Medical Cardiac Arrest Medical Directive Flashcards

1
Q

Medical Cardiac Arrest MD

What are the indications for the medical cardiac arrest md?

A

Non-traumatic cardiac arrest.

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2
Q

Medical Cardiac Arrest MD

What are the conditions for CPR?

A

LOA: Altered
Other: Performed in 2 minute intervals.

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3
Q

Medical Cardiac Arrest MD

What are the conditions for Manual Defibrillation?

A

Age: ≥24 hours
LOA: Altered
Other: VF OR pulseless VT

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4
Q

Medical Cardiac Arrest MD

What are the conditions for AED or SAED Defibrillation?

A

Age: ≥24 hours
LOA: Altered
Other: Defibrillation indicated. If not using manual defibrillation.

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5
Q

Medical Cardiac Arrest MD

What are the conditions for epinephrine administration?

A

Age: ≥24 hours
LOA: Altered
Other: Anaphylaxis suspected as causative event.

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6
Q

Medical Cardiac Arrest MD

What are the conditions for a medical TOR?

A

Age: ≥16 years
LOA: Altered
Other: Arrest not witnessed by paramedic
AND
No ROSC 20 minutes of resuscitation
AND
No defibrillation delivered.

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7
Q

Medical Cardiac Arrest MD

What are the contraindications to CPR?

A

Obviously dead as per BLS PCS
Meet conditions of the BLS PCS Do Not Resuscitate (DNR) Standard

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8
Q

Medical Cardiac Arrest MD

What are the contraindications to Manual Defibrillation?

A

Rhythms other than VF or pulseless VT.

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9
Q

Medical Cardiac Arrest MD

What are the contraindications to AED or SAED Defibrillation?

A

Non-shockable rhythm.

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10
Q

Medical Cardiac Arrest MD

What are the contraindications to epinephrine administration?

A

Allergy or sensitivity to epinephrine.

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11
Q

Medical Cardiac Arrest MD

What are the contraindications to a Medical TOR?

A

Known reversible cause of the arrest unable to be addressed.
Pregnancy presumed to be ≥20 weeks gestation.
Suspected hypothermia.
Airway obstruction.
Non-opioid drug overdose/toxicology.

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12
Q

Medical Cardiac Arrest MD

What is the dosing for manual defibrillation ≥24 hours to <8 years?

A

Initial dose of 2 J/kg, subsequent doses 4 J/kg. Dosing interval 2 min, max # of doses n/a.

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13
Q

Medical Cardiac Arrest MD

What is the dosing for manual defibrillation ≥8 years?

A

As per RBHP/manufacturer.
Dosing interval 2 min, max # of doses n/a.

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14
Q

Medical Cardiac Arrest MD

What is the dosing for epinephrine?

A

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
Epi dose may be rounded to the nearest 0.05 mg.

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15
Q

Medical Cardiac Arrest MD

When do we normally transport, if patch for TOR fails, or TOR doesn’t apply?

A

Transport to the closest appropriate hospital following ROSC or 20 minutes of resuscitation without ROSC.

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16
Q

Medical Cardiac Arrest MD

When would we patch early (following the 4th analysis) to consider a TOR?

A

If there are extenuating circumstances surrounding egress, prolonged transport, or significant clinical limitations where the paramedic considers ongoing resuscitation to be futile.

17
Q

Medical Cardiac Arrest MD

Can the BHP deny or approve a Medical TOR even if the patient meets or does not meet the criteria for a TOR?

A

Yes.

18
Q

Medical Cardiac Arrest MD

When should very early transport (after a minimum of one analysis and defibrillation if indicated) once an egress plan is organized be considered?

A
  1. pregnancy presumed to be ≥20 weeks gestation (fundus above umbilicus, ensure manual displacement of the uterus to the left);
  2. hypothermia;
  3. airway obstruction;
  4. non-opioid drug overdose/toxicology, or;
  5. other known reversible cause of arrest not addressed.
19
Q

Medical Cardiac Arrest MD

When should transport of refractory VF or pulseless VT patients take place?

A

After the third consecutive shock.

20
Q

Medical Cardiac Arrest MD

How is refractory VF or pulseless VT defined in the medical cardiac arrest MD?

A

Persistent VF or pulseless VT after 3 consecutive shocks.