Cardiac Arrest Management (CAM) Protocol

Question 1

? *PRIORITIES DURING CARDIAC ARREST RESUSCITATION

Answer 1

1. High Quality Continuous Chest Compressions with minimal interruptions
2. Low-volume interposed ventilations
3. Early defibrillation
4. Switch Compressors every 2 Minutes

Question 2

If suspected FBAO:

Answer 2

BLS: Inspect Airway; ALS: Laryngoscopy

Question 3

CAM Triangle (REVIEW AND COMMIT TO MEMORY)

Answer 3

Question 4

ROSC - PRIORITIES IN POST ARREST RESUSCITATION

Answer 4

1. Immediate recognition and treatment of re-arrest
2. Preventing re-arrest through effective and continuous management of C – A – B
3. Thorough assessment and identification / treatment of correctable causes
4. Movement and transport decisions that prioritize ongoing patient care

Question 5

in ROSC, where is pulse palpated and for how long

Answer 5

Palpate femoral pulse continuously for first 10 minutes prior to patient movement

Question 6

What is (one) sign of an impending re-arrest

Answer 6

A falling ETCO2

Question 7

? ETCO2 parameters during ROSC

Answer 7

35 – 45 mmHg

Question 8

? ROSC Epinephrine parameters

Answer 8

Epinephrine 10mcg/mL
o 1mL (10mcg) every 2 minutes, slow IV/IO
push
o Titrate to SBP of greater than or equal to
90mm/Hg

Question 9

ROSC - ? Circulation treatment goals

Answer 9

o Peripheral pulses present
o Systolic BP > 90 mmHg
o Ongoing fluid therapy**

Question 10

? Airway / Breathing / Oxygenation etiologies in a ROSC Pt (Hs/Ts)

Answer 10

o Tension pneumothorax
o Bronchoconstriction
o Pulmonary embolus
o Upper airway obstruction
o Opiate overdose

Question 11

What are principal reasons for putting in an advanced airway?

Answer 11

o Improve ventilation or oxygenation
o Protect against aspiration
o Effectively ventilate while moving

Question 12

ROSC - Initial Actions

Answer 12

□ Initiate 10 minute continuous femoral pulse check
□ Continue rescue breathing as needed
□ Paddles attached and EKG waveform visible
□ VF alarm set, SpO2 and EtCO2 waveforms visible

Question 13

ROSC - Circulation - Priorities?

Answer 13

Obtain peripheral IV access (18 g preferred, 20 g minimum)
□ Initiate NS fluid bolus
□ Assess for peripheral pulses
□ Obtain manual blood pressure
□ Push dose epinephrine IN ADDITION TO fluids for systolic BP < 90 mmHg

Question 14

ROSC - Priorities - Airway / Ventilation

Answer 14

□ Assess for responsiveness and spontaneous ventilations
□ Assess EtCO2, lung sounds, SpO2
□ Maintain BLS airway or place advanced airway as indicated
□ Place advanced airway if needed to ventilate while moving patient
□ Oxygenate to SpO2 94% to 99%
□ Oxygen flow rate titrated to prevent SpO2 100%

Question 15

ROSC - Prior to Moving Patient, Confirm

Answer 15

□ Patient has sustained ROSC approximately ≥ 10 minutes
□ C-A-B have been effectively stabilized or appropriate efforts made
□ Team has planned how to effectively ventilate during move
□
Team is prepared to recognize re-arrest:
* STOP MOVING
* RESUME CAM ON SCENE

Question 16

Post Arrest Resuscitation Transport Priorities

Answer 16

Transport is indicated after a patient has sustained ROSC for approximately 10 minutes
and effective efforts have been made to stabilize airway, breathing, and circulation
* Continuous patient assessment and treatment must remain the priority during transport.
* Recognizing hypotension, inadequate ventilation, or re-arrest, will have a large impact on
patient outcome.

Question 17

Re-Arrest Guidelines
(Loss of ROSC)

Answer 17

• Re-arrests require the same high-quality CAM and ALS care as the initial arrest:
  o Remain on scene
  o Ensure adequate workspace
  o Begin CAM Procedure
  o Defibrillate VF / VT ASAP
• Provide an additional 20 minutes of high-quality CAM prior to any further movement or
  initiating transport.
• If ROSC is obtained again, reassess, stabilize C – A – B as indicated, then continue
  with previous transport plan.
• If no ROSC, or multiple re-arrests, through 20 minutes from initial re-arrest consider
  underlying cause, circumstances, and presentation, then contact base for consultation

Question 18

Prioritizing Care in Re-Arrest
Re-Arrest On Scene

Answer 18

• If re-arrest occurs during movement to
  gurney or ambulance, resume CAM on
  scene outside of ambulance

Question 19

Prioritizing Care in Re-Arrest
Re-Arrest during transport

Answer 19

• If re-arrest occurs after loading but prior
  to leaving scene, unload patient from
  ambulance, resume CAM, and move to
  workable space

Question 20

What are the patient parameters for Base Contact and DOD for the following:

Asystole / PEA
* Never defibrillated, no
shockable rhythm
observed

Answer 20

After 20 minutes of
resuscitation efforts

Consider DOD after 20 minutes;
base consult