Medical Cardiac Arrest Medical Directive Flashcards
Medical Cardiac Arrest Medical Directive
A Primary Care Paramedic may provide the treatment prescribed in this Medical Directive if authorized.
Indications
Non-traumatic cardiac arrest
Conditions - CPR
Age: n/a LOA: Altered HR: n/a RR: n/a SBP: n/a Other: Performed in 2 minute intervals
Conditions - Manual Defibrillation
Age: ≥30 days LOA: Altered HR: n/a RR: n/a SBP: n/a Other: VF OR pulseless VT
Conditions - AED Defibrillation
Age: ≥30 days LOA: Altered HR: n/a RR: n/a SBP: n/a Other: Defibrillation indicated
Conditions - Epinephrine
Age: n/a LOA: Altered HR: n/a RR: n/a SBP: n/a Other: Anaphylaxis suspected as causitive event
Conditions - Medical TOR
Age: ≥18 years LOA: Altered HR: n/a RR: n/a SBP: n/a Other: Arrest not witnessed by EMS AND No ROSC AND No defibrillation delivered
Contraindications - CPR
Obviously dead as per BLS PCS
Meet conditions of Do Not Resuscitate (DNR) Standard
Contraindications - Manual Defibrillation
Rhythms other than VF or pulseless VT
Contraindications - AED Defibrillation
Non-shockable rhythm
Contraindications - Epinephrine
Allergy or sensitivity to epinephrine
Contraindications - Medical TOR
Arrest thought to be of non-cardiac origin
Treatment
- Consider CPR
- Consider Manual defibrillation (if available and authorized)
- Consider AED defibrillation (if not using manual defibrillation)
- Consider epinephrine (only if anaphylaxis is suspected as causative event)
- Mandatory Provincial Patch Point
Consider Manual defibrillation (if available and authorized)
Age ≥30 days to <8 years: Dose: 1 defibrillation Initial dose: 2 J/kg Subsequent dose(s): 4 J/kg Dosing interval: 2 min Max. # of doses: 4
Age ≥8 years Dose: 1 defibrillation Initial dose: As per BH/manufacturer Subsequent dose(s): As per BH/manufacturer Dosing interval: 2 min Max. # of doses: 4
Consider AED defibrillation (if not using manual defibrillation)
Age ≥30 days to <8 years:
With Pediatric Attenuator Cable: Dose: 1 defibrillation Max. single dose: As per BH/manufacturer Dosing interval: 2 min Max. # of doses: 4
Without Pediatric Attenuator Cable: Dose: 1 defibrillation Max. single dose: As per BH/manufacturer Dosing interval: 2 min Max. # of doses: 4
Age ≥8 years: Dose: 1 defibrillation Max. single dose: As per BH/manufacturer Dosing interval: 2 min Max. # of doses: 4
Consider epinephrine (only if anaphylaxis is suspected as causitive event)
Route: IM Concentration: 1 mg/mL = 1:1000 Dose: 0.01 mg/kg* Max. single dose 0.5 mg Dosing interval: n/a Max # of doses: 1 *The epinephrine dose may be rounded to the nearest 0.05 mg
Mandatory Patch Point
Patch to BHP for authorization, following the 3rd analysis, to consider Medical TOR (if applicable). If the BH patch fails, or the medical TOR does not apply, transport to the closest appropriate receiving facility following ROSC or the 4th analysis.
Clinical Considerations
Consider very early transport after the 1st analysis (and defibrillation if indicated) in the following settings: pregnancy presumed to be ≥20 weeks gestation (fundus above umbilicus, ensure manual displacement of uterus to left), hypothermia, airway obstruction, suspected pulmonary embolus, medication overdose/toxicology, or other known reversible cause of arrest not addressed.
Similarly, plan for extrication and transport for patients with refractory ventricular fibrillation and pediatric cardiac arrest (after 3 analyses), ensure quality CPR can be continued.
In cardiac arrest associated with opioid overdose, continue standard medical cardiac arrest directive. There is no clear role for routine administration of naloxone in confirmed cardiac arrest.
Follow the Deceased Patient Standard once TOR has been implemented.
Defibrillation Joule Settings
This section is intentionally left blank
