Medical + Trauma Cardiac Arrest Flashcards
Medical Cardiac Arrest Medical Directive
What are the INDICATIONS?
How do I establish a non-traumatic situation? Observations, Questions?
What does refractory mean?
Has to be a non-trauamatic cariac arrest
Observe the pertinant negatives, the MOI, and make a clinical judgment
Keeps falling back into it
Medical Cardiac Arrest Medical Directive
In what settings should you consider very early transport AFTER a minimum of 1 analysis once an egress plan is organized?
Pregnancy situation, what’s considered 20 weeks gestation + action plan?
What do you do for patients in refractory VF or pulseless VT?
pregnancy presumed to be GREATER/EQUAL to 20 weeks gestation
hypothermia
airway obstruction
non-opioid drug overdose/toxicology
OR
other known reversible cause of arrest not addressed
Fundus above umbilicus and ensure manual displacement of uterus to left
transport after the 3rd consecutive shock
switch the pads from regular position to posterior and anterior
Medical Cardiac Arrest Medical Directive
What are the CONDITIONS for CPR?
What are the CONTRAINDICATIONS for CPR?
Must be performed in 2min intervals
An altered LOA
Obviously dead as per BLS PCS
OR
Meet conditions of DNR standard
Medical Cardiac Arrest Medical Directive
What are the CONDITIONS for AED Defibrillation?
What are the CONTRAINDICATIONS for AED Defibrillation?
Pt has to be GREATER/EQUAL to 24h old
An altered LOA
It’s indicated by the defib
If manual defibrillation isn’t in use
Non-shockable rhythm
Medical Cardiac Arrest Medical Directive
What are the CONDITIONS for Manual Defibrillation?
What are the CONTRAINDICATIONS for Manual Defibrillation?
pt is GREATER/EQUAL to 24h old
pt is altered (LOA)
pt is in TF of pulseless VT
Rhythms other than VF or pulseless VT
Medical Cardiac Arrest Medical Directive
What are the CONDITIONS for epinephrine?
How many doses of epi would you give in a VSA?
What are the CONTRAINDICATIONS for epinephrine?
Pt has to be GREATER/EQUAL to 24h old
Have an altered LOA
Have anaphylaxis suspected as a causative event
1
Allergy or sensitivity
Medical Cardiac Arrest Medical Directive
What are the CONDITIONS for a medical TOR?
What are the CONTRAINDICATIONS for a medical TOR?
Pt has to be GREATER/EQUAL to 16y old
Altered LOA
Arrest not witnessed by paramedic
AND
No ROSC after 20 minutes of resuscitation
AND
No defibrillation delivered
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
Medical Cardiac Arrest Medical Directive
What do you do if the patch fails?
Mandatory Provincial Patch Point
What sould you consider doing in terms of patching?
Transport to the closest appropriate hospital following ROSC or 20 minutes of resuscitation without ROSC (do this if the TOR doesn’t apply either)
Patch early after the 4th analysis to consider TOR
For PCPs the patch has to follow 20min of resuscitation
Medical Cardiac Arrest Medical Directive
What is the TREATMENT plan for Manual Defibrillation for a patient GREATER/EQUAL to 24h old but LESS then 8y old?
What is the TREATMENT plan for Manual Defibrillation for a patient GREATER/EQUAL then 8y old?
Dose - 1 defibrillation
Initial dose - 2J/kg
Subsequent and max dose(s) - 4 J/kg
Dosing interval - 2 min
Max # of doses - reasonably unlimited
Dose - 1 defibrillation
Initial dose - As per BH/ manufacturer
Subsequent and max dose(s) - As per BH/ manufacturer
Dosing interval - 2 min
Max # of doses - reasonably unlimited
Medical Cardiac Arrest Medical Directive
What is the TREATMENT plan for an AED for a patient GREATER/EQUAL to 24h old but LESS then 8y old?
What is the TREATMENT plan for an AED for a patient GREATER/EQUAL then 8y old?
