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BSO EMS Protocols > Cardiac Arrest > Flashcards

Cardiac Arrest Flashcards

1
Q

Cardiac Arrest Standing Orders: Information:

A

There is no scientific basis for starting the resuscitation process on a patient in asystole who has succumbed to the dying process of a terminal illness. Consideration should be given to NOT starting resuscitation efforts in these cases.

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2
Q

Cardiac Arrest Standing Orders: Decision not to Resuscitate:

A
  • Pt must be in asystole and apneic
  • If one of the following are present
  • Lividity
  • Rigor Mortis
  • Tissue decomposition
  • A Valid DNR is in place (yellow paper)
  • Injury incompatible with life
  • If ALL of the following are present
  • Known downtime > 20 min with no CPR
  • Asystole
  • Pupils Fixed and Dilated
  • Apneic
  • No HYPOTHERMIA
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3
Q

ADULT & PEDIATRIC: In general, when the scene is safe, all Cardiac Arrests should be ____.

A
  • worked on scene for 20 minutes
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4
Q

MICCR

A

Minimally Interrupted Cardio Cerebral Resuscitation

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5
Q

Begin MICCR -

A
  • Emphasis is placed on minimizing interruptions in compressions to no more than 5 seconds
  • Defibrillations: 200J for adult and 2J/kg initially for pediatrics then subsequent shocks at 4J/kg
  • Perform all assignments in Pit Crew fashion and make all efforts to obtain a ROSC prior to leaving the scene.
  • Once available, apply the monitor/ defibrillator with minimal interruptions to chest compressions and set to continuous compressions.
  • The ResQPOD shall be used on all pulseless adult patients without chest trauma and all pediatric patients > 1 year.
  • Patient Igel-ETCO2-RESQPOD
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6
Q

Cardiac Arrest Transport Destination

A
  • All cardiac arrest patients will be transported to the closest approved STEMI Facility if transport time is less than 20 minutes
  • Pediatric patients who have regained a ROSC shall be transported to a comprehensive pediatric emergency department. Pulseless pediatric patients shall be transported to closest appropriate emergency department (excluding Free Standing ED’s)
  • All Witnessed Cardiac Arrest Patients Must be Transported.
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7
Q

Termination of Efforts of Medical Codes after Resuscitation has started.

A

Consider terminating efforts when an “officer in charge” determines appropriate and:

  • Persistent Asystole has been documented for 15 minutes
  • ETCO2 of less than 10mmHg
  • Absence of hypothermia
  • Normal Saline 500ml Must be administered
  • All ALS interventions have been completed
  • Reversible causes have been addressed (H’s and T’s)
  • Social support group is in place for the family if needed
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8
Q

First step for Adult Cardiac Arrest

A

Establish Responsiveness

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9
Q

Adult Cardiac Arrest

No respirations/ gasping

A

Check Pulse

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10
Q

Adult Cardiac Arrest

Pulse Present

A

Inset OPA/ NPA and ventilate
* 1 breath every 6 seconds, via a BVM
If patient requires ventilatory support for more than 2 minutes the patient should receive an Advance Airway.
* Reassess pulse every 2 minutes

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11
Q

Adult Cardiac Arrest

No Pulse

A

Begin 220 compressions

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12
Q

Adult Cardiac Arrest

Airway Patent

A

High Performance CPR

  • Ventilate 2x via BVM
  • Place an IGEL and RESQPOD
  • Perform cycles of 220 compressions in two minutes, 5 seconds pause for rhythm check and defibrillate
  • Asynchronous breaths with compressions
  • 1 breath every 10 seconds
  • PIT CREW and apply auto pulse
  • Left Humeral IO needle
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13
Q

Adult Cardiac Arrest

V-Fib/ V-Tach

A
  • Defib: 200J
  • EPI Drip
    (Continue Epi Drip until transfer of care)
  • Amiodarone
  • 1st Dose - 300mg IV/IO
    -2nd Dose - 150mg IV/IO
    (OK to substitute Lidocaine when Amiodarone is not available.
  • Lidocaine 100mg IV/IO push. Repeat once after 5 minutes if no effect)
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14
Q

Adult Cardiac Arrest

Torsades

A
  • Mag Sulfate - 2g IV/IO

* Defibrillate

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15
Q

Adult Cardiac Arrest

Asystole & PEA

A
  • EPI Drip

continue Epi Drip until transfer of care

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16
Q

First step for Pediatric Cardiac Arrest

A

Establish Responsiveness

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17
Q

Pediatric Cardiac Arrest

No respirations/ gasping

A

Check Pulse

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18
Q

Pediatric Cardiac Arrest

Pulse Present

A

Insert OPA/ NPA and ventilate, 1 breath every 3 seconds, via a BVM.
- Reassess pulse every 2 minutes

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19
Q

Pediatric Cardiac Arrest

No Pulse

A

Begin 220 Compressions
PIT crew HP CPR
- Briefly Pause Compression, Assess rhythm and defibrillate as needed.

