR after shocks 5
Appropriate airway management 5
Appropriate cycles of drug rhythm check/shock-CPR 5
Administers appropriate drug(s) and doses 10
Asystole Management
Recognizes asystole 10
Verbalizes potential reversible causes of asystole (H’s and T’s) 10
Administers appropriate drug(s) and doses 10
Immediately resumes CPR after rhythm checks 5
Post-Cardiac Arrest Care
Identifies ROSC 10
Ensures BP and 12 lead ECG are performed, O2 saturation is monitored, verbalizes need 5
for endotracheal intubation and waveform capnography, and orders laboratory tests
Considers targeted temperature management 10
Total 147
Comments:
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
Remediation (if needed):
Instructor’s Signature:________________________________ Instructor’s Signature:__________________________
Print Instructor’s Name:_______________________________ Print Instructor’s Name:________________________
Date:______________________________________________ Date:_______________________________________
• A check mark (✓) will be indicated if the management/procedure was successfully performed.
• If the grade is below 90% but not less than 75% there will be a remediation after the student reviewed the Critical Performance
Steps but the initial grade will be recorded. If the grade is below 75%, remediation will be done and the score that can only be
obtained after passing the remediation is 75%.
• If the remediation is to be schedule, the instructor will collect this sheet before the student leaves the laboratory.
• Instructor’s signature affirms that skills tests were done according to the current AHA Guidelines

Adapted and modified from the American Heart Association ACLS Provider Manual 2015
 MEGACODE TESTING CHECKLIST 6/11
Bradycardia → VF → PEA → PCAC

Name: ______________________________ Section: __________ Date: ____________ Rating: __________ Remarks: ___________

Critical Performance Steps Weight Check if done

correctly
Team Leader
Ensures high-quality CPR at all times 5
Assigns team member roles 5
Ensures that team members perform well 5
Bradycardia Management
Starts oxygen if needed, places monitor, starts IV 6
Places monitor leads in proper position 3
Recognizes symptomatic bradycardia 10
Administers correct dose of atropine 10
Prepares for second-line treatment 5
VF Management
Recognizes VF 10
Clears before analyze and shock 3
Immediately resumes CPR after shocks 5
Appropriate airway management 5
Appropriate cycles of drug rhythm check/ shock-CPR 5
Administers appropriate drug(s) and doses 10
PEA Management
Recognizes PEA 10
Verbalizes potential reversible causes of PEA (H’s and T’s) 10
Administers appropriate drug(s) and doses 10
Immediately resumes CPR after rhythm and pulse checks 5
Post-Cardiac Arrest Care
Identifies ROSC 10
Ensures BP and 12 lead ECG are performed, O2 saturation is monitored, verbalizes need 5
for endotracheal intubation and waveform capnography, and orders laboratory tests
Considers targeted temperature management 10
Total 147
Comments:
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
Remediation (if needed):
Instructor’s Signature:________________________________ Instructor’s Signature:__________________________
Print Instructor’s Name:_______________________________ Print Instructor’s Name:________________________
Date:______________________________________________ Date:_______________________________________
• A check mark (✓) will be indicated if the management/procedure was successfully performed.
• If the grade is below 90% but not less than 75% there will be a remediation after the student reviewed the Critical Performance
Steps but the initial grade will be recorded. If the grade is below 75%, remediation will be done and the score that can only be
obtained after passing the remediation is 75%.
• If the remediation is to be schedule, the instructor will collect this sheet before the student leaves the laboratory.
• Instructor’s signature affirms that skills tests were done according to the current AHA Guidelines

Adapted and modified from the American Heart Association ACLS Provider Manual 2015
 MEGACODE TESTING CHECKLIST 9
Tachycardia → PEA → VF → PCAC

Name: ______________________________ Section: __________ Date: ____________ Rating: __________ Remarks: ___________

Critical Performance Steps Weight Check if done

correctly
Team Leader
Ensures high-quality CPR at all times 5
Assigns team member roles 5
Ensures that team members perform well 5
Tachycardia Management
Starts oxygen if needed, places monitor, starts IV 8
Places monitor leads in proper position 3
Recognizes unstable tachycardia 10
Recognizes symptoms due to tachycardia 5
Performs immediate synchronized cardioversion 10
PEA Management
Recognizes PEA 10
Verbalizes potential reversible causes of PEA (H’s and T’s) 3
Administers appropriate drug(s) and doses 10
Immediately resumes CPR after rhythm and pulse checks 5
VF Management
Recognizes VF 10
Clears before analyze and shock 3
Immediately resumes CPR after shocks 5
Appropriate airway management 5
Appropriate cycles of drug rhythm check/ shock-CPR 5
Administers appropriate drug(s) and doses 10
Post-Cardiac Arrest Care
Identifies ROSC 10
Ensures BP and 12 lead ECG are performed, O2 saturation is monitored, verbalizes need 5
for endotracheal intubation and waveform capnography, and orders laboratory tests
Considers targeted temperature management 10
Total 142
Comments:
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
Remediation (if needed):
Instructor’s Signature:________________________________ Instructor’s Signature:__________________________
Print Instructor’s Name:_______________________________ Print Instructor’s Name:________________________
Date:______________________________________________ Date:_______________________________________
• A check mark (✓) will be indicated if the management/procedure was successfully performed.
• If the grade is below 90% but not less than 75% there will be a remediation after the student reviewed the Critical Performance
Steps but the initial grade will be recorded. If the grade is below 75%, remediation will be done and the score that can only be
obtained after passing the remediation is 75%.
• If the remediation is to be schedule, the instructor will collect this sheet before the student leaves the laboratory.
• Instructor’s signature affirms that skills tests were done according to the current AHA Guidelines

Adapted and modified from the American Heart Association ACLS Provider Manual 2015