Dose - 1 defibrillation
Max.single Dose - As per BH/manufacturer
Dosing interval - 2 min
Max # of doses - reasonably unlimited
Dose - 1 defibrillation
Max.single Dose - As per BH/manufacturer
Dosing interval - 2 min
Max # of doses - reasonably unlimited
Medical Cardiac Arrest Medical Directive
What is the TREATMENT plan, CONCENTRATION, and ROUTE for epinephrine
Remember the condition?
what about the dose?
Route - IM
Concentration - 1:1000
Dose - 0.01mg/kg
Max.Single Dose - 0.5mg
Dosing interval - no interval
Max # of doses - 1
ONLY if anaphylaxis is the causative event
it can be rounded to the nearest 0.05mg
Medical Cardiac Arrest Medical Directive
What are top 2 CLINICAL CONSIDERATIONS?
Consider RBH advanced airway strategy -SGA- where more than OPA/NPA and BVM is required
There is no clear role for routine administration of naloxone in confirmed cardiac arrest
Medical Cardiac Arrest Medical Directive
What are the extenuating circumstances? (does’nt meet TOR but should)
What are the impeeding factors for a TOR? (stuff the doctor is gonna be like mmmmm I don’t know)
- extenuating egress
- prolonged transport
- caregiver wishes
- existence of DNR confirmation form
- underlying end stage progressive illness
The BHP might NOT authorize TOR even though the patient meets TOR rule:
- location of the patients
- EtCO2
- age
- bystander witnessed
- bystander CPR
- transportation time
- unusual cause of cardiac arrest such as
electrocution, hanging, and toxicology
Trauma Cardiac Arrest Medical Directive
What are the INDICATIONS?
How do I establish a non-traumatic situation? Observations, Questions?
Cardiac Arrest secondary to severe blunt or penetrating trauma
Make a clinical observation, analysis, and judgment of the overall scene
Trauma Cardiac Arrest Medical Directive
What are the CONDITIONS for CPR?
What are the CONTRAINDICATIONS for CPR?
An altered LOA
Must be performed in 2min intervals
Obviously dead as per BLS PCS
Meet conditions of Do Not Resuscitation (DNR) Standard
Trauma Cardiac Arrest Medical Directive
What are the CONDITIONS for AED Defibrillation?
What are the CONTRAINDICATIONS for AED Defibrillation?
Pt has to be GREATER/EQUAL to 24h old
An altered LOA
It’s indicated by the defib
If manual defibrillation isn’t in use
Non-shockable rhythm
Trauma Cardiac Arrest Medical Directive
What are the CONDITIONS for Manual Defibrillation?
What are the CONTRAINDICATIONS for Manual Defibrillation?
GREATER/EQUAL to 24h old
an altered LOA
VF or pulseless VT
Rhythm other than VF or pulseless VT
Trauma Cardiac Arrest Medical Directive
What are the conditions of a TOR?
pt has to be GREATER/EQUAL to 16y old
has to be altered
no palpable pulses
AND
no defibrillation delivered
AND
rhythm asystole
AND
No signs of life since fully extricated OR
their are/were signs of life with the closest ED GREATER/EQUAL to 30min away OR
rhythm PEA with the closest ED GREATER/EQUAL to 30min
Trauma Cardiac Arrest Medical Directive
What are the CONTRAINDICATIONS for TOR?
What does organized electrical activity on ECG mean/look like?
What are the 4 signs of life?
pt is LESS then 16y old
defibrillation deliveredelivered
signs of life since fully extricated
rhythm PEA and closest ED is LESS then 30min away
the pt has a penetrating trauma to the torso or head/neck and the LTH is LESS then 30min away
PEA - electrical activity is there but not siffcient enough to contract
respirstory efforts
reactive pupils
any spontaneous movement
organize electrical activity on ECG
Trauma Cardiac Arrest Medical Directive
What do you do if the patch fails or the TOR doesn’t apply?
Mandatory Provincial Patch Point
Transport to the closest appropriate receiving facility following the 1st analysis/defibrillation.
Trauma Cardiac Arrest Medical Directive
What is the TREATMENT plan for Manual Defibrillation for a patient GREATER/EQUAL to 24h old but LESS then 8y old?
What is the TREATMENT plan for Manual Defibrillation for a patient GREATER/EQUAL then 8y old?
