Medical Arrest, ROSC, Cardiac Ischemia Questions Flashcards
For a Medical Cardiac Arrest, when should rhythm analysis/defibrillation be performed?
IMMEDIATELY. Interpretation comes from putting on defib pads FIRST
When should you do your rhythm interpretations/analyses?
After 2 minutes of CPR (ensure quality CPR is being adminsitered)
Do paramedics count pre-arrival interventions?
NO. Care delivered prior to arrival can be “considered” and documented.
Will you be continuing CPR while charging for a shock?
Yes stupid
Should you stop the ambulance for a manual rhythm interpretation if you’re en-route?
YES. This minimizes artifact AND risk of inaccurate rhythm interpretation/analysis
Should you stop the ambulance if you’re using a semi-automated rhythm analysis?
YES. Also minimizes artifact AND risk of inaccurate rhythm interpretation/analysis
If you have an SGA placed, what should your compressions and ventilations be?
Continuous compressions
Ventilations provided asynchronously at a rate of 10 breaths/min (one every six seconds)
What’s your Mandatory Patch Point for Medical Cardiac Arrest?
For PCPs:
Patch will follow 3rd rhythm interpretation/analysis IF considering medical TOR. If patch fails OR medical is not applicable, transporting to most appropriate facility following ROSC or 4th interpretation/analysis
What happens if your patient gets a ROSC but re-arrests en-route and you’re only using SAED?
1) Pull over
2) Initiate one IMMEDIATE rhythm interpretation/analysis
3) Treat rhythm appropriately AND
4) Continue with transportation to receiving facility with no further stops
If in your opinion, a patient would benefit from further interpretation/analysis/defib, can you do it?
Only if you patch BHP and you get clearance for it
In the event of Cardiac Arrest due to Anaphylaxis, can you transport early?
Yes, under the “unusual circumstances clinical consideration
In the event of Cardiac Arrest due to Anaphylaxis, should you delay defibrillation to administer EPI?
Hell no; defib > EPI
Should you treat electrocution as a Mediacl Cardiac Arrest or Trauma?
Medical UNTIL proper justification for trauma (i.e significant blunt/penetrating)
Should you do pulse checks every 2 minute interval (rhythm interpretation/analysis)?
Yes - to help identify ROSC or PEA
Do you treat commotio cordis and hangings as Medical Cardiac Arrest?
Yes, UNLESS life threatening TRAUMA is noted.
In the event of ROSC, what should you target SPO2 values at?
94 -98% (AVOID 100%)
Despite ideal SPO2 values, should oxygen admin be continued if patient remains unstable?
Yes
Post ROSC, what should you maintain ventilation values at?
Maintain ventilation rate of approx. 10 breaths per min (1 breath every 6 seconds)
What ETCO2 vitals should you maintain post ROSC?
30-40 mmHg (with waveform capnography)
Regardless of amount of fluid administered prior to ROSC, is chest auscultation is clear, how much bolus are you administering?
10 ml/kg up to a max of 1000 mL, TARGETING for an SBP of equal or greater than 90 mmHg
When should a 12 lead be performed?
Within 10 minutes of patient contact
What happens if you encounter situations that doesn’t allow for a 12 lead to be performed?
Document barriers that didn’t allow for this goal to be achieved
What should you do if you do a 12 lead ECG and you identify an Inferior STEMI?
V4R MUST be completed to rule in or out RVI when considering nitroglycerin.
These patients are PRELOAD DEPENDANT; administration of nitro may cause significant hypotension
What do you change if performing a 15 lead ECG?
V4 = V4R
V5 = V8
V6 = V9
If a STEMI is identified, do you have to repeat a 12 lead ECG?
No
If no evidence of STEMI, what should you do?
Get 2 rhythm strips of 12 lead ECG’s (old and new one)
Should you administer ASA if they’ve previously taken ASA?
Yes. Always apply cardiac ischemia medical directive as if no care had been rendered prior to arrival
Why? ASA has a WIDE therapeutic index (no side effects can be from 80-1500 mg)
What is prior history defined as?
Previously authorized or prescribed to the patient by a certified Medical Doctor
What are the conditions for nitroglycerin use?
Prior history OR an established IV
An IV MUST be initiated prior to the administration of nitroglycerin in FIRST TIME suspected cardiac ischemia patients.
What if a patient (who needs nitro) already has an IV in place?
Assess it for patency. If appropriate, use it for first time administration.
This only applies for PCP with Autonomous IV Certification
Is CPAP appropriate for patients with CHF?
Yes
Can nitroglycerin be administered for an isolated posterior STEMI?
Yessir
When should you use nitro with CAUTION?
Patients with tachycardia OR SBP close to 100 mmHg
