Cardiac Arrest Flashcards
Defib settings
Zoll: 120J, 150J, 200J
Lifepack: 200J, 300J, 360J
What will ETC02 tell you in a cardiac arrest
- Higher ETC02: higher cardiac output (good CPR)
-Lower etco2: change compressors or improve CPR quality - etco2 decreasing: observe for chest compressor fatigue, hyperventilation, airway obstruction, or tracheal tube displacement.
- etco2 increasing: CPR is likely effective and ventilation appropriate; substantial rise can indicate ROSC.
What does ETC02 mean at the 20 min mark of CPR
etco2 levels < 10 mm Hg associated with futility (exceptions include hypothermia)
etco2 levels > 25 mm Hg associated with survival
Signs of a ROSC
SIGNS OF ROSC:
- Sudden increase in ETCO2
- Spontaneous respirations
- Palpable pulses
- Change in colour
- Spontaneous movement
Medical TOR conditions
Age 16+
LOA altered
Other
Arrest not witnessed by paramedics AND
No defib delivered AND
No ROSC in 20 mins of resuscitation
Medical TOR contraindications
- known reversible cause of the arrest unable to be addressed
- pregnancy presumably over 20 weeks gestation
- suspected hypothermia
- airway obstruction
- non-opioid drug overdose/toxicology
Trauma TOR conditions
16+ year old
LOA altered
HR 0
RR 0
No palpable pulses AND no defib delivered AND rhythm asystole AND no signs of life any time since fully extricated with the closest ED more or equal to 30 mins away OR rhythm PEA with the closest ED more or equal to 30 mins away
Trauma TOR contraindications
- Age <16 years
- Defibrillation delivered
- Signs of life after extricated
- Rhythm PEA and closest ED <30 mins away
- Pt’s with penetrating trauma to the torso or head/neck and lead trauma hospital <30 mins away
What must a paramedic do upon obtaining a valid MOH DNR Confirmation Form and determining the patient is in respiratory or cardiac arrest?
The paramedic shall not initiate CPR if respirations and pulse are absent for at least three minutes.
When must a paramedic initiate CPR despite a valid MOH DNR Confirmation Form?
CPR must be initiated if:
• The patient is capable and clearly expresses a wish to be resuscitated.
• The patient’s wishes are unclear due to vague, incomplete, or ambiguous documentation.
What care must paramedics provide to patients with a valid DNR?
Paramedics must provide patient management to alleviate pain or provide comfort based on the patient’s clinical condition.
What steps must a paramedic follow after determining death?
- Advise the CACC/ACS.
- Follow the Deceased Patient Standard.
- Document the time of death.
What information is required for a DNR Confirmation Form to be valid?
- Patient’s name (first and last).
- Checkbox indicating either:
• A treatment plan excludes CPR.
• CPR is unlikely to benefit the patient. - Professional designation of the signer (M.D., R.P.N., R.N., or R.N. EC).
- Name and signature of the professional.
- Date the form was signed.
- Checkbox indicating either:
What interventions are included in CPR as per the DNR standard?
• Chest compressions
• Defibrillation
• Artificial ventilation
• Airway insertion (e.g., oropharyngeal, endotracheal)
• Transcutaneous pacing
• Administration of advanced drugs (e.g., vasopressors, antiarrhythmics)
When should a paramedic contact the CACC/ACS under the DNR Standard?
After determining the patient is deceased, the paramedic must notify the CACC/ACS as part of following the Deceased Patient Standard.
Can a paramedic accept a copy of a valid MOH DNR Confirmation Form?
Yes if fully completed
What are “comfort measures” under the DNR Standard?
Comfort measures are actions taken to provide pain relief, reduce suffering, and ensure patient dignity without initiating resuscitation.
What does DNR standard have under treatment
Treatment refers to any action provided for therapeutic, preventive, palliative, or diagnostic purposes, including a course of treatment or plan of care.
What should a paramedic do if the substitute decision-maker on the scene demands CPR for a patient with a valid DNR form?
The paramedic must assess the situation carefully. Unless the patient previously expressed a wish to override the DNR, the form should be followed.
What is a “Deceased Patient” as per the deceased pt care standard
- Obviously dead.
• Subject of a medical certificate of death under the Vital Statistics Act.
• Without vital signs and a valid MOH DNR Confirmation Form.
• Without vital signs and a Termination of Resuscitation (TOR) Order.
• Without vital signs and a Withhold Resuscitation Order
Define “Expected Death as per the deceased pt care standard
Death that was imminently anticipated due to a progressive end-stage terminal illness.
Define “Obviously Dead as per the deceased standard
Death confirmed by gross signs such as:
• Decapitation.
• Transection.
• Decomposition or putrefaction.
• Absence of vital signs with additional findings.
What are gross signs of death?
Decapitation.
• Transection.
• Visible decomposition.
• Charred body.
• Open head/torso wound with outpouring of cranial/visceral contents.
• Rigor mortis.
• Dependent lividity.
What is an MOH DNR Confirmation Form?
A Ministry of Health document confirming that resuscitation should not be initiated.
Who can issue a Termination of Resuscitation (TOR) Order?
A Base Hospital Physician.
What is the first step when encountering a deceased patient?
Confirm the patient is deceased based on the criteria in the Deceased Patient Standard.
How should deceased patients be treated?
With respect and dignity.
What should paramedics consider when dealing with the deceased’s family?
The family’s emotional needs and provide compassionate care.
What should paramedics do if foul play is suspected?
Follow the Police Notification Standard and notify CACC/ACS to contact law enforcement.
When must paramedics follow directives under the Coroners Act?
In all cases of unexpected or suspicious deaths.
What should paramedics do in an expected death?
Notify CACC/ACS and ensure the primary care practitioner or Palliative Care Team is informed.
When can paramedics leave the scene of an expected death?
• Practitioner or Palliative Care Team assumes responsibility.
• Police or coroner are present.
• Required documentation is complete.