Dose - 1 defibrillation
Initial dose - 2J/kg
Dosing interval - no interval
Max # of doses - 1
Dose - 1 defibrillation
Initial dose - As per BH/ manufacturer
Dosing interval - no interval
Max # of doses - 1
Trauma Cardiac Arrest Medical Directive
What is the TREATMENT plan for an AED for a patient GREATER/EQUAL to 24h old but LESS then 8y old?
With or without the pediatric cable - what is that?
What is the TREATMENT plan for an AED for a patient GREATER/EQUAL 8y old?
Dose - 1 defibrillation
Max.single Dose - As per BH/manufacturer
Dosing interval - no interval
Max # of doses - 1
same either way, it’s Pediatric defibrillation cables
Dose - 1 defibrillation
Max.single Dose - As per BH/manufacturer
Dosing interval - no interval
Max # of doses - 1
Trauma Cardiac Arrest Medical Directive
How and what do you do to determine if it’s a traumatic situation?
Should I consider a fluid bolus for a trauma cardiac arrest patient?
If no obvious external signs of significant blunt trauma, consider medical cardiac
arrest and treat accordingly
An intravenous fluid bolus may be considered, where it does not delay transport and should not be prioritized over the management of other reversible pathology. This assists with potential reversible causes.
Cardiac Arrest Standards - clinical considerations - things to remember
What should you remeber about Rhythm interpretation/analysis?
What about pre-arrival interventions? Consider?
How do you follow the energy settings?
Should be performed immediatly
Should have subsequent interpretations/analyses occuring at 2min intervals
Keep with good quality CPR
DON’T count them, complete a full 20min of resus and consider patching
follow specific manufacturer guidelines that are supported by each respective RBH program
Cardiac Arrest Standards- clinical considerations - things to remember
What tretment is preferred?
What about CPR and charging?
Can the ambulance be moving or stopped when using a semi-automated rhythm analysis en-route?
What if you’re using a manual interpretation?
Manual defibrillation
continue with compressions during the charge cycle
It MUST be stopped to minimize artifact and the risk of an inaccurate rhythm interprestation/analysis.
It SHOULD be stopped…
Cardiac Arrest Standards - supraglottic airway
Once the supraglottic airway is placed you should continue with compression and provide vetilations asynchronously at a rate of ? for adults?
For children and infants?
10 breaths/min (1 every 6sec)
20 breaths/min (1 every 3sec)
Cardiac Arrest Standards - ROSC
What should you do if there’s a ROSC while en-route and there’s a re-arrest but you’re using a semi-automated defibrillator?
What do you if you think they would benifit from further interpretation?
Pull over
Initiate 1 immediate rhythm interpretation/analysis
Treat rhythm appropriately
AND
Continue with transportation to the receiving facility with NO FURTHER STOPS.
Patch to the BHP
Cardiac Arrest Standards- clinical considerations - things to remember
What do you do for sudden cardiac arrests that occur on scene or en-route?
What are known reversible causes of a cardiac arrest?
Use full medical cardiac arrest medical directive - i.e. 20min rhythm analyses
Hypovolemia
Hydrogen ion (acidosis)
Hyper/hypokalemia
Toxins
Tension Pneumothorax
Thrombosis (pulmonary and coronary)
Tamponade (cardiac)
Cardiac Arrest Standards- clinical considerations - things to remember
Is BGL important?
Remember to ? when analysis reveals a non-shockable rhythm -what’re they
What are commotio cordis (chest impact) + hangings treated as?
NO it serves no clinical value
Check for a pulse (the rhythms mentioned are PEA and Asystole)
Medical Cardiac arrests
Cardiac Arrest Standards- clinical considerations - things to remember
Anaphylactic Cardiac Arrest is treated as?
Electrocution situation and defibrillation concerns?
Asthmatic Cardiac Arrest treat as?
A single dose of IM epinephrine 1:1,000 is indicated if you believe it’s directly related to the anaphylactic reaction and treat as medical arrest - DO NOT delay the transport
Consider this ‘unusual circumstances’ for transport
If there’s significant trauma then treat as such
Treat as medical, responds well usually
Medical cardiac arrest knowing that salbutamol is difficult to deliver effectively and so you should focus on ventilation and oxygenation