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20
Q

Pediatric Cardiac Arrest

Patent Airway

A

Ventilate 2x via BVM

  • Insert an IGEL and ventilate at a rate of 1 breath every 6 seconds, asynchronized with cycles of 220 compressions
  • Place RESQPOD for age > 1 year
  • Patient - IGEL - ETCO2 - RESQPOD
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21
Q

Adult Cardiac Arrest

Airway FBAO

A

Attempt to remove FBAO with laryngoscope and Magil forcepts. If obstruction cannot be removed perform a cricothyrotomy

22
Q

Pediatric Cardiac Arrest

High Performance CPR

A
  • 2 BVM Then Place an IGEL
  • Perform cycles of 220 compressions in two minutes, 5 second pause for rhythm check and defibrillate
  • Asynchronous breaths with compressions
  • 1 breath every 6 seconds
  • PIT Crew
  • IO needle
  • Humeral > 10 yoa
  • Femoral < 10 yoa
23
Q

Pediatric Cardiac Arrest

V-Fib/ V-Tach - Drug/ Electrical Therapy

A
  • 2 J/KG first, then 4J/KG all subsequent
  • EPI: (weight based dose x2) in 100ml bag over 16 min (use 1:10,000 for dosing according to Handtevy or Med tool)
  • Amiodarone 5mg/kg every 5 min. Max single dose 300mg. May repeat 1x.
24
Q

Cardiac Arrest Standing Orders

ETCO2

A
  • EtCO2 less than 10 mmHg increase effectiveness of compressions
  • EtCO2 above 20 mmHg is ideal FOR RESUSCITATION
25
Q

Cardiac Arrest Reversible Causes

H’s

A
  • Hydrogen Ion (Acidosis)
  • Ventilation
  • Hyperkalemia (Renal Failure) - Ca Chloride, Sodium Bicarb, Albuterol
  • Hypoglycemia - Glucose
  • Hyopxia - Oxygen & Ventilate
  • Hypovolemia - Fluid Bolus
  • Hypothermia - Warming
26
Q

Cardiac Arrest Reversible Causes

T’s

A
  • Tamponade (Cardiac)
  • Thrombus (coronary and pulmonary)
  • Trauma
  • Toxins or Tablets (OD):
  • Opiates (Narcan)
  • Beta Blockers (Glucagon),
  • Tricyclic Antidepressants (Sodium Bicarb),
  • Calcium Channel Blocker (Calcium Chloride)
  • Tension Pneumothorax
  • Bilateral Pleural Decompression
27
Q

Adult Cardiac Arrest

Hyperkalemia

A
  • Calcium Chloride: 1 gram, slow IV/IO over 2 minutes
  • Once intubated, Albuterol: 10mg via nebulizer, 4 x 2.5mg continuous treatments
  • Sodium Bicarbonate: 50 mEq IV/IO, administered slow over 2 minutes
28
Q

Adult Cardiac Arrest

Excited Delirium

A
  • Sodium Bicarbonate: 50 mEq IV/IO, amp administered slow over 2 minutes.
  • Cold Normal Saline (if available): 30ml/kg IV/IO. Maximum of 1L. Assess lung sounds every 500ml.
29
Q

Adult Cardiac Arrest

Drowning

A

Immediate VENTILATION

30
Q

Adult Cardiac Arrest

Third Trimester Cardiac Arrest

A

Manually displace the uterus to the left, rather than tilting the patient to the left.

31
Q

Adult Cardiac Arrest

Hanging

A
  • Consider spinal motion restriction

* Transport to closest facility

32
Q

Adult Cardiac Arrest

Drug Overdose

A
  • Treat OPIOID overdoses with Narcan after cardiac arrest medications have been given.
33
Q

Adult Cardiac Arrest

Hypoglycemic Patients

A

Administer D10: 250ml IV/IO

34
Q

Adult Cardiac Arrest

CPR Induced Consciousness

A
  • Defined as patients without a spontaneous heartbeat who gain consciousness while receiving CPR.
  • Etomidate 10mg IV/IO. May repeat x 1 prn
35
Q

Adult Cardiac Arrest

Electrocution/ Lightning Strike

A
  • Immediate Defibrillation as applicable
  • Consider Spinal Motion Restriction
  • Transport patient as a trauma Alert
36
Q

