Medical Arrest, ROSC, Cardiac Ischemia Questions

Question 1

For a Medical Cardiac Arrest, when should rhythm analysis/defibrillation be performed?

Answer 1

IMMEDIATELY. Interpretation comes from putting on defib pads FIRST

Question 2

When should you do your rhythm interpretations/analyses?

Answer 2

After 2 minutes of CPR (ensure quality CPR is being adminsitered)

Question 3

Do paramedics count pre-arrival interventions?

Answer 3

NO. Care delivered prior to arrival can be “considered” and documented.

Question 4

Will you be continuing CPR while charging for a shock?

Answer 4

Yes stupid

Question 5

Should you stop the ambulance for a manual rhythm interpretation if you’re en-route?

Answer 5

YES. This minimizes artifact AND risk of inaccurate rhythm interpretation/analysis

Question 6

Should you stop the ambulance if you’re using a semi-automated rhythm analysis?

Answer 6

YES. Also minimizes artifact AND risk of inaccurate rhythm interpretation/analysis

Question 7

If you have an SGA placed, what should your compressions and ventilations be?

Answer 7

Continuous compressions
Ventilations provided asynchronously at a rate of 10 breaths/min (one every six seconds)

Question 8

What’s your Mandatory Patch Point for Medical Cardiac Arrest?

Answer 8

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

Question 9

What happens if your patient gets a ROSC but re-arrests en-route and you’re only using SAED?

Answer 9

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

Question 10

If in your opinion, a patient would benefit from further interpretation/analysis/defib, can you do it?

Answer 10

Only if you patch BHP and you get clearance for it

Question 11

In the event of Cardiac Arrest due to Anaphylaxis, can you transport early?

Answer 11

Yes, under the “unusual circumstances clinical consideration

Question 12

In the event of Cardiac Arrest due to Anaphylaxis, should you delay defibrillation to administer EPI?

Answer 12

Hell no; defib > EPI

Question 13

Should you treat electrocution as a Mediacl Cardiac Arrest or Trauma?

Answer 13

Medical UNTIL proper justification for trauma (i.e significant blunt/penetrating)

Question 14

Should you do pulse checks every 2 minute interval (rhythm interpretation/analysis)?

Answer 14

Yes - to help identify ROSC or PEA

Question 15

Do you treat commotio cordis and hangings as Medical Cardiac Arrest?

Answer 15

Yes, UNLESS life threatening TRAUMA is noted.

Question 16

In the event of ROSC, what should you target SPO2 values at?

Answer 16

94 -98% (AVOID 100%)

Question 17

Despite ideal SPO2 values, should oxygen admin be continued if patient remains unstable?

Answer 17

Yes

Question 18

Post ROSC, what should you maintain ventilation values at?

Answer 18

Maintain ventilation rate of approx. 10 breaths per min (1 breath every 6 seconds)

Question 19

What ETCO2 vitals should you maintain post ROSC?

Answer 19

30-40 mmHg (with waveform capnography)

Question 20

Regardless of amount of fluid administered prior to ROSC, is chest auscultation is clear, how much bolus are you administering?

Answer 20

10 ml/kg up to a max of 1000 mL, TARGETING for an SBP of equal or greater than 90 mmHg

Question 21

When should a 12 lead be performed?

Answer 21

Within 10 minutes of patient contact

Question 22

What happens if you encounter situations that doesn’t allow for a 12 lead to be performed?

Answer 22

Document barriers that didn’t allow for this goal to be achieved

Question 23

What should you do if you do a 12 lead ECG and you identify an Inferior STEMI?

Answer 23

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

Question 24

What do you change if performing a 15 lead ECG?

Answer 24

V4 = V4R
V5 = V8
V6 = V9

Question 25

If a STEMI is identified, do you have to repeat a 12 lead ECG?

Answer 25

No

Question 26

If no evidence of STEMI, what should you do?

Answer 26

Get 2 rhythm strips of 12 lead ECG’s (old and new one)

Question 27

Should you administer ASA if they’ve previously taken ASA?

Answer 27

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)

Question 28

What is prior history defined as?

Answer 28

Previously authorized or prescribed to the patient by a certified Medical Doctor

Question 29

What are the conditions for nitroglycerin use?

Answer 29

Prior history OR an established IV

An IV MUST be initiated prior to the administration of nitroglycerin in FIRST TIME suspected cardiac ischemia patients.

Question 30

What if a patient (who needs nitro) already has an IV in place?

Answer 30

Assess it for patency. If appropriate, use it for first time administration.

This only applies for PCP with Autonomous IV Certification

Question 31

Is CPAP appropriate for patients with CHF?

Answer 31

Yes

Question 32

Can nitroglycerin be administered for an isolated posterior STEMI?

Answer 32

Yessir

Question 33

When should you use nitro with CAUTION?

Answer 33

Patients with tachycardia OR SBP close to 100 mmHg