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