Cardiac Arrest Overview

Question 1

Signs of Obvious Death

Answer 1

In the case of obvious death CPR is not needed:
- Evidence of tissue decomposition, including rigor mortis and/or lividity
- Decapitation
- Incineration
- Trans-section
- Open skull fracture with exposed brain matter

Question 2

Management of the Scene

Answer 2

• Maintain open lines of communication between yourself and all on scene resources
• When giving directions be clear
• Clear space of all obstructions that may pose an issue to treating patient if possible

Question 3

Compression Rates and Depth

Answer 3

DEPTH: 5 cm in adults and 1/3 of chest depth on children, infants, and neonates

ONE RESPONDER CYCLE: 30:2 on all, except 3:1 on neonates

TWO RESPONDER CYCLE: 30:2 for adults, 15:2 for children and infants, 3:1 for neonates

RATE: 100-120/min

Question 4

Determining Cause of Arrest

Answer 4

Once Primary Survey is complete and CPR is underway, attempt to determine possible causes of cardiac arrest. If you suspect treatable cause, call EPOS early for transport orders - do not wait 15 min/3 no-shock advised

Question 5

Treatable Causes

Answer 5

• Hypothermia
• Sepsis
• Cardiac tamponade
• Thrombosis (coronary or pulmonary)
• Tension pneumothorax
• Hypovolemia
• Hypoxia (overdose, airway obstruction/choking, smoke inhalation, drowning, asthma, anaphylaxis)

Question 6

Cardiac Arrest - Asphyxial cause

Answer 6

In the case where cause of arrest is due to hypoxia complete one round (2 mins or 5 cycles) of CPR prior to analyzing on AED.

Question 7

Transporting with Active CPR

Answer 7

Upon receiving transport orders from EPOS:
- Load patient onto cot
- Switch to analyzing every 4-5 mins
- Use clamshell/backboard for effective compressions
- keep cot at level to allow compressor to continue effective chest compressions

DURING TRANSPORT:
- Stop vehicle to analyze

• If shock advised stay on scene and continue analyzing every 2 mins until no-shock advised (or ROSC) then continue transport w/analysis every 4-5 mins if CPR still in progress

FOR HYPOTHERMIC PATIENTS:
- apply AED and analyze , defibrillate up to three times if indicated, continue with CPR and rapid transport to hospital (after 3 defibrillations do not pause CPR for analyzing and shocks)

Question 8

Return of Spontaneous Circulation (ROSC)

Answer 8

If patient shows signs of life (breathing, coughing, movement, etc):
- Stop CPR and check for pulse
- If carotid pulse present begin transport immediately
- Continue assessing ABC’s and any interventions
- Leave AED attached until arrival at hospital and be prepared for re-arrest

Question 9

Advanced Directives

Answer 9

• Legal documents outlining allowed resuscitation orders in certain circumstances
• Commonly comes in the form of Do Not Resuscitate (DNR) orders or Medical Orders for Scope of Treatment Document (MOST)
• Once found and validity is confirmed follow patients wishes as outlined in the directive
• If unsure of validity call EPOS for consult
• ALWAYS INITIATE CARDIAC ARREST PROTOCOL UNTIL DNR IS VERIFIED

Question 10

Discontinuation Orders and Recognition of Life Extinct (ROLE)

Answer 10

Except in cases of obvious death, following criteria must be confirmed by 2 paramedics independently after discontinuation of resuscitation:
- No palpable carotid pulse (90 secs)
- No heart sounds heard (90 secs)
- No breath sounds heard/respiratory effect observed (90 secs)
- Fixed and dilated pupils (non-reactive to light)
- No response to central stimuli (previous chest compression enough to demonstrate)

Question 11

Delivery of Death Notification

Answer 11

• It may fall to you to deliver death notifications
• You are required to stay on scene for all out of hospital deaths until police arrive