Medical + Trauma Cardiac Arrest

Question 1

Under the MEDICAL cardiac arrest, what are the primary clinical considerations?

Answer 1

Consider very early transport after minimum of one analysis for;
1. Pregnancy presumed to be ≥ 20 weeks gestation
2. Hypothermia
3. Airway obstruction
4. Non-opioid drug overdose/toxicology
5. Other known reversible causes

Question 2

Under the MEDICAL cardiac arrest standard, what are the conditions for EPINEPHRINE?

Answer 2

≥ 24 hours old
LOA altered
Anaphylaxis suspected as causative event

Question 3

Under the MEDICAL cardiac arrest standard, what are the conditions for a medical TOR

Answer 3

≥ 16 years old
LOA altered
Arrest not witnessed by paramedic AND no ROSC after 20 minutes of resuscitation AND no defibrillation delivered

Question 4

Under the MEDICAL cardiac arrest standard, what are the contraindications for EPINEPHRINE

Answer 4

Allergy or sensitivity to epinephrine

Question 5

Under the MEDICAL cardiac arrest standard, what are the contraindication for a medical TOR

Answer 5

• 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

Question 6

What are some clinical considerations for early transport

Answer 6

Hypovolemia
Hydrogen ion (acidosis)
Hyper/hypokalemia
Toxins
Tension pneumothorax
Thrombosis
Tamponade

Question 7

What are the indications for the TRAUMA cardiac arrest medical directive

Answer 7

Cardiac arrest secondary to severe blunt or penetrating trauma

Question 8

What are the conditions for a TOR under the TRAUMA cardiac arrest medical directive

Answer 8

≥ 16 years
HR 0, RR 0
LOA altered
- No palpable pulses
AND
- No defibrillation delivered AND
- Rhythm asystole
AND
- No signs of life at any time since fully extricated
OR
- Signs of life when fully extricated with the closest ED ≥30 minutes transport time away OR
- Rhythm PEA with the closest ED ≥ 30 minutes transport time away

Question 9

What are the contraindications for a TOR under the TRAUMA cardiac arrest medical directive

Answer 9

• Age under 16 years
• Defibrillation delivered
• Signs of life at any time since fully extricated medical contact
• Rhythm PEA and closest ED <30 minutes transport time away
• Patients with penetrating trauma to the torso or head/neck and Lead trauma hospital < 30 minutes transport time away

Question 10

What are signs of life

Answer 10

Any spontaneous movement
Respiratory efforts
Organized electrical activity on ECG
Reactive pupils

Question 11

What is refractory VT or VF? And what does it indicate during a cardiac arrest?

Answer 11

It’s persistant VF or pulseless VT after 3 consecutive shocks.
It indicates that you should initiate transport.

Question 12

At what rate should you ventilate for an adult and child when using an SGA?

Answer 12

Adult: 1 breath every 6 seconds
Child: 1 breath every 3 seconds

Question 13

What is the course of action if your ROSC patient re-arrest while on route and you’re using a semi-automated defibrillator?

Answer 13

1. Pull over
2. Initiate one rhythm interpretation/analysis
3. Treat rhythm appropriately
4. Continue with transport to the receiving facility with no fruther stops