Adult Cardiac Arrest

Refractory V-Fib/ V-Tach

A
  • Defined as persistent V-Fib/ V-Tach (with no transient interruption of V-Fib/ V-Tach) that is NOT CONVERTED by standard defibrillation (3 or more shocks)
  • Initially managed by treating any applicable CORRECTABLE CAUSES (H’s & T’s) and appropriate antiarrythmic medications: Amiodarone: 300mg IV/IO, repeat at 150mg IV/IO after 3-5 minutes.
  • If standard defibrillation attempts and 450mg of Amiodarone have failed to convert persistent V-Fib/ V-Tach, DOUBLE SEQUENTIAL DEFIBRILLATION may be utilized.
37
Q

Double Sequential Defibrillation

A
  • Emphasis is placed on minimizing interruptions in compressions during this procedure
  • Apply an additional set of external defibrillation pads (anterior/ posterior)
  • Verify both monitors/defibrillators are attached and confirm V-Fib/ V-Tach rhythm.
  • Charge both monitors to the maximum energy setting and ensure all team members are clear of the patient.
  • Defibrillate by pressing both shock buttons as synchronously as possible.
  • Follow defibrillation with immediate chest compressions.
38
Q

Adult Cardiac Arrest
Post Resuscitation
Post ROSC should be managed in the order of:

A
  • Rate (reference specific protocol)
  • Rhythm (reference specific protocol)
  • Blood Pressure/ICE (Goal is to maintain a SBP of 100mmHg)
  • 12 - LEAD
39
Q

Adult Cardiac Arrest
Post Resuscitation
RESQPOD

A
  • Remove RESQPOD from the ETT or IGEL

* Patient - Igel/ET tube - ETCO2 - RESQPOD

40
Q

Adult Cardiac Arrest
Post Resuscitation
Next step after assessing cardiac stability and removing the RESQPOD

A
  • Place ice pack in the Axilla and Groin
41
Q

Adult Cardiac Arrest
Post Resuscitation
hypotensive patient

A
  • Normal Saline - 1L bolus

* Push Dose Epinephrine - if no response to fluid boluses

42
Q

Adult Cardiac Arrest
Post Resuscitation
Post V-Vib/V-Tach Considerations

A
  • Administer AMIODARONE INFUSION: (150mg into 50ml of Normal Saline, infused over 10 minutes) for patients who converted after two defibrillation and have not received an Amiodarone bolus during arrest.
  • If patient converts after initial defibrillation, no anti arrhythmic should be given
  • If patient does not convert after one defibrillation, give antiarrhythmic.
43
Q

Adult Cardiac Arrest
Post Resuscitation
Post Torsades Considerations

A

Administer Mag Sulfate: See infusion protocol.

44
Q

Adult Cardiac Arrest

Transport of Cardiac Arrest

A

All patients in cardiac arrest will be transported to a STEMI facility if the transport time is less than 20 minutes regardless of regaining a ROSC. All other patients will be transported to the closest appropriate facility excluding free standing ED’s.

45
Q

Pediatric Cardiac Arrest
Post Resuscitation
Initial priorities following ROSC

A
  • Maintain adequate oxygenation and ventilation
  • Rate
  • Rhythm
  • Blood Pressure
46
Q

Pediatric Cardiac Arrest
Post Resuscitation
Rate:

A
  • Provide oxygenation and Ventilation if heart rate is less than 60 BPM
  • Begin CPR if heart rate remains less than 60 BPM with S/S of poor perfusion (Altered Mental Status) despite oxygenation and ventilation for 60 seconds (30 seconds for a neonate)
  • Push Dose Epinephrine: If after one minute of CPR the heart rate remains less than 60 BPM
47
Q

Pediatric Cardiac Arrest
Post Resuscitation
Rhythm

A

Reference specific protocol

48
Q

Pediatric Cardiac Arrest
Post Resuscitation
Blood Pressure

A
  • Minimum Pediatric Systolic Blood Pressure Values:
    • Neonates: 60 mmHg
    • Infants: 70 mmHg
    • Children 1-10 years old: 70 + age in years x2 mmHg
    • Children greater than 10: 90 mmHg
49
Q

Pediatric Cardiac Arrest
Post Resuscitation
Hypotension

A
  • Fluid boluses are 20ml/kg and may be repeated 2x prn for hypotension; maximum 60ml/kg (for non trauma related hypotension).
  • Assess lung sounds and blood pressure often.
50
Q

Pediatric Cardiac Arrest Torsades

A
  • Mag Sulfate - 40mg/kg IV/IO. Slow IVP

- Defibrillate

51
Q

Pediatric Cardiac Arrest Asystole & PEA

A
  • EPI: (weight based dose *2) in 100 ml bag over 16 min ( use 1:10,000 for dosing according to Handtevy or Med tool

BSO EMS Protocols (13 decks)

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