EMT Cardiac ACLS SOP Flashcards
What is the sequence in which orders to treat the cardiac arrest patient are received?
first, by the sending physician
then, by the Standing Operating Procedures approved by Exceptional Medical Transport in conjunction with the Exceptional Medial Director
and finally, online medical control
In the absence of of specific orders to treat the cardiac arrest patient by the sending physician, what prevails?
Exceptional Medical policies
Who can supercede Exceptional policies, and when?
the Medical Director, at any time, can override Exceptional policies
What happens when the patient has cardiac arrest at the sending hospital?
resuscitation will be the responsibility of the sending physician and nursing staff, The Exceptional team, if not needed should then request to be called back when the patient is stable for transport
What is arrest happens during transfer from the patient bed to the ambulance?
the patient should be diverted to the ER. SCT team may attempt airway and dysrhythmia stabilization enroute to the ER if it is in the best interest of the patient. A specialty care transport Chart will be filled out with the details of the incident along with an incident report attached.
What happens when a patient arrests during transport to the receiving hospital?
SCT team will resucitate according to the orders given by the sending physician, Exceptional Medical Director, and the SOP as they apply. Team will notify dispatch of arrest and the need to divert. Team will manage airway with BLS technique until intubation or King tube placement or arrival to intended ED.
After the patient has been delivered to the intended ER when diversion is needed for cardiac arrest while transporting, who are the 5 people that the SCT RN is required to notify?
Sending physician Sending RN Original Receiving RN Exceptional SCT medical director Chief transport nurse All names of personnel notified will be included in the chart
What happens if cardiac arrest occurs enroute from the ambulance to the receiving hospital bed?
The patient will be diverted to the receiving hospital ER for definitive treatment. Airway and dysrhythmia stabilization may be attempted enroute to ER. Sending physician then Exceptional SOP will be followed until report can be given to the ER staff. All events will be documented in the patient chart along with an incident report
What happens if cardiac arrest occurs on the recieving unit?
Report is given to the recieving staff. Al events are documented in the patients record along with an incident report. The SCT RN will give notification to the sending physician, sending RN, Exceptional SCT medical director, and chief transport RN. All names of persons notified will be included in the Exceptional patient chart.
Per ACLS Adult Cardiac Arrest Algorithm, what two heart rhythms are considered shockable?
ventricular fibrillation
pulseless V tach
Per ACLS Adult Cardiac Arrest Algorithm, what is the timeframe for a round of CPR?
2 minutes
Per ACLS Adult Cardiac Arrest Algorithm, what is the dose, frequency, and point of initiation of Epinephrine?
1 mg every 3-5 minutes
after the first round of CPR
Per ACLS Adult Cardiac Arrest Algorithm, what is the dose of the first round of Amiodarone?
300 mg
Per ACLS Adult Cardiac Arrest Algorithm, what is the dose of the 2nd round of Amiodarone?
150 mg
What is the best indicator of ROSC?
abrupt, sustained Petco2 increase
Per ACLS Adult Cardiac Arrest Algorithm, what are the H’s of the H’s and T’s?
hypovolemia hypoxia Hydrogen atom (acidosis) Hypo/ hyperkalemia Hypothermia
Per ACLS Adult Cardiac Arrest Algorithm, what are the T’s of the H’s and T’s?
Tension pneumothorax Tamponade Toxins Thrombosis, pulmonary Thrombosis, coronary
If the patient is in Vfib / Pulseless V tach, what are the 8 steps you should take?
- CPR until defibrilator is available
- Defibrillate q2min
- establish IV w/ NSS KVO
- Give epinephrine 1mg q 3-5 minutes throughout resucitation while continuing CPR
- During next round of CPR, give amiodarone or lidocaine
- If rhythm is terminated by Lidocaine, start lidocaine drip. If rhythm is terminated by amiodarone, 150mg bolus over 10 minutes
- if Torresades administer Magnesium
- consider advanced airway
Per ACLS Adult Cardiac Arrest Algorithm, what is the drug and dose to treat Torsades De Pointes?
Magnesium Sulfate 1 gram in 50 cc D5W to run over 2 minutes
PEA encompasses a group of rhythms that are organized or semi organized but lack a palpable pulse. PEA rhythms include (5)
EMD (electromechanical dissociation) Idioventricular rhythms Ventricular escape rhythms Brady-asystolic rhythms Post defibrilation Idioventricular Rhythms
when transporting the patient in PEA, CPR should be maintained throughout treatment with puls check every __ minutes
2
Give __ ml NSS bolus per SOP when treating the patient in PEA
500
While resuscitating the patient in PEA, what is the dose and frequency for epinephrine throughout resuscitation attempt?
Epinephrine 1.0 mg 1:10,000 IV push and repeat q 3 min
when administering epinephrine when you don’t have IV access but you do have a King tube is place, what is the dose?
2 times the recommended dose diluted in 10 cc NS
Total amount of solutions given via ETT/King tube are not to exceed __ cc
50 cc
If unable to maintain adequate oxygenation with BVM and 15L O2, what should you do?
And if you do, what should you be monitoring?
intubate or or insert King tube
monitor ETCO2 by waveform capnography
what is the normal range for waveform capnography?
35 - 45 mmHg
High quality CPR is achieved when the ETCO2 value is at least __ - __ mmHg
10 - 20
when performing CPR with waveform capnography in place, what would you expect to see if you achieve ROSC?
an increase in ETCO2 to 35- 45 mmHg indicating that more CO2 is being dumped into the lungs
Reversable causes of PEA include the H’s (6) and T’s (5)
What are they?
Hypovolemia Hypoxia Hypothermia Hypo. / Hyperkalemia Hypoglycemia Hydrogen atom (acidosis) Tamponade (cardiac) Tension pneumothorax Thrombosis, pulmonary or cardiac Toxins Trauma
Exceptional SOP is the same for Asystole as it is for PEA except for one thing you can do for Asystole, what is it?
External Pacing
what are the 6 ECG rhythms with a heart rate less than 60/min that are classified s Bradycardia?
Sinus bradycardia first degree AV block second degree AV block Type I Wenckenback/ Mobitz I Type II Mobitz II Third-degree AV block / complete